A complete arch of permanent teeth supported by just four strategically placed implants -- placed by a Yale-trained, board-certified periodontist in Costa Mesa
All-on-4 dental implants represent one of the most significant advances in full-arch tooth replacement over the past two decades. The concept is straightforward but surgically demanding: an entire arch of fixed, non-removable prosthetic teeth is supported by just four titanium implants placed at precise positions and angles within the jawbone. Unlike traditional dentures that sit on top of the gums and rely on adhesive or suction, an All-on-4 restoration is permanently anchored to the bone, restoring chewing function, speech clarity, and facial structure in a way that closely replicates natural teeth.
The procedure was developed by Portuguese implantologist Dr. Paulo Malo in collaboration with Nobel Biocare, the world's leading dental implant manufacturer. Dr. Malo's research, published extensively throughout the early 2000s, demonstrated that four implants placed in specific positions could reliably support a full arch of teeth -- even in patients who had been told they lacked sufficient bone for conventional implants. The protocol was a paradigm shift because it made fixed full-arch rehabilitation accessible to a much broader population of edentulous (toothless) and soon-to-be-edentulous patients.
At The Loft Dental Studio in Costa Mesa, Dr. Chanook David Ahn -- a Yale-trained, board-certified periodontist -- performs All-on-4 and All-on-6 implant procedures with the precision and surgical expertise that this technique demands. As a fellowship-trained specialist and UCLA School of Dentistry faculty member, Dr. Ahn brings an academic rigor and depth of experience to every case that sets The Loft Dental Studio apart from general dental practices offering this treatment.
The defining innovation of the All-on-4 protocol is the strategic angulation of the posterior (back) implants. In a traditional implant approach, all implants are placed vertically, straight into the bone. This works well when there is abundant bone volume in every region of the jaw. However, many patients who need full-arch replacement have experienced significant bone resorption, particularly in the posterior regions where bone loss tends to be most severe after tooth extraction.
The All-on-4 technique solves this problem by tilting the two posterior implants at angles of up to 45 degrees. This angulation achieves several critical objectives simultaneously:
The two anterior (front) implants are placed vertically in the denser bone of the anterior jaw, where bone resorption is typically minimal. Together, the four implants create a stable quadrilateral foundation that can support 10 to 14 prosthetic teeth in a single fixed bridge.
One of the most compelling aspects of the All-on-4 protocol is the possibility of immediate loading -- meaning patients can receive a full set of temporary fixed teeth on the same day as their implant surgery. This is often marketed as "Teeth in a Day," and while the name is accurate, it is important to understand what this involves and what realistic expectations should be.
Prior to surgery, Dr. Ahn works closely with Dr. Richard Lu, the practice's prosthodontist, to plan the case digitally using 3D cone beam computed tomography (CBCT) imaging and digital impressions. A temporary prosthesis (often called an immediate conversion prosthesis) is pre-fabricated or designed so that it can be attached to the implants immediately after they are placed.
On the day of surgery, the failing or remaining teeth are extracted, the four implants are placed into the jawbone at their predetermined positions and angles, and the temporary bridge is secured to the implants using multi-unit abutments. The patient leaves the office that same day with a full arch of fixed, functional teeth. These temporary teeth are not removable by the patient -- they are screwed into the implants and can only be removed by the dental team.
The same-day teeth are temporary. They are typically made from acrylic or a reinforced composite material and are designed to function well during the healing period while osseointegration occurs. Patients can eat soft foods immediately and gradually progress to a normal diet over the first several weeks.
After approximately four to six months of healing, during which the implants fully integrate with the jawbone, the temporary prosthesis is removed and replaced with the final prosthesis. The final bridge is typically crafted from high-strength monolithic zirconia or a zirconia-porcelain hybrid, custom-designed for optimal aesthetics, occlusion (bite alignment), and durability. This final prosthesis is the one that will serve the patient for 15 to 20 years or more with proper maintenance.
Immediate loading requires that the implants achieve a minimum level of primary stability at the time of placement -- typically measured by insertion torque values above 35 Ncm. If the bone is too soft or the implant does not achieve adequate initial stability, Dr. Ahn may opt for a delayed loading protocol, where the implants are allowed to heal beneath the gums for three to six months before the prosthesis is attached. This is a clinical judgment that prioritizes long-term success over speed, and it is one of the reasons why having a board-certified periodontist manage this procedure matters.
Schedule a consultation with Dr. Ahn to find out if All-on-4 is right for you
Book Your All-on-4 ConsultationWhile All-on-4 uses four implants per arch, the All-on-6 variation uses six implants to provide additional support and load distribution. Neither approach is inherently superior -- the right choice depends on the patient's specific anatomy, bone density, functional demands, and long-term goals.
Dr. Ahn evaluates every patient's case individually using 3D CBCT imaging, clinical examination, and a thorough assessment of bone density, jaw anatomy, and functional factors before recommending four or six implants. There is no one-size-fits-all protocol -- the treatment plan is tailored to deliver the most predictable long-term outcome for each individual.
All-on-4 implant placement is one of the most technically demanding procedures in implant dentistry. It requires surgical expertise in bone biology, implant angulation, soft tissue management, extraction socket handling, and prosthetic planning -- all within a single surgical appointment. The stakes are high: improperly angled implants, insufficient primary stability, or poor prosthetic planning can lead to implant failure, prosthesis fracture, or the need for costly revision surgery.
A board-certified periodontist has completed three additional years of full-time residency training beyond dental school, focused exclusively on the surgical management of the tissues that support teeth: bone, gums, and the periodontal ligament. This training includes hundreds of hours of supervised implant placement, bone grafting, soft tissue grafting, and the management of complex surgical cases -- training that general dentists do not receive in their core curriculum.
Board certification through the American Board of Periodontology requires passing rigorous written and oral examinations that test both theoretical knowledge and clinical judgment. It is a voluntary credential that demonstrates a periodontist's commitment to the highest standard of care in their specialty.
Dr. Chanook David Ahn brings a level of training and experience to All-on-4 procedures that is difficult to match:
At The Loft Dental Studio, All-on-4 treatment is a true collaboration between Dr. Ahn (surgical specialist) and Dr. Richard Lu (prosthodontist). This dual-specialist approach means that the surgical plan is designed from the start with the final prosthetic result in mind. Dr. Lu plans the ideal tooth position, bite alignment, and aesthetic outcome, and Dr. Ahn then places the implants at the precise positions needed to support that prosthetic design. This reverse-engineering approach -- planning backward from the desired result -- produces outcomes that are functionally superior and aesthetically natural.
Many general dental practices have a single dentist performing both the surgery and the prosthetics. While this can work for simple cases, All-on-4 is not a simple case. Having two specialists who each focus on what they do best results in a higher quality outcome and a more predictable experience for the patient.
The All-on-4 protocol was specifically designed to expand candidacy for full-arch implant treatment to patients who might otherwise be told they are not eligible due to bone loss. That said, not everyone is a candidate, and a thorough evaluation is essential.
For patients with extreme bone loss in the upper jaw -- cases where even the tilted All-on-4 approach cannot find sufficient bone in the maxilla -- zygomatic implants offer an advanced alternative. These specialized implants are significantly longer than conventional implants (30 to 52.5 mm) and are anchored into the zygomatic bone (cheekbone), which provides a dense, reliable anchorage point that is not affected by the bone resorption patterns that occur in the upper jaw after tooth loss.
Zygomatic implant placement is a highly specialized procedure performed by a small number of trained surgeons. In some cases, a combination of conventional implants in the anterior and zygomatic implants in the posterior can provide a stable foundation for a full-arch prosthesis without any bone grafting whatsoever. Dr. Ahn evaluates whether zygomatic implants may be appropriate during the 3D CBCT planning phase of treatment.
Every All-on-4 case begins with a detailed evaluation that includes a full medical history review, comprehensive dental examination, 3D CBCT imaging of both jaws, digital impressions, and photographs. Dr. Ahn and Dr. Lu review the imaging together to assess bone volume, bone density, sinus and nerve positions, and the optimal implant positions. A digital treatment plan is created that maps each implant's position, angle, and depth before surgery.
On the day of surgery, the patient receives local anesthesia and, in most cases, IV or oral sedation for comfort. Any remaining failing teeth are extracted. The four (or six) implants are placed according to the digital plan. Once adequate primary stability is confirmed, the pre-fabricated temporary prosthesis is attached to the implants and adjusted for fit, bite, and aesthetics. The entire surgical appointment typically lasts three to five hours per arch.
Over the next four to six months, the implants undergo osseointegration -- the biological process by which bone cells grow directly onto the titanium implant surface, creating a permanent bond. During this period, the patient wears the temporary prosthesis, eats a progressively normal diet, and returns for periodic follow-up visits so Dr. Ahn can monitor healing. Oral hygiene instruction is provided to ensure the tissues remain healthy during this critical phase.
Once osseointegration is confirmed through clinical and radiographic evaluation, new digital impressions are taken to fabricate the final prosthesis. Dr. Lu designs the definitive bridge -- typically monolithic zirconia for its exceptional strength and lifelike aesthetics -- and oversees multiple try-in appointments to ensure ideal fit, bite, color, and tooth shape before the final bridge is delivered. The final prosthesis is secured to the implants with small screws that can only be accessed by the dental team, providing a permanent but serviceable restoration.
Swelling, bruising, and mild to moderate discomfort are expected and entirely normal. Prescribed pain medication and anti-inflammatory drugs manage discomfort effectively. A cold compress applied to the face in 20-minute intervals helps reduce swelling. Diet is limited to soft, cool foods such as smoothies, yogurt, scrambled eggs, and mashed potatoes. Light bleeding from the surgical sites is normal during the first 24 hours.
Swelling begins to subside significantly by day four or five. Most patients can return to desk work or non-physical occupations within three to five days after surgery. Bruising may appear and then gradually fade. Diet can be expanded to include softer cooked foods. The temporary prosthesis is functional, and patients can speak and eat with increasing comfort each day.
By the third week, most patients feel substantially recovered. Diet continues to expand, though hard, crunchy, or sticky foods should still be avoided to protect the healing implants. Soft tissue healing is largely complete, and any residual numbness from the anesthesia has resolved. Follow-up appointments with Dr. Ahn ensure healing is progressing as expected.
The bone continues to remodel and strengthen around the implants during this period. While the patient is functioning normally with their temporary teeth, the biological foundation is still maturing. By month four to six, osseointegration is typically complete and the transition to the final prosthesis can begin.
All-on-4 implants require ongoing maintenance to ensure long-term success. While they are not susceptible to cavities like natural teeth, the tissues and bone surrounding the implants can develop peri-implant disease (similar to gum disease around natural teeth) if not properly maintained.
Patients who maintain a consistent home care routine and attend their scheduled professional maintenance appointments can expect their All-on-4 implants to provide decades of reliable function and natural-looking aesthetics.
All-on-4 dental implant treatment is a significant investment in your oral health, function, and quality of life. While the upfront cost is higher than removable dentures, the long-term value is considerable when you factor in the durability of the restoration, the preservation of bone health, and the elimination of ongoing denture-related expenses such as adhesives, relines, and replacements.
Dental insurance may cover a portion of the treatment, particularly the extraction and some implant costs, depending on your plan. The Loft Dental Studio works with most PPO dental insurance plans to maximize your benefits. For the balance not covered by insurance, we offer flexible financing options through CareCredit and Lending Club, which provide low-interest and interest-free payment plans that allow patients to spread the cost of treatment over time.
We encourage patients to view All-on-4 implants as a long-term investment. When amortized over the 20+ year lifespan of the restoration, the annual cost is often comparable to what patients spend on denture maintenance, adhesives, relines, and replacements -- with vastly superior function and comfort.
Contact The Loft Dental Studio to schedule your comprehensive implant evaluation with Dr. Ahn
Call (714) 549-7030All-on-4 dental implants are a full-arch tooth replacement system that uses four strategically placed titanium implants to support an entire arch of fixed prosthetic teeth. Two implants are placed vertically in the front of the jaw and two are tilted at angles of up to 45 degrees in the posterior, maximizing bone contact and often eliminating the need for bone grafting. The technique was developed by Dr. Paulo Malo in collaboration with Nobel Biocare and has been supported by over two decades of published clinical research. Patients can often receive a temporary set of fixed teeth on the same day as surgery, making it one of the most efficient paths to full-mouth rehabilitation.
All-on-4 dental implants in Costa Mesa typically range from $20,000 to $35,000 per arch for the complete treatment, including surgical implant placement, the temporary prosthesis, and the final zirconia bridge. All-on-6 treatment may cost slightly more due to the additional implants. The total cost depends on case complexity, whether extractions or localized bone grafting are needed, the prosthetic material selected, and whether IV sedation is used. The Loft Dental Studio offers financing options through CareCredit and Lending Club to help make treatment accessible.
The primary difference is the number of implants used to support the full-arch prosthesis. All-on-4 uses four implants per arch while All-on-6 uses six, providing additional points of support and force distribution. All-on-6 may be recommended for patients with larger jaw arches, those who grind their teeth (bruxism), or when bone volume permits the placement of additional implants for added long-term security. Dr. Ahn uses 3D CBCT imaging and clinical evaluation to determine the optimal number of implants for each individual patient.
Yes -- the All-on-4 technique was specifically designed for patients with bone loss. The tilted posterior implants engage denser anterior bone and bypass the maxillary sinuses and inferior alveolar nerve, allowing treatment to proceed even when posterior bone is deficient. For patients with extreme upper jaw bone loss, zygomatic implants that anchor into the cheekbone may provide an alternative that avoids bone grafting entirely. Dr. Ahn's expertise in bone regeneration also allows him to augment bone in cases where grafting would improve the treatment outcome.
The titanium implants themselves can last a lifetime with proper care and consistent maintenance. The prosthetic bridge typically lasts 15 to 20 years before it may require replacement or refurbishment due to normal wear. Published long-term studies show All-on-4 implant survival rates exceeding 95% at 10 years when the procedure is performed by experienced surgical specialists. Success depends on regular professional maintenance visits every three to four months, diligent home care, and avoiding risk factors such as smoking.
The procedure is performed under local anesthesia, and most patients at The Loft Dental Studio also choose IV sedation or oral sedation for maximum comfort. The majority of patients report that the procedure was significantly less uncomfortable than they expected. Post-operative discomfort is managed with prescribed medication for the first few days and typically transitions to over-the-counter pain relievers by day three to five. Swelling and bruising are normal and generally resolve within seven to ten days.
All-on-4 placement is a complex surgical procedure involving precise implant angulation, management of limited bone volume, simultaneous extractions, and often real-time clinical decisions about implant positioning based on bone quality encountered during surgery. Board-certified periodontists complete three additional years of surgical residency training beyond dental school, with extensive hands-on experience in implant placement, bone and soft tissue management, and complex surgical cases. Dr. Ahn's Yale residency training, board certification, and UCLA faculty appointment represent the highest level of qualification for performing this procedure.