All-on-4 Implants in Barcelona
What is All-on-4?
All-on-4 is a technique for the complete reconstruction of the upper or lower dental arch supported by four dental implants. The two anterior implants are placed vertically, while the two distal implants are angled at 30–45° to make optimal use of available bone and avoid anatomical structures.
The method was developed in 2003 and has demonstrated clinical effectiveness in restoring masticatory function and dental aesthetics.
Indications
The primary goal of All-on-4 is the rehabilitation of complete edentulism, particularly in cases of significant bone atrophy where conventional two-stage implantology is difficult to perform.
The main causes of bone atrophy include prolonged tooth loss, chronic periodontal overload, and systemic conditions such as type 2 diabetes mellitus and osteoporosis.
Diagnostics and Treatment Planning
Pre-operative planning includes cone beam computed tomography (CBCT) to assess bone height, width, and density, as well as the location of anatomical structures. Patients with endocrine disorders undergo additional investigations, including glycated haemoglobin (HbA1c) monitoring.
Surgical Stage
The procedure is carried out under local anaesthesia. The distal implants are placed at an angle to avoid the maxillary sinuses or the mandibular canal, which in most cases eliminates the need for bone grafting. When non-viable teeth are extracted simultaneously, implants may be placed directly into the sockets.
Immediate Loading
Within 3–5 days of placement, a provisional fixed adaptive prosthesis with a monolithic metal framework (titanium or chrome-cobalt) is fitted. The prosthesis distributes masticatory load evenly, minimises implant micromovement, and provides an aesthetic appearance from the very first days following surgery.
Definitive Prosthetics
The final prosthesis is fabricated individually, taking into account the patient's occlusion and preferences. The 2026 standard is a zirconia prosthesis on a monolithic framework, offering high strength, durability, and natural aesthetics. An alternative is metal-composite constructions on a zirconia or titanium framework — lighter in weight and more affordable, though somewhat less durable.
Advantages of All-on-4
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Rapid restoration of masticatory function
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Minimal number of surgical interventions
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Ability to avoid bone grafting in most cases
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Stability and longevity of the construction
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High aesthetic result from day one
Warranties and Documentation
Every Sweden Martina, Nobel, or Straumann implant placed has an individual serial number registered in the manufacturer's database. The patient receives an implant passport stating the date of surgery, model, reference number, length, diameter, and torque value.
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Manufacturer's warranty: replacement of a defective implant under the manufacturer's warranty policy
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Clinic warranty: 2 years — in the event of complications arising from clinical error or protocol violation, repeat intervention is carried out at the clinic's expense (bone graft biomaterials are not covered by the warranty)
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Prosthesis warranty: 1 year, with the option of extension subject to attendance at preventive check-ups
Indications for All-on-4
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Complete edentulism of the upper and/or lower jaw
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Subtotal edentulism with retention of individual teeth
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Significant bone atrophy Class I–III
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Failure or intolerance of removable dentures
Contraindications
Absolute:
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Uncontrolled diabetes mellitus (HbA1c ≥ 8.0%)
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Bisphosphonate therapy without a washout period
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Severe coagulopathies
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Severe autoimmune diseases in active phase
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Confirmed allergy to anaesthetic components or titanium
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Psychiatric disorders precluding informed consent
Relative:
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Acute inflammatory processes in the oral cavity
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Caries or pulpitis of antagonist teeth
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Unsanitised oral cavity
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Smoking more than one pack per day
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History of radiotherapy (individual assessment required)
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Pregnancy and breastfeeding
Alternative Protocols
All-on-6 — indicated in cases of advanced Class III atrophy, bruxism, or when a full arch of 14 crowns is required. Six implants provide more predictable biomechanics.
Zygomatic implants (Zygoma) — indicated in cases of critical atrophy of the upper jaw (Class IV). Long zygomatic implants are anchored in the zygomatic bone, bypassing the maxillary sinuses. The procedure requires a highly qualified surgeon.
