The "All-on-4" dental implants (or "all on 6" when 6 implants are necessary) is a dental procedure used to restore a full arch of missing teeth using only four dental implants to support a raw of 10 or 12 crowns instead of many unit implants with above crown. This innovative approach allows patients with extensive tooth loss to regain a functional and pleasing smile.

The protocol for "All-on-4" dental implants starts by a Consultation: The process begins with a comprehensive consultation with a qualified prosthodontist or oral surgeon who specializes in dental implant procedures. During this consultation, the dentist will evaluate your oral health, discuss your treatment goals, and determine if you are a suitable candidate for "All-on-4" implants. It is nowadays most of time done remote. You don't need to come to different dental clinics for consultation and waist hours. You just have to send your x-ray or your documentation in order to receive various quotes. Nowadays dentists are used to prepare and send remote by Whatsapp or email dental quotes. Having an x-ray is mandatory unless you have a quote from another dentist or if the protocol is simple (you need a full mouth restoration for 1 or 2 jaws). You will note that if in the dental clinic premises the protocol might change (ie a dental crown is enough and no implant is necessary or if you need 3 implants and a bridge and not 1 implants, this will only change the final cost but not the protocol as a well organized dental clinic with its own lab shall be able to treat the same day 1 implant or a full mouth restoration (so 8 implants and 24 temporary dental crowns).

Your dental quote will be based on the consultation (very often remote through Whatsapp video for instance) and diagnostic imaging (such as X-rays, CT scans, or 3D imaging), the dentist will develop a personalized treatment plan tailored to your specific needs. This plan will include the number and placement of implants, as well as the design of the final prosthesis.

In some cases (10% of cases) preparatory procedures are required before implant placement. This could include tooth extractions, bone grafting to augment bone volume in areas of bone deficiency, or treatment for gum disease. Surgery day protocol:Implant placement: On the day of surgery, the dentist will surgically place four dental implants into the jawbone at strategic locations to maximize support and stability for the final prosthesis. The implants are typically tilted posteriorly to take advantage of available bone and avoid the need for bone grafting in many cases.Temporary prosthesis: Following implant placement, a temporary prosthesis may be attached to the implants to restore function and aesthetics while the implants integrate with the jawbone (a process called osseointegration). This temporary prosthesis allows patients to eat and speak comfortably during the healing period, which typically lasts several months.Healing and osseointegration: Over the next few months, the implants will fuse with the surrounding bone, providing a stable foundation for the final prosthesis. During this time, regular follow-up appointments will be scheduled to monitor healing and ensure optimal implant integration.Final prosthesis fabrication: Once osseointegration is complete and the implants have become fully integrated with the jawbone, the dentist will take impressions of the implants and surrounding tissues to fabricate the final prosthesis. Prosthesis placement: The final prosthesis is securely attached to the implants, restoring a full arch of teeth and providing a natural-looking smile that functions like natural teeth. The dentist will ensure that the prosthesis fits comfortably and functions properly before finalizing the treatment.

There is a second "all on 4" protocol involving only 1 trip instead of 2. In the standard above mentioned protocol, you usually do the same day the extractions + implants + temporary crowns and then come back around 5 months for about 5 days for the permanent crowns.

For those who come from far away you can have the all on four immediate loading protocol meaning you will do directly the permanent crowns and skip the temporary crowns. The pro is that you save time. The cons is that it is in average +20% more expensive, the dental crowns cannot be in zirconium but in a specific ceramic type and in some cases there can be a gum problem.

"All-on-4 dental" implants offer a minimally invasive and cost-effective solution for restoring a full arch of missing teeth, providing patients with a durable, stable, and aesthetically pleasing smile that can significantly improve their quality of life.

Bulgaria has few clinics and hospitals but some are well reputed and the medical offer of Bulgaria covers all medical treatments. If most clinics are located in Sofia and its outskirts, some cities like Pleven or Varna offer few hundreds hospital beds. Some dental clinics are well known from foreign patients while plastic surgery is one of the medical category offered in Bulgaria.