All-on-4 Abroad: What to Expect Day by Day, From First Trip to Permanent Bridge

All-on-4 replaces a full arch of teeth with a fixed bridge carried by four implants. It is the treatment patients most often travel for, because you leave the first trip with a working set of fixed teeth, and because the price difference between Belgrade and Western Europe is measured in five figures.

This is a day-by-day account of what actually happens: before you fly, during the first week in Belgrade, the healing months at home, and the second trip for the permanent bridge. If you are still deciding between All-on-4 and All-on-6, there is a short section on that too.

Who All-on-4 is for

You are a candidate if you have lost most or all of the teeth in one jaw, or if the teeth you have left are loose, broken down or failing and would need removing anyway. Patients with a removable denture who want fixed teeth are the most common case.

The four implants are placed at angles that use the denser bone at the front of the jaw, which is why All-on-4 usually works without bone grafting even when the back of the jaw has shrunk after years without teeth. If your bone allows six implants, All-on-6 spreads the load further; see below.

Before you fly

1. Free online consultation. You send a panoramic X-ray, or a 3D CT scan if you have one, plus photos. Dr Perduv confirms whether All-on-4 is realistic, whether extractions or grafting are needed, and whether one jaw or both.
2. Treatment plan and price. Written, itemised. All-on-4 is €4,500 per jaw; All-on-6 is €5,500 per jaw. Both include the implants, the temporary bridge, the permanent bridge and the follow-up check-ups.
3. Dates. Plan about 7 days in Belgrade for the first trip. We organise your hotel for the duration of the treatment and the airport transfer.
4. Medical preparation. Tell us about blood thinners, diabetes, osteoporosis medication and smoking. None of these rule you out on their own, but they change the plan.

Trip 1: implants and the temporary bridge (about 7 days)

Day 1: examination and 3D scan

A clinical examination and a CT scan taken at the clinic. The scan is used to plan the exact position and angle of each implant. You go through the plan with the dentist and sign off on it.

Day 2: surgery

Any remaining teeth in the arch are removed and the four implants are placed in the same session, under local anaesthesia, with conscious sedation available if you want it. The surgery takes two to three hours for one jaw. Impressions for the temporary bridge are taken.

Day 2 or 3: the temporary bridge

A fixed acrylic bridge is screwed onto the implants. This is the immediate-loading part of All-on-4: you leave the clinic with teeth that do not come out. The temporary is lighter than the final bridge on purpose, so the implants are not overloaded while the bone heals.

Days 3 to 7: recovery and checks

Swelling peaks around day two to three and eases from there. Some bruising on the cheeks or under the chin is common and looks worse than it feels. Pain is managed with ordinary painkillers. You come in for a check on the bite and the bridge, stitches are checked, and you get written aftercare instructions before you fly home.

Healing at home: 3 to 6 months

This is where most of the treatment time goes, and where you do the work. The implants are integrating with the bone under the temporary bridge.

• Food: soft foods for the first two weeks, then gradually firmer, but nothing hard or chewy on the temporary bridge for the whole healing period. No nuts, crusty bread, steak or ice.
• Cleaning: brush the bridge as you would teeth, and clean underneath it every day with a water flosser or floss threaders. The area where the bridge meets the gum is where food collects.
• Smoking: the single biggest risk factor for implant failure. Stop for the healing period at minimum.
• Contact: you have a direct line to the clinic. If the temporary bridge chips or feels loose, tell us; a local dentist can tighten a screw or smooth a chip with the documentation we send.

Trip 2: the permanent bridge (5 to 7 days)

1. The temporary bridge is removed and the implants are checked for stability.
2. Impressions or a scan for the permanent bridge, and shade selection.
3. Try-in of the framework and the tooth set-up, with adjustments to the bite and the look.
4. The finished bridge, a fixed bridge with 10 ceramic crowns on All-on-4 or 12 on All-on-6, is fitted and screwed in.
5. A final check and cleaning instructions for the permanent bridge.

All-on-4 vs All-on-6

The difference is two implants and two crowns. Six implants distribute chewing force over more points, which is an advantage in the upper jaw where bone is softer, for patients who grind their teeth, and where the bone volume allows. Four implants are enough in most lower-jaw cases and in upper jaws with good bone, and they avoid grafting where the back of the jaw has resorbed.

The decision is made from the CT scan, not from preference. Cost difference with us is €1,000 per jaw. More on the All-on-6 page.

What All-on-4 costs abroad vs at home

Two trips with flights at €200 to €300 each way, and accommodation covered by us for the treatment period, leave the total for one jaw at roughly €5,500. For a patient from the UK, where All-on-4 is typically quoted at £10,000 to £16,000 per arch, the saving is the same order as in Germany. Full details on the implants abroad cost guide.

Risks and how we handle them

• Implant failure. A small percentage of implants do not integrate, most often because of smoking, uncontrolled diabetes or infection. If it happens, the implant is removed and, after healing, replaced. Every implant we place comes with an implant passport documenting the system and size.
• Temporary bridge fracture. Acrylic can chip under hard food. It is a repair, not a failure.
• Speech. The upper bridge can affect the "s" and "t" sounds for the first weeks. It resolves as you adapt.
• Warranty. Ask for the terms in writing before you book, at any clinic. We put ours in the treatment plan.

Frequently asked questions

How long does All-on-4 take from start to finish?

About 7 days for the first trip, 3 to 6 months of healing at home, and 5 to 7 days for the second trip. Total elapsed time is four to seven months, of which about two weeks are spent in Belgrade.

Can I eat normally with the temporary bridge?

You can eat, but not everything. Soft and medium-firm foods only until the permanent bridge is fitted. This is temporary and it protects the implants.

Is All-on-4 painful?

The surgery is done under local anaesthesia, with conscious sedation as an option. Expect swelling and discomfort for three to five days, managed with standard painkillers. Most patients describe it as easier than they feared.

How long does an All-on-4 bridge last?

The implants are designed to last for life with good hygiene. The bridge is a prosthesis and will wear; a ceramic bridge typically lasts 15 years or more before needing refurbishment.

How do I clean under an All-on-4 bridge?

A water flosser once a day along the gum line, floss threaders or super floss under the bridge, and a soft brush on all surfaces. We show you before you leave, and check how it is going at the second trip.

Can both jaws be done in one trip?

Yes. Upper and lower All-on-4 in the same week is common. The surgery is longer and the first days are harder, so most patients who do both choose sedation for the surgery.

Next step

Send your panoramic X-ray through the free online consultation. You get a yes or no on All-on-4 versus All-on-6, the itemised price, and the dates for both trips before you book anything. Read more on the All-on-4 page and see finished cases on the before and after page.