All-on-4: From Painful Bites
to Beaming Smiles
A Patient Case Study

The patient and his situation

Mr. Devonald, in his 60s, had been dealing with deteriorating dental health for over a decade by the time he contacted us from the UK. His mouth contained multiple bridges, several failed root canal treatments, and a complex history of dental interventions that had never quite resolved the underlying problems. His remaining teeth were in poor condition, several were infected, and he was experiencing chronic pain that affected eating and daily life.

His UK dentists had been treating individual problems as they arose: an infection here, a failing bridge there. There was no comprehensive plan that addressed the overall picture. The cost of ongoing piecemeal treatment was mounting and the outcomes were not improving. A friend who had been treated at Picasso Dental recommended he contact us.

Why All-on-4 was the right solution

After reviewing his dental records, X-rays, and panoramic film, it was clear that attempting to save the remaining compromised teeth was not a sound long-term strategy. Each preserved tooth carried ongoing risk of infection, failure, and further bone loss. The treatment that would genuinely solve his situation was full-arch restoration using All-on-4 dental implants.

All-on-4 involves placing four implants per jaw, with the two posterior implants angled at up to 45 degrees to maximise contact with available bone without requiring bone grafting. A full-arch fixed bridge is then attached to these four implants, giving the patient a complete permanent set of teeth that is fixed in place and cannot be removed.

The significant advantage for patients like Mr. Devonald is that All-on-4 does not require large amounts of bone volume. The angled posterior implants bypass the areas of bone resorption that accumulate when teeth have been missing or in poor condition for years. This is why All-on-4 is often possible without bone grafting even in patients with significant bone loss.

Treatment planning and execution

Mr. Devonald required full extraction of all remaining compromised teeth and All-on-4 implant placement in both upper and lower jaws. This is a significant treatment, but it is completed in a single surgical session under sedation, and temporary fixed teeth are attached on the same day.

We completed his 3D CT-based surgical planning before his arrival in Vietnam, designing the exact position and angle of all eight implants virtually to optimise bone engagement and ensure the final bridge would achieve the aesthetic result he wanted. He was given clear expectations: the same-day teeth would be a temporary acrylic bridge, functional and aesthetically reasonable, to be worn during the four to six month osseointegration period. The final restoration would be a full-arch zirconia bridge, the strongest and most aesthetic option available.

The surgical day proceeded as planned. All remaining teeth were extracted, implants were placed in both jaws, and temporary bridges were attached before he left the operating suite. He went from a mouth full of pain and failing teeth to fixed temporary teeth in a single day.

The final restoration

After five months in the UK, Mr. Devonald returned to Hanoi. Imaging confirmed excellent osseointegration at all eight implants. Impressions were taken for the definitive zirconia bridges. The dental laboratory fabricated monolithic zirconia full-arch bridges for both upper and lower jaws: extremely strong, stain-resistant, and designed to replicate the natural appearance of a complete healthy dentition.

At the final seating appointment, the temporary bridges were removed and the zirconia bridges were torqued to the implant abutments. Fit, occlusion, and aesthetics were verified. He looked in the mirror at what was arguably the best set of teeth he had in decades.

"Making the decision to go to Hanoi and have the dental treatment done by Picasso was of the best decisions I have taken for a long time. I not only received top class dental care, it was so cost effective in comparison to having all this work undertaken at an Australian dental practice."

Gerald Mair, Hanoi Old Quarter, Google review

The outcome

Mr. Devonald described the transformation as extraordinary. He could eat steak, hard bread, and crunchy vegetables again, foods he had avoided for years. The chronic pain that had accompanied his dental problems was gone. He said the Picasso Dental team had given him back something fundamental that years of dental treatment in the UK had failed to resolve.

The total cost of his treatment in Vietnam, including two trips and all fees, was significantly less than what equivalent treatment would have cost in the UK, had a UK clinic even offered a comprehensive solution rather than continuing to treat individual problems piecemeal.

What All-on-4 treatment at Picasso involves

• Pre-treatment assessment and virtual planning A full 3D CBCT scan and clinical examination on arrival confirms the treatment plan developed from records sent in advance. Virtual implant positioning is finalised and the surgical guide is confirmed. Written cost breakdown provided and signed off before surgery.
• Surgical day: extractions, implants, and same-day teeth All remaining compromised teeth extracted, four implants per arch placed using the surgical guide, temporary fixed bridge attached on the same day. Patient leaves with functional fixed teeth. Total surgical time under local anaesthesia with sedation is typically 4 to 6 hours for both arches.
• Initial healing and home recovery (3 to 6 months) Implants integrate with the jawbone during this period. The temporary bridge functions normally for eating, speaking, and daily life. Video follow-up consultations are available during the healing period. No clinic visits are required unless a concern arises.
• Second visit: permanent zirconia bridge (3 to 5 days) CBCT imaging confirms osseointegration at all implants. Impressions and digital scans for the permanent bridge. Try-in appointment. Final full-arch zirconia bridges fitted, torqued, and verified for bite and aesthetics. Complete clinical documentation and sign-off.