How Full-Arch Implant Surgery Works: The Procedure Step by Step
Medically reviewed by Dr. Sergio Calleja, DDS, MPH — Board-Certified Oral & Maxillofacial Surgeon · Last reviewed 2026-05-02
Full-arch implant treatment compresses what used to take years of dentistry into one carefully planned surgical day — followed by several months of healing before the final teeth are made. The surgery itself typically takes two to four hours per arch, and most patients leave with fixed provisional teeth within about 24 hours.
Here is the process, step by step, as it happens at our practice.
- 1
Consultation, Records, and 3D Planning
Dr. Calleja examines your teeth, gums, and bite, reviews your medical history, and takes a low-radiation 3D CBCT scan that maps your jaw bone in detail — its height, width, density, and the position of nerves and sinuses. This scan determines where each implant can be safely anchored and whether tilted implants can use your existing bone without grafting. Digital impressions and photographs feed a digital smile design: your new teeth are designed on the computer — shape, size, shade, and bite — before anything is done in your mouth.
- 2
The Surgical Plan and Provisional Fabrication
Using the 3D data, the implant positions are planned virtually and your provisional bridge is fabricated in advance, ready for surgery day. You receive written pre-operative instructions, prescriptions, and anesthesia guidelines (fasting rules, medication adjustments, and a driver arranged for after sedation).
- 3
Surgery Day: Extractions and Implants in One Visit
Under IV sedation or general anesthesia in the office — you are comfortably asleep — any remaining failing teeth in the arch are removed, the bone is shaped where needed, and four to six implants are placed according to the virtual plan. The back implants are typically tilted to engage the strongest available bone. Each implant's tightness in the bone (primary stability) is measured; strong stability is what makes same-day teeth possible.
- 4
Provisional Fixed Teeth — Same Day or Next Morning
If implant stability meets the threshold — which it does for most patients — the pre-made provisional bridge is adjusted and screwed onto the implants the same day or the following morning. You leave with fixed, natural-looking teeth. In the minority of cases where the bone quality does not safely allow immediate loading, a temporary denture is worn instead while the implants heal covered — a judgment call made in your favor, not against you.
- 5
Healing: 3–6 Months of Osseointegration
Over the next three to six months, bone fuses to the implant surfaces — osseointegration. During this window the provisional bridge is deliberately protected with a modified diet (liquid, then soft), because chewing forces that overload healing implants are the main cause of early failure. You are seen at scheduled follow-ups to monitor healing and hygiene.
- 6
Final Prosthesis Design and Delivery
Once integration is confirmed, new records are taken and your definitive bridge is fabricated — typically monolithic zirconia (a very strong ceramic) or acrylic teeth on a milled titanium frame. It is tried in, the bite is refined, and the final teeth are secured. This set is stronger, more precise, and more lifelike than the provisional, and it is what you live with for years to come.
What "Teeth in a Day" Really Means
The phrase is accurate but easy to over-read. What is true: you walk in with failing teeth or a denture and walk out (or return the next morning) with a fixed, screwed-in set of teeth — no gap-toothed months, no removable flipper. What is also true: those are provisional teeth, made of reinforced acrylic, designed for healing rather than heavy chewing. They look good and let you speak and eat soft foods, but they are stage one of two.
The definitive bridge comes months later for a biological reason, not a scheduling one: the implants must fuse to bone before they can safely carry full chewing forces, and the gums remodel during healing, so a bridge made on day one would not fit precisely by month four. Practices that skip the provisional stage are not faster — they are either delaying your teeth or overloading your implants. Expect two sets, and expect the second to be worth the wait.
Frequently Asked Questions
How long does All-on-4 surgery take?
Typically about two to four hours for one arch, including extractions and implant placement, performed under IV sedation or general anesthesia in the office. Treating both arches in one session takes proportionally longer and is planned case by case.
Am I asleep during full-arch implant surgery?
Yes. The procedure is performed under IV sedation or general anesthesia administered in-office by our surgical team — you are comfortable and unaware during surgery, and most patients remember little or nothing of it. You will need a driver and an adult with you the rest of the day.
Do I really get teeth the same day?
Most patients do — a fixed provisional bridge is attached the same day or the next morning, provided the implants achieve strong initial stability in the bone. If your bone quality does not safely allow it (a minority of cases), you wear a temporary denture while the implants heal, and the fixed teeth follow. Either way, you are never left without teeth.
Will I need bone grafting first?
Often not — that is one of the technique's main advantages. Tilting the back implants lets them anchor in the denser front portion of the jaw, avoiding the areas where bone is usually deficient. When upper-jaw bone loss is too severe even for tilted implants, options include grafting or, in selected cases, zygomatic (cheekbone) implants. Your CBCT scan answers this question definitively at consultation.
What are the final teeth made of?
The two mainstream options are monolithic zirconia — a very strong, stain-resistant ceramic milled as one piece — and acrylic (or nano-ceramic) teeth on a milled titanium bar. Zirconia is the most durable and lifelike; acrylic-titanium is lighter, easier to repair, and costs less. Dr. Calleja and your restorative dentist help you choose based on bite forces, esthetics, and budget.
Can I get upper and lower arches done at the same time?
Yes — full-mouth (double-arch) treatment in a single surgical session is common and avoids going through anesthesia and recovery twice. It makes for a longer surgery day and a more demanding first week, so candidacy depends on your health and the complexity of each arch.
Have Questions About Full-Arch Implants?
Dr. Calleja evaluates every case personally at the Waldorf and California, MD offices — consultations in English or Spanish.
This page is general patient education, not personal medical advice. Every patient's anatomy and health history are different — treatment details, risks, and recovery vary case by case and are reviewed with you during your consultation. For emergencies, call 911.