How full-arch patients decide: the All-on-4 patient journey, stage by stage

The stages of the All-on-4 patient journey

1. Living with the problem. Loose or failing teeth, an uncomfortable denture, avoiding certain foods or smiling in photos. This can go on for a long time.
2. Trigger. Something makes it urgent: a tooth lost, a denture breaking, an event coming up, a friend who has had treatment.
3. Private research. Reading, watching videos, looking at prices, often late at night, often without telling anyone.
4. Shortlist. Comparing a few practices on clinicians, reviews, price information and how they come across.
5. Enquiry. A form, a call or a message. The first real contact, and the first test of the practice.
6. Consultation. Examination, usually a CBCT scan (cone beam CT, a 3D X-ray used to plan implants), options and costs.
7. Decision at home. Talking it over with a partner or family, checking finance, sometimes getting a second opinion.

The dotted lines matter. Some people go back to research after a consultation, and some go back to the shortlist to get a second opinion. A journey that looks lost is often only paused.

The questions at each stage

Most of the questions full-arch patients ask are about three worries: cost, pain and whether they can trust the practice. Cost anxiety (fear of the bill and of being sold more than they need) and pain anxiety (fear of the surgery and recovery) come up at almost every stage, in different forms.

Two points from that table shape the whole plan. First, the partner appears late but decides a lot, so the consultation and what the patient takes home have to work for someone who wasn't in the early research. Second, the practice's front desk is part of the journey at the enquiry stage. A slow or scripted reply ends journeys that marketing took a long time to start.

Second opinions

A second opinion is a consultation at another practice to check the first one. For a treatment this size, some patients will get one, and practices shouldn't treat it as a loss. It is a normal part of the decision. What matters is how the practice comes across when compared side by side: the clarity of the plan, whether the costs were written down, and whether the patient felt listened to or sold to. A practice that expects the comparison, and says so ("take this plan with you, and compare it with anyone"), tends to come across as the more confident choice.

Finance

Finance usually enters the journey twice. Early, as a quiet question during private research ("could I even afford this monthly?"), and late, as a real application during the decision at home. The early question is answered by a clear price and finance page. The late one depends on the practice making the application simple, explaining it at the consultation and giving the patient time. How the page should present finance is on price and finance pages for full-arch treatment, and what a finance promotion may say is set by the rules linked from there.

What marketing does at each

Each stage has a job for marketing and a channel suited to it.

Two constraints affect the middle stages. Meta removed detailed targeting options relating to health causes from January 2022,¹ so early-stage ads can't be aimed at people by an interest in dentures or implants; the creative has to find them. Google restricts remarketing lists and other advertiser-curated audiences for ads about invasive medical procedures, including surgical procedures,² so staying in front of past visitors through ads isn't always available. Organic content and the practice's own follow-up carry more of the load as a result.

The last two stages are run by the practice, not by the ads. All-on-4 nurture, meaning keeping in touch with people who attended but didn't decide, is the practice's job, done by its own team, with consent. The detail is on following up patients who aren't ready yet, and the wider picture of the stages after the enquiry is on what happens after the enquiry.

Measuring the journey

A long journey is hard to measure because the first touch and the treatment start can be far apart. The platforms see the click and, at best, the enquiry. They don't see the consultation, the conversation at home or the start, unless the practice sends that information back.

The measurement I set up follows the stages:

The measure that matters most at the end is full-arch consultation conversion: of the patients who attended a consultation, how many started treatment, and how long it took them.

Sending booked and attended consultations and treatment starts back to Google Ads within its upload window (90 days for offline import³) lets it learn which ads lead to starts, not just to form fills; treatment completed later is measured in the practice's own report. Meta gets only the booked and attended consultations, with no treatment detail, sent only with the patient's recorded explicit consent and hashed, and Meta may restrict or reject them for a health advertiser, so it optimises towards booked and attended consultations. It also gives the practice its own answer to the question this page can't answer with a published number: how long does the journey take at your practice?

To work it out, take every full-arch treatment start in the last year, find the date of that patient's first enquiry, and look at the spread of days between them. Do the same between consultation and start. Those two numbers tell you how long to wait before judging a campaign, and how long follow-up needs to last.

The full method for tying marketing to booked revenue, including how the data gets from the practice system into the ad platforms, is in measuring marketing against booked revenue.

If you want to map and measure this journey for your practice, email me about your practice, or read how I work.