All-on-4 Dental Implant Lawsuits: Defendants, Payouts, and Proof

An All-on-4 dental implant lawsuit is a dental malpractice or consumer fraud case brought by a patient who received a full-arch implant procedure and alleges harm from unnecessary extractions, deceptive sales tactics, or negligent surgery. Most of these cases are filed individually against the dentist and the clinic chain, and most settle privately out of court. A joint KFF Health News and CBS News investigation published in late 2024 drew national attention to a pattern of complaints involving private equity-owned implant chains, and new filings have continued into 2025.

What Patients Are Suing Over

The All-on-4 procedure replaces an entire arch of teeth with a fixed prosthesis anchored by four titanium implants. It typically costs $15,000 to $60,000 per arch, and it is irreversible: the patient’s remaining natural teeth are extracted before the implants go in. If the implants fail, the patient may not have enough bone left for further options.¹

That irreversibility drives the litigation. A consistent set of allegations runs through the cases:

Healthy or treatable teeth were extracted to justify a full-arch implant procedure when less invasive dentistry would have worked. The dean of the Harvard School of Dental Medicine has said implants are frequently recommended for teeth that could be saved with root canals or crowns, and that profitability drives those recommendations.¹
Non-dentist salespeople, often called “patient education consultants,” secured financing commitments of $30,000 to $65,000 before the patient ever consulted a dentist.²
Surgery was performed negligently. Allegations include anesthesia wearing off mid-procedure, implants placed at improper angles or depths, and prosthetics so misaligned the patient cannot chew.
Patients were not given a meaningful disclosure of risks, alternatives, or the permanent nature of removing their natural teeth.
Implant placement damaged the inferior alveolar nerve in the lower jaw, leaving the patient with permanent numbness, pain, or tingling in the lip, chin, and jaw.

The Chains Being Sued

ClearChoice Dental Implant Centers, a chain of more than 100 clinics specializing in full-arch restorations, is the most prominent defendant. ClearChoice was acquired in 2020 by Aspen Dental for roughly $1.135 billion, funded almost entirely with debt. Aspen Dental is owned by the private equity firms Ares Management, Leonard Green & Partners, and American Securities.³⁴

Publicly documented cases against ClearChoice include:

Becky Carroll (New Jersey, filed 2021). Carroll alleges she paid $31,000 to replace all her upper natural teeth, that anesthesia wore off during surgery, and that the resulting prosthetic teeth were so misaligned with her lower teeth that she could not chew for more than two years. She also alleges she met with a non-dentist “patient education consultant” who arranged financing before she ever spoke with a dentist. The case was still ongoing as of late 2024. ClearChoice has denied all allegations of malpractice and negligence.⁵³
A 2021 Maryland case in which an unnamed patient alleged ClearChoice “convinced” her to extract eight healthy upper teeth while “greatly downplaying the risks.” ClearChoice denied wrongdoing and settled privately.¹
A 2023 Florida case alleging the clinic provided no alternative treatment options before extracting all the patient’s teeth, which the complaint called “totally unnecessary.” ClearChoice denied wrongdoing and settled.¹
Brenda Black v. Aspen Dental Management (Kings County, New York, 2025). Black’s suit alleges improper care during a full-arch procedure at a Clear Choice center between July 2022 and November 2023. A November 2025 ruling allowed her to amend her complaint to add three additional dentists as defendants under the continuous treatment doctrine. Aspen Dental Management was removed as a named defendant.⁶

Maryland attorney Fred Goldberg, who has represented at least six clients in cases against ClearChoice, told investigators his clients consistently met with a salesperson to sign financing paperwork before ever consulting with a dentist.¹ In its own statement, ClearChoice called full-arch implants a “well-accepted standard of care for patients with severe tooth loss and teeth with poor prognosis” and said its private equity owners do not influence clinical decisions.³

Other chains have faced similar claims. A 2020 Texas lawsuit alleged a dentist at an Affordable Care clinic removed “every single tooth” from a patient’s mouth when it was not medically necessary; Affordable Care denied wrongdoing and settled privately.¹ As of 2026, active civil litigation in Illinois, Wisconsin, and Indiana targets Eon Clinics over its All-on-4 and All-on-6 procedures, with allegations of deceptive marketing, misrepresentation of provider credentials, substandard implant components, failed osseointegration, nerve damage, and treatments abandoned when clinics closed. Legal teams have been working to consolidate some claims into a class action format for consumer fraud, though full class certification has not been confirmed.⁷

What These Cases Are Worth

Most All-on-4 malpractice cases settle out of court, and most settlement terms are confidential. Reported settlements in dental implant nerve injury cases have ranged from $125,000 to more than $1.1 million, with the highest reported figure, $1,125,000, involving an implant infection that caused osteomyelitis.² Cases involving severe facial or mandibular nerve damage have settled in the $650,000 to $700,000 range.¹

Those figures reflect individual malpractice settlements, not class action awards. In the Eon Clinics litigation, plaintiffs are seeking refunds, corrective medical expenses, pain and suffering compensation, and punitive damages.⁷

What You Have to Prove

A dental malpractice claim generally requires expert testimony on four points: what the applicable standard of care was, that the dentist deviated from it, that the deviation caused the injury, and the extent of the harm. In most states, the same standard applies whether a general dentist or a specialist placed the implant.¹

Informed consent is a separate claim. A dentist must disclose the risks, benefits, and alternatives to the proposed treatment, including the option of no treatment. If a patient shows that material information was withheld and that a reasonable person would have declined the procedure with full disclosure, the dentist can be liable. Signing a consent form is not an automatic shield. Courts have treated standard form agreements as unenforceable contracts of adhesion when they function as a formality rather than a genuine disclosure.

One limit matters here. Informed consent is a defense only against non-negligent surgical risks. It does not excuse negligent performance of the procedure itself, so a patient who signed every form in the office can still sue if the implant was placed improperly.

How Long You Have to File

Filing deadlines vary by state and can end a case before it begins. Examples from the reported cases:

New York: Two years and six months from the date of the alleged malpractice. The “continuous treatment doctrine” pauses the clock until the patient is formally discharged from that course of treatment. The Kings County court applied this doctrine in Black v. Aspen Dental, finding that because Black received ongoing care through November 2023, her claims against newly added dentists were not time-barred.⁶
Massachusetts: Three years from the date the patient learns or reasonably should have learned of the injury, with a hard outer limit of seven years from the date of injury. A pre-suit claim letter must be sent at least six months before filing.⁸
Connecticut: Two years from discovery of the injury, with a three-year absolute cap from the date the malpractice occurred. A certification from a qualified dental professional must accompany the filing.⁹
Illinois: Generally two years for dental malpractice, subject to the discovery rule, and three years for consumer fraud claims.⁷

All-on-4 complications sometimes surface months or years after surgery, as implants fail or bone deteriorates. For that reason, the discovery rule and the continuous treatment doctrine are frequently litigated in these cases.

Why the Pattern Keeps Repeating

Three of the largest dental implant chains changed hands in rapid succession: ClearChoice for roughly $1.1 billion in 2020, Affordable Care for about $2.7 billion in 2021, and Dental Care Alliance for approximately $1 billion in 2022.¹ Critics argue the private equity model, which loads acquired companies with debt and seeks returns within a few years, creates pressure to maximize revenue through high-margin procedures like full-arch implants. The ClearChoice acquisition alone was funded by a $1.2 billion first lien senior secured term loan and brought Aspen Dental’s leverage to 6.7 times its earnings.¹⁰ Federal oversight is limited: more than 90 percent of private equity health care acquisitions fall below the $101 million threshold that triggers antitrust review by the FTC or Justice Department.¹¹

Staffing is a related issue. An analysis of more than 1,000 clinics at major equity-owned dental chains found that over 70 percent listed only general dentists on staff, with no oral surgeons, periodontists, or prosthodontists. Affordable Dentures & Implants listed specialists at fewer than 5 percent of its 400-plus locations. ClearChoice was an outlier, employing at least one oral surgeon or prosthodontist at each of its centers. Research suggests implants have double the failure rate when placed by general dentists compared to specialists, yet most states impose no special training requirement for implant surgery.¹²

If you believe you were harmed by an All-on-4 procedure, keep your financing paperwork, your pre-surgery consultation records, and any imaging the clinic took before the extractions. Those documents are usually what a malpractice attorney needs first to evaluate whether you have a case.

1
KFF Health News. Dental Implants Investigation: Failures and Unnecessary Healthy Teeth
2
CBS News. Dental Implants Increasing for Profit, Experts Say
3
Katie Couric Media. Dentists, Implants, and ClearChoice Investigation
4
PE Hub. PE-Backed Aspen Dental Buys Sun Capital’s ClearChoice
5
Chicago Sun-Times. Dental Implants: Dentists Pulling Healthy, Treatable Teeth
6
Findlaw. Brenda Black v. Aspen Dental Management, Inc.
7
LawFold. Eon Clinics Lawsuit
8
Segal Law. Dental Malpractice
9
Coop Group Law. Dental Malpractice in Connecticut
10
Private Equity Stakeholder Project. Private Equity Health Care Acquisitions: November 2020
11
Alliance for Retired Americans. Investigating Private Equity’s Takeover of Health Care
12
Daily Montanan. Dentists Are Pulling Healthy and Treatable Teeth to Profit From Implants