All-on-4 and All-on-6: Solutions for Full-Arch Tooth Loss

All-on-4 and All-on-6 are modern dental implant techniques that allow for the restoration of a full dental arch even in cases of complete edentulism (total absence of teeth). Essentially, these are fixed implant-supported prostheses: the entire upper or lower dental arch is anchored on 4 or 6 dental implants, respectively. These systems provide patients with non-removable teeth that look and function like natural ones—and can often be placed in just one day. Let’s take a closer look at what the All-on-4 and All-on-6 concepts entail, who they are suitable for, their benefits and drawbacks, implant selection, and what to expect from the procedure.

What is All-on-4 and All-on-6 implantation?

All-on-4 is a method of full-arch restoration using four implants. Four titanium implants are placed in the jawbone, onto which a full-arch prosthesis (bridge) is fixed. Typically, two implants are positioned vertically in the front region, and two are placed at an angle of approximately 45° in the posterior regions. This tilted placement of the rear implants allows the surgeon to avoid anatomically important structures (such as the maxillary sinuses in the upper jaw) and make the most of the available bone volume, eliminating the need for bone grafting. The All-on-4 concept is essentially a graftLESS technique—the entire prosthetic structure is supported by four implants placed in areas where bone has been best preserved, so additional sinus lifts or bone augmentation are often unnecessary.

All-on-6 is a similar approach but uses six implants to support the full-arch prosthesis. The implants are usually placed at more upright (nearly vertical) angles along the length of the jaw, providing greater stability and support for the prosthesis. Increasing the number of implants to six allows for a more even distribution of chewing forces across the jaw. This approach can offer improved long-term structural integrity and reduce the risk of overloading any single implant. This is particularly relevant for the upper jaw, where bone quality is generally lower: All-on-6 creates a stronger foundation for the prosthesis, which is important for chewing efficiency and may extend the lifespan of the restoration.

Both techniques involve a fixed bridge with artificial teeth and a pink base that mimics the gums. The prosthesis is crafted in a continuous “horseshoe” shape that replaces not only the teeth but also the lost volume of gums and bone—hence the pink component, which is thicker than natural gums. This monolithic design provides what’s known as “cross-arch stability”—a strong connection of all implants through a single framework, which is critical for the long-term success of the method. Unlike removable dentures, the patient does not need to take the bridge out—it is permanently screwed onto the implants.

Who Is a Good Candidate for All-on-4 and All-on-6 Implants?

The primary candidates for All-on-4 or All-on-6 are patients with complete edentulism, meaning the total absence of teeth in the upper or lower jaw. These techniques were developed specifically for such cases, allowing the restoration of the entire dental arch using several implants instead of traditional removable dentures. All-on-4 is also used in patients with teeth that require extraction due to incurable conditions (e.g., generalized periodontitis or severe tooth decay): during a single surgery, the remaining teeth can be extracted, and implants with a temporary prosthesis placed immediately, effectively providing a full smile restoration in a short time.

These technologies are well suited for people who cannot or do not wish to wear removable dentures. If conventional full dentures are poorly retained, cause irritation, or discomfort, a fixed prosthesis on 4 or 6 implants can be a life-changer — it stays firmly in place and allows chewing almost like natural teeth. Patients seeking to regain confidence in their smile and improve their quality of life also benefit greatly: implants prevent further bone atrophy in the jaw and support the natural contours of the face, which is especially important after a prolonged period without teeth.

It is crucial that the patient’s overall health condition allows for implant surgery. The patient must have sufficient bone volume or be willing to undergo preliminary bone grafting (in the case of All-on-4, grafting can often be avoided thanks to the tilted placement of implants in the anterior region where bone remains). There should be no uncontrolled systemic conditions that interfere with healing (e.g., unstable diabetes), and the patient must be committed to maintaining excellent oral hygiene. Smoking, untreated periodontal disease, or poor hygiene can increase the risk of complications, so all these factors are assessed by the dentist before making a decision.

In general, All-on-4 and All-on-6 are recommended for those who want to receive permanent fixed teeth in the case of total tooth loss. They are ideal for fully edentulous jaws and are also suitable for patients with a few remaining diseased teeth — such teeth are removed if necessary, and the patient can immediately proceed with implant placement and prosthetics using the All-on-4 or All-on-6 concept.

All-on-4: Advantages and Disadvantages

Advantages of All-on-4

• Less invasive and no need for bone grafting. The All-on-4 method was designed as a “graftless” solution: implants are placed in the existing bone, avoiding sinus lifts or other bone augmentation. The two posterior implants are placed at an angle in the front sections of the jaw, where the bone is usually denser, instead of the atrophied posterior areas. This allows implantation even in patients with limited bone volume without additional surgeries and avoids anatomical structures (sinuses, mandibular canal, etc.).
• Rapid tooth restoration – “teeth in a day”. All-on-4 allows for immediate placement of a temporary fixed prosthesis right after implant placement. Thanks to special multi-unit abutments, the patient can leave the clinic with new temporary teeth on the same day. This immediate function significantly increases comfort – the patient is never without teeth. After about 4–6 months, when the implants fully integrate, the temporary prosthesis is replaced with a permanent, custom-made one from durable materials. This shortens the overall treatment time and provides aesthetics from day one.
• Fewer implants – less surgical intervention. As the name implies, All-on-4 uses only 4 implants to support the prosthesis. Fewer implants mean a simpler and faster surgery, fewer bone perforations, and potentially faster healing. It’s also more budget-friendly – four implants cost less than six or eight, making it a cost-effective solution. With fewer implants and no additional procedures (grafts), the total treatment cost and time are usually lower than in classic full-mouth implant protocols.
• High success rate and durability. With over 25 years of use, All-on-4 has substantial evidence of its effectiveness. Clinical studies show excellent long-term outcomes: implant survival rates average ~98% over 7–10 years. About 95% of patients are satisfied with their new teeth, reporting improved chewing, speech, and aesthetics. These high indicators make All-on-4 a safe and predictable protocol for both doctors and patients. The technology is globally recognized, with pioneer Nobel Biocare reporting over 250,000 successfully treated patients.

Limitations and Disadvantages of All-on-4

• Implant positioning and load requirements. Since the prosthesis relies on only four implants, their correct placement and integration are crucial. If one implant fails, the entire structure may be compromised. In some cases, the bridge may stay on three implants (if the failed one isn’t terminal), but if a terminal implant fails, a new prosthesis is often needed. Precise planning and high primary stability are critical.
• Possible implant overload. With only four implants, each bears significant chewing load. The prosthesis usually includes posterior cantilevers, creating leverage. Patients with strong bites or bruxism may risk implant overload or prosthesis breakage. For such cases, All-on-6 or additional implants may be recommended.
• Bone volume requirements. Although All-on-4 avoids bone grafting, it still requires adequate bone in specific areas (usually anterior jaw sections). If the bone is too narrow or low, preparatory procedures or alternative methods (like zygomatic implants) might be needed.
• Hygiene and maintenance. The fixed bridge covers the gum, leaving spaces underneath where food can accumulate. It requires thorough hygiene: daily cleaning under the bridge with special brushes, irrigators, or superfloss, and professional cleanings every 6–12 months. The patient cannot remove the prosthesis themselves – a doctor must unscrew it for maintenance. Lifelong care is essential to prevent peri-implantitis or implant loss.
• Sensation and speech. Initially, the prosthesis may feel foreign – it’s bulkier than natural teeth due to artificial gums. Patients may experience unfamiliar chewing sensations as implants lack periodontal ligaments (no tactile feedback). Slight temporary speech issues (e.g., with “s”, “z” sounds) are also possible but usually resolve within days or weeks.

All-on-6: Advantages and Disadvantages

Advantages of All-on-6

• Greater stability and even load distribution. The main benefit of the All-on-6 configuration is additional support. Six implants create a wider base, providing the prosthesis with greater stability compared to just four implants. Chewing forces are distributed across six points, reducing the load on each implant. This structure has a built-in safety margin: even if one implant fails over time, the prosthesis can still be retained on the remaining five (though it may require adjustment to close the gap). Overall, All-on-6 is considered a highly reliable option for patients with high functional demands, such as those with strong biting forces.
• Better outcomes for the upper jaw. The upper jaw typically has more porous bone, which offers weaker implant support and requires a more cautious approach. Using six implants is especially suitable for the upper arch: the extra implants compensate for lower bone density and help distribute biting and chewing forces more evenly. Experience shows that All-on-6 in the upper jaw offers longer-lasting prosthetics and a lower risk of loosening over time, as six implants provide a stronger anchorage in the bone.
• Less stress on each implant and prosthesis. Thanks to the increased number of supports, an All-on-6 prosthesis may have shorter or no cantilevered (overhanging) sections behind the back implants. This means less leverage stress, reducing the risk of bending or breaking the prosthetic bridge. As a result, the prosthetic material (e.g., a durable monolithic zirconia framework) works under optimal conditions and is less likely to break. Statistics and clinical practice show that All-on-6 prostheses are exceptionally long-lasting: with proper design and sufficient material thickness, these bridges serve for many years without cracks or fractures.
• Broader range of indications. The “all-on-6” concept is more flexible in terms of indications: it suits both patients with good bone structure (allowing six implants without limitations) and those with somewhat lower bone density who would benefit from extra implant support. If jaw anatomy allows, most implantologists agree that six implants are better than four, as additional supports increase the chances of success. Therefore, All-on-6 is often considered the “gold standard” for full fixed restoration when bone conditions allow for the placement of six implants.

Limitations and Disadvantages of All-on-6

• More extensive surgery and bone requirements. Placing six implants is naturally a more invasive procedure than placing four. It involves more surgical drilling, a longer operation, and potentially a more difficult recovery (more swelling, discomfort). The patient must have enough bone volume along the entire jaw to accommodate six implants. If bone is lacking where additional implants are needed, bone grafting or sinus lift procedures (for the upper jaw) may be required before or during implantation. Therefore, All-on-6 is more commonly used when bone volume is relatively preserved or after prior bone restoration. In complex cases with very limited bone, All-on-4 may be the better option since it requires fewer implants and uses the remaining bone more efficiently.
• Higher cost and complexity. Understandably, six implants and a larger amount of work mean higher treatment costs. All-on-6 implantation involves more implants, more components, and more lab work on the prosthesis, making it more expensive than All-on-4. Additionally, the planning and surgical execution may be more complex — sometimes requiring surgical guides and more precise implant placement to fit all six optimally. Not every clinical case allows for easy placement of six implants, especially in patients with narrow jaws or proximity to important anatomical structures. This requires high expertise and precise 3D planning, which is now possible thanks to digital tools like CBCT and computer-guided implant positioning.
• Hygiene and maintenance remain critical. Having six implants instead of four does not relieve the patient from the responsibility of maintaining them properly. In fact, the larger structure means even more areas that must be kept clean. Hygiene recommendations for All-on-6 are the same as for All-on-4: regular cleaning under the bridge, use of interdental brushes, irrigators, and professional check-ups and cleanings at least once a year. Neglecting these can lead to complications such as gum inflammation around the implants or implant loss due to peri-implantitis. Patients must understand that implants require lifelong care and maintenance, whether it’s 4, 6, or even 8 implants.
• Anatomical limitations. In some cases, jaw anatomy (sinus location, nerve canals, bone shape) may not allow for placing all six implants in ideal positions. For example, in the upper jaw, it can be difficult to find space for a third implant on each side between the canine and the maxillary tuberosity due to the proximity of the sinus. In the lower jaw, the mandibular nerve canal may be an obstacle. In such cases, the surgeon may recommend modifying the plan (e.g., using 5 implants — sometimes referred to as All-on-5), performing additional procedures (like bone grafts or sinus lifts), or reverting to All-on-4 to avoid risking injury to critical structures.

How to Choose Between All-on-4 and All-on-6?

The choice between All-on-4 and All-on-6 protocols is always an individual decision made by the dental implantologist together with the patient based on the specific clinical situation. Key factors include:

• Bone condition. If the patient has sufficient bone volume and density throughout the jaw, placing six implants may be the optimal option for maximum stability and prosthesis longevity. In cases where the bone is severely atrophied in the posterior areas and the patient wishes to avoid bone grafting procedures, the doctor may recommend All-on-4 – placing implants in the front where bone is available and tilting the posterior implants to cover more of the arch. Thus, All-on-4 is often chosen when bone availability is limited, and All-on-6 when there is enough bone to fully benefit from the additional implants.
• Jaw being restored. In practice, All-on-4 shows excellent results on the lower jaw, as it usually has higher bone density and 4 implants can provide sufficient stability. On the upper jaw, due to its porosity, doctors often prefer All-on-6 (if feasible) to compensate for the weaker bone with more support points. Sometimes 6 implants are used on the upper and 4 on the lower jaw – everything depends on the patient’s specific anatomy.
• Bite and chewing load. If the patient has strong jaw muscles, habits of chewing hard foods, or bruxism (teeth grinding), a 6-implant system will be more resistant to such loads. Additional implants reduce the risk of overloading and distribute the force over a larger area. For patients with weaker bites or the elderly who mostly consume soft foods, 4 implants may be sufficient. The doctor assesses these factors during treatment planning.
• Financial resources and treatment time. All-on-4 is generally slightly more affordable and faster to implement (fewer implants, often fewer stages). If the budget is limited and both 4 and 6 implants are clinically viable, using 4 implants may be a reasonable compromise without significantly sacrificing quality. At the same time, if the cost difference is not critical, investing in 6 implants may provide extra peace of mind regarding the long-term durability of the prosthesis – it acts like an insurance policy in case one implant fails unexpectedly.
• Patient preferences. Some patients feel psychologically more confident knowing they have the “maximum possible” number of implants for better stability and prefer All-on-6. Others want to minimize surgical intervention and the number of implants, so they may lean toward All-on-4 if deemed acceptable by the doctor. Both protocols, when performed properly, yield excellent outcomes, so the decision often depends on the clinic’s philosophy and the patient’s personal situation.

It is worth trusting your implantologist’s recommendation: an experienced surgeon will use CT scan data, a physical examination, and clinical expertise to propose the option that best balances safety, predictability, and cost. In complex cases, the doctor may simulate both scenarios and explain the pros and cons of each. Both All-on-4 and All-on-6 are effective solutions for full edentulism, so the most important thing is choosing the right protocol for the individual patient and executing it correctly.

Which Implants Are Best to Use?

The success of full-arch “all-on-4/6” implantation largely depends on the quality and correct selection of implants. While many implant brands are available, priority should be given to premium systems from trusted companies. Brands like Straumann (Switzerland) and Nobel Biocare (USA/Switzerland) offer decades of experience, scientific research, and clinical success rates that confirm the reliability of their implants.

For instance, Straumann has developed a complete concept for immediate full-arch rehabilitation – Pro Arch, which uses the innovative Straumann BLX implants. Straumann BLX implants are designed specifically for immediate loading protocols: they feature a unique thread design and a special SLActive® surface that accelerates osseointegration (bone integration). This is especially important for All-on-4/6 protocols, where the temporary prosthesis is often placed immediately, and the implants are loaded from day one. Fast and strong integration enhances the chances of successful immediate restoration.

On the other hand, Nobel Biocare – the pioneer of the All-on-4 concept – offers implant lines such as NobelActive and NobelParallel CC, along with multi-unit abutments designed for angled placement and immediate loading. Nobel Biocare reports implant survival rates of 98% over a ~7.5 year follow-up period using their All-on-4 systems, and clinical studies confirm stable bone levels and healthy gums around both straight and angled implants in these protocols. This reflects the high quality of their implants and components.

Therefore, it is best to choose implants from top-tier manufacturers. They may cost more, but they provide predictable outcomes. Selecting the right implant type is also important: for example, in soft upper jawbone, wider diameter implants or special thread designs for better primary stability are often used. If the bone height is severely reduced, zygomatic implants (anchored in the cheekbone) may be necessary – though these are specialized solutions.

In standard All-on-4/6 cases, implantologists typically use either a system they specialize in or the one that best suits the clinical conditions. Straumann, Nobel Biocare, as well as Dentium (USA), BioHorizons, Zimmer Biomet, and other reputable systems – all have solutions for full-arch restorations. Clinics that position themselves as expert centers usually offer patients premium-class implants, since the implant acts as the “root” and determines the success of the entire treatment. When restoring an entire smile, it is not advisable to save on implant quality: a well-chosen implant with proper care can last a lifetime, while budget options may carry a higher risk of complications or lack long-term research data.

What to Expect After the Procedure?

Recovery after All-on-4 or All-on-6 implantation is generally quite fast, although it involves several stages. Since the prosthesis is often fixed immediately, the patient can return to a relatively normal life with new teeth within a day or two. However, certain precautions should be followed during the early postoperative period:

• First days after surgery. Moderate swelling of the face and gums, possible bruising on the skin, minor pain at the implant sites, and light bleeding are normal. The doctor will prescribe painkillers and, if necessary, antibiotics to prevent infection. Most patients report that the pain and discomfort are less than expected, and they feel quite well 2–3 days after the implants are placed. During this time, it is important to apply ice packs to the cheeks (especially on the first day), sleep with your head elevated, and limit physical activity. The mouth should be gently rinsed with antibacterial mouthwash (chlorhexidine) as recommended by the doctor.
• Diet and load on the implants. Even though temporary teeth may be fixed immediately, you should not chew hard food until the implants have integrated. For the first 2–6 weeks after surgery, follow a soft diet: eat pureed soups, porridge, yogurt, soft fish fillets or well-cooked meat, omelets, etc. Avoid hard, crunchy foods (nuts, crackers, raw vegetables, steaks), very hot dishes, and chewing gum. This is a critical period when osseointegration – the fusion of bone and implants – takes place, and excessive pressure can interfere with this process. The doctor will usually give clear instructions regarding the diet and duration. Gradually, after several weeks, you can start introducing firmer foods, but a full return to a normal diet is only possible after the permanent prosthesis is placed (around 4–6 months).
• Healing and placement of permanent teeth. Implants typically integrate into the bone over 3–6 months (the exact time depends on individual factors such as bone quality). During this period, you will wear a temporary prosthesis, which looks aesthetic but is made from lighter materials and not intended for heavy chewing. After a few months, once the implants have fully stabilized, the process of making the permanent prosthesis begins. The doctor will take impressions (or 3D scans) of your jaw with the implants, try on the bridge framework, and a dental technician will create the final structure – a durable prosthesis (usually made from metal-acrylic, composite, or monolithic zirconia ceramic). This prosthesis will be precisely adjusted for your bite, gum shape, and color – to closely mimic natural teeth. After installation of the permanent bridge, you will be able to chew any food. The total treatment time from the first consultation to receiving non-removable, beautiful teeth is usually between 4 and 8 months, which is significantly faster than traditional bone grafting protocols that may take 1–2 years.
• Routine check-ups and prevention. After prosthetic treatment is completed, it is very important to maintain implant health. Dental clinics usually schedule regular check-ups – first within 1–3 months after prosthesis placement, then every 6 months during the first year. After that, check-ups are recommended at least once a year. During these visits, the doctor will evaluate gum health, check the bone level around implants via X-ray, perform professional cleaning under the prosthesis (removing the bridge to clean the implants and the underside, then reinstalling it). Retention screws may also need to be replaced over time (they can loosen or wear out). Regular check-ups help prevent issues such as peri-implantitis (inflammation around the implant) or detect them early for effective treatment. Remember, implants are not prone to cavities, but the gums around them can become inflamed with poor hygiene, so professional monitoring is key to long-term success.
• Long-term performance. With proper care, implants can last for decades – even a lifetime. The prosthesis (bridge) itself may need repairs or replacement of some components over time – for example, after 10–15 years the acrylic teeth material may wear down, or pads and screws may need replacing. However, once successfully integrated, the basic implants remain in the bone and continue to serve as a solid foundation. Many patients who received All-on-4/6 report that they returned to normal life: eating their favorite foods, speaking and smiling confidently without worrying about dentures. Studies confirm a high quality of life and satisfaction among these patients with the treatment outcomes.

In conclusion, All-on-4 and All-on-6 are truly revolutionary solutions for people who have lost all their teeth. They combine the speed of getting a new smile, the convenience of a fixed restoration, and excellent functionality. A well-chosen technique, high-quality implants, and the professionalism of the dental team ensure treatment success. Following care instructions and attending regular check-ups will help keep your new teeth healthy for many years. Whether you choose implantation on 4 or 6 implants, the result is a beautiful, natural-looking smile and restored self-confidence – which is invaluable for the quality of life of a fully edentulous patient.