Short answer: All-on-4 is a treatment concept in which a fixed dental bridge is placed on four implants in a completely toothless jaw. Placing the back implants at an angle often makes treatment possible without additional bone surgery when bone is insufficient. All-on-6 uses six implants. In suitable cases, temporary fixed teeth can be fitted on the same day or within a few days; suitability is determined by a CT scan and an examination.
For many people who have lost, or are about to lose, all their teeth, removable complete dentures were the main option for many years. However, a denture that moves, a reduced sense of taste because the palate is covered and difficulty chewing can noticeably affect quality of life. The All-on-4 concept, commonly known as "all on four," and its version with more implants, All-on-6, are a modern approach that allows a fixed row of teeth to be placed on a small number of implants in toothless jaws. In this article we explain clearly what the method is, who it suits and what its limits are.
What is All-on-4?
All-on-4 is a treatment concept based on placing a fixed prosthesis (a row of teeth) that the patient cannot remove onto four implants placed in a completely toothless jaw. Two of these four implants are placed upright in the front of the jaw, and two are placed at an angle in the back.
This angle given to the back implants is the key feature of the method. It allows longer implants to be used without coming close to the sinus in the upper jaw or the jaw nerve in the lower jaw, and makes more efficient use of the existing bone. As a result, treatment can be planned for many patients with limited bone volume without additional surgery such as a sinus lift or extensive bone grafting.
What sets this approach apart from implant-supported removable dentures is that the patient does not take the prosthesis out. With implant-supported removable dentures, the denture attaches to the implants with snap-like parts and the patient removes it for cleaning. An All-on-4 prosthesis, on the other hand, is screwed onto the implants; only the dentist can remove it, for checkups and maintenance. Which type of prosthesis is suitable is assessed together, based on bone structure, manual dexterity and the person's expectations.
What is the difference between All-on-4 and All-on-6?
The main difference between All-on-4 and All-on-6 is the number of implants supporting the prosthesis: one uses four implants, the other six. This difference directly affects how forces are distributed and how treatment is planned.
- All-on-4: Can be used with fewer implants in a limited bone volume. Surgical time and the healing burden are relatively lower.
- All-on-6: Chewing forces are spread across more implants. It may be preferred for patients with sufficient bone volume, strong chewing forces or a teeth-clenching habit. If a problem develops with one implant, more of the prosthesis's support can be preserved.
Which option is suitable is decided by assessing bone quantity and quality, the condition of the teeth in the opposing jaw, chewing forces and general health. For some patients, other plans with a different number of implants may also be considered.
Who is it suitable for?
Full-mouth implant treatment can be considered for adults who have lost all their teeth, or whose remaining teeth cannot be saved, and who want fixed teeth. It can be a suitable option especially in the following situations:
- People who wear removable complete dentures and are bothered by the denture moving
- Those who are about to lose most of their teeth because of advanced gum disease
- Patients for whom placing many implants is difficult because of bone loss
- People who want to avoid lengthy bone grafting procedures and whose anatomy allows it
However, some conditions require careful assessment or may require postponing treatment: uncontrolled diabetes, heavy smoking, a history of radiotherapy to the head and neck, the use of certain medications that affect bone metabolism and conditions that make it hard to maintain oral hygiene. For this reason, a detailed medical history is taken before treatment and, if needed, the relevant physicians are consulted.
The treatment process and same-day teeth
All-on-4 treatment progresses in four main stages: planning, surgery, temporary prosthesis and permanent prosthesis. In suitable cases, temporary fixed teeth can be fitted on the same day or within a few days after the implants are placed; this is called "immediate loading."
- Examination and planning: Bone volume and the positions of the sinus and nerves are assessed with an intraoral examination, a dental CT scan and digital impressions. The locations and angles of the implants are planned based on this data.
- Surgical stage: If needed, the remaining teeth are extracted and the implants are placed under local anesthesia. Sedation may also be considered for anxious patients.
- Temporary fixed prosthesis: If the implants have reached sufficient initial stability, a lightweight temporary row of teeth is fixed to them. Eating soft foods during this period is important.
- Permanent prosthesis: Fusion of the implants with the bone usually takes a few months. At the end of this period, a permanent prosthesis made of more durable materials is fitted.
Fitting temporary teeth on the same day is not possible for every patient. If the initial stability of the implants is not sufficient, a different temporary solution may be used during healing. The duration and fee of treatment are provided in writing after the CT scan and planning.
What are the advantages and limits?
The All-on-4 and All-on-6 concepts offer important advantages for the right patient; however, like any method, this approach also has limits. Both need to be known for a sound decision.
Advantages
- Provides a fixed row of teeth that the patient does not remove.
- Because it does not cover the palate in the upper jaw, the sense of taste and temperature is preserved.
- Often reduces the need for additional surgery when bone is insufficient.
- In suitable cases, temporary fixed teeth can be obtained within a short time.
- Can provide more confidence when chewing and speaking than a removable denture.
Limits
- It is a surgical procedure and requires suitable general health.
- Cleaning under the prosthesis requires care; if neglected, inflammation can develop around the implants.
- Prosthesis parts may wear or break over time; maintenance and repair may be needed.
- Some patients with very advanced bone loss may need different implant solutions or bone augmentation procedures.
How are care and longevity maintained?
Long-term, problem-free use of an All-on-4 prosthesis depends largely on daily care and regular checkups. Scientific studies show that this treatment has high long-term success rates in suitable patients; however, maintaining the result also depends on the patient's care.
- Daily cleaning: The surfaces of the prosthesis should be cleaned with a soft brush, and the underside facing the gums with super floss, an interdental brush and a water flosser.
- Checkups: Checkups are generally recommended every 6 months. When needed, the dentist removes the prosthesis and professionally cleans the implants and the underside of the prosthesis.
- Night guard: For patients who clench or grind their teeth, a night guard may be recommended to protect the prosthesis.
- Smoking: Smoking harms the health of the tissues around the implants; quitting is recommended.
For other common questions about implant treatment, see our frequently asked questions page.
When should you get an assessment for complete tooth loss in Ankara?
If you have trouble chewing with your removable denture, your teeth are loose because of gum disease, or you were previously told that implants were not possible because of insufficient bone, a new assessment with an up-to-date CT scan may reveal new options. At our polyclinic in Park Oran Ofis in Çankaya, treatment is planned by considering the CT scan, a general health assessment and prosthetic planning together. For appointment information, visit our contact page.
Frequently asked questions
Can teeth be fitted on the same day with All-on-4?
In suitable cases, when the implants reach sufficient initial stability, temporary fixed teeth can be fitted on the same day or within a few days. The permanent prosthesis is made after the implants fuse with the bone, usually a few months later.
Can an All-on-4 prosthesis be removed?
The patient cannot remove the prosthesis; it is screwed onto the implants. The dentist, however, can remove it when needed for checkups and professional cleaning.
Can All-on-4 be done for people with little bone?
Thanks to the angled placement of the back implants, treatment can be carried out for many patients with limited bone volume without additional bone surgery. In every case, however, suitability is assessed with a dental CT scan.
Should I choose All-on-4 or All-on-6?
The choice is based on bone quantity, chewing forces, a teeth-clenching habit and the condition of the teeth in the opposing jaw. If there is enough bone, All-on-6 may be preferred because it spreads forces across more implants; the decision is made after an examination.
