THE ESSENTIALS · 30-SECOND OVERVIEW
Compare the full-arch plan, not only the number of implants.
Ask about temporary teeth, healing and the final restoration.
Include cleaning, maintenance and future reviews in the decision.
Compare the planning, maintenance and cost considerations behind full-arch implant options.
Key takeaways
- All-on-4 and All-on-6 describe full-arch concepts supported by four or six implants; neither number is universally better.
- CBCT, examination, bone distribution, bite and prosthetic design help determine implant number and position.
- A fixed temporary bridge may be possible in selected cases, but it is not the same as the definitive restoration.
- Cleaning access, smoking, clenching, general health and professional maintenance affect long-term care.
- Compare complete treatment phases and components, not the advertised implant count alone.
What the terms mean
“All-on-4” commonly refers to a complete fixed arch supported by four implants, sometimes using angled posterior implants to work with available bone. “All-on-6” uses six implants distributed across the arch. These are treatment concepts rather than a promise of immediate, permanent teeth for everyone.
Ask the Dentagram team to confirm the case-specific appointment sequence and provisional treatment stages before booking non-refundable travel.
The practical differences
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| Question | Four-implant concept | Six-implant concept |
|---|---|---|
| Implant number | Four implants support the arch | Six implants support the arch |
| Bone distribution | Can be useful where a four-position design makes best use of available bone | Requires suitable bone and restorative positions for six implants |
| Redundancy | Fewer supporting units; a complication affecting one implant may have a larger design impact | More supporting units may offer additional distribution, but do not remove biological or mechanical risk |
| Surgery and cost | May involve fewer implant components | May involve two additional implants and components |
| Evidence | Can perform well in selected patients | Can perform well in selected patients; pooled comparisons do not prove six is always superior |
The implant count should follow the diagnosis and prosthetic plan. Adding implants is not automatically safer if their positions are poor or hygiene becomes difficult. Using fewer is not automatically more conservative if the distribution is unsuitable.
Plan your next step.
Discuss your questions
Agree an individual plan
Arrange follow-up
Who may be considered for a fixed full arch?
Full-arch treatment may be discussed for people who have lost most or all teeth in an arch, have teeth with a poor overall prognosis, or cannot function with a removable denture. It is a major restorative decision. Each remaining tooth should be assessed before extraction; treatable natural teeth should not be removed merely to fit a standard package.
Suitability may be affected by:
- bone quantity and distribution;
- active gum disease or infection;
- smoking or nicotine use;
- diabetes and other health conditions;
- medications and healing factors;
- clenching, grinding and bite forces;
- ability to clean beneath a fixed bridge;
- expectations about appearance, speech and adaptation.
Why CBCT and restorative planning come first
CBCT may help assess three-dimensional bone and nearby structures. It must be interpreted together with the mouth examination, photographs, scans and the intended final tooth position. A surgically convenient implant position is not enough if it compromises the bridge, speech, lip support or cleaning.
The written plan should identify which teeth are to be removed, why they cannot predictably be maintained, the proposed implant number and positions, grafting possibilities, temporary restoration, final materials and contingencies if immediate loading is not advisable.
Temporary fixed teeth and the definitive restoration
Some patients may leave the surgical phase with a fixed provisional bridge. This depends on implant stability and the ability to control loading. The provisional restoration helps shape function and appearance during healing, but it may have a restricted diet and is designed differently from the final bridge.
After healing, new records may be taken for the definitive restoration. The final phase can involve verification, tooth set-up or try-in, bite refinement and fitting. Ask whether the advertised price includes both provisional and definitive teeth, all abutments, laboratory stages and adjustments.
Recovery: what the schedule cannot predict
Early swelling, bruising, tenderness and dietary limitation can occur after surgery. The extent varies with extractions, grafting and the individual. Recovery from the procedure is not the same as osseointegration. Even if a provisional bridge is fitted quickly, the implant-bone interface still requires protection during healing.
Patients need written guidance on cleaning, diet, medicine, smoking, emergency contact and review. Worsening swelling, persistent bleeding, discharge, fever, altered sensation, increasing pain or movement of the bridge warrants prompt clinical advice.
Maintenance is part of the treatment
A full-arch bridge is fixed for the patient, but it still requires access beneath it for cleaning and professional review. The patient may need specialist brushes, floss threaders, water irrigation or other tools selected by the dental team. Maintenance visits assess the tissues, plaque control, bite, screws, components and the restoration.
Evidence on the ideal recall and professional maintenance protocol is limited; care should be personalised. Ask who will provide routine maintenance at home, which records the local dentist will receive and how implant components can be identified.
Advantages, limitations and risks
Potential advantages include fixed function, replacement of a complete arch and avoiding a removable denture in suitable patients. Limitations include substantial surgery, irreversible extractions, adaptation to a bridge, cleaning demands, component wear and the need for continuing maintenance.
Risks may include infection, failure of an implant to integrate, gum or bone inflammation, fracture or wear of the provisional or final restoration, screw or component problems, altered sensation and aesthetic or speech dissatisfaction. Grafting or a different treatment may be needed if the planned design cannot be delivered safely.
Alternatives can include maintaining strategic natural teeth, a removable denture, an implant-retained removable overdenture, a different number of implants or staged treatment.
What changes the cost?
- extractions and management of infection;
- implant number, system and components;
- grafting or sinus procedures;
- sedation, where clinically appropriate and offered;
- provisional fixed bridge or removable temporary;
- final bridge framework and tooth material;
- laboratory verification and try-in stages;
- reviews, maintenance and contingency work;
- one, two or more journeys.
Dentagram provides an itemised, case-specific estimate after the available records have been reviewed and the clinical assessment has been completed. Ask which items are confirmed and which remain provisional.
How many trips are usually involved?
A common pattern is one trip for definitive assessment, extractions where required, implant placement and a temporary restoration, followed by healing at home and a later trip for the definitive bridge. Complex grafting, staged surgery or an unsuitable immediate-loading situation may require a different pathway. Travel should be booked only after a case-specific plan.
Frequently asked questions
Is All-on-6 always stronger than All-on-4?
No. Implant number alone does not determine strength or success. Distribution, bone, implant stability, bridge design, bite and maintenance are all important.
Can I have fixed teeth immediately?
Possibly, in selected cases. The decision is made after surgery-level assessment of stability and loading. A removable or delayed provisional should be discussed as a contingency.
Are all remaining teeth removed?
Only teeth assessed as unsuitable to retain should be extracted. Ask for a tooth-by-tooth diagnosis and alternatives before irreversible treatment.
How do I clean under a full-arch bridge?
The team should demonstrate cleaning beneath the bridge and around the implants using suitable aids. Design for cleaning access should be discussed before treatment, not only after fitting.
Evidence and further reading
- PubMed, systematic review comparing four and six implants for maxillary fixed prostheses
- PubMed, overview of systematic reviews of All-on-4 and All-on-6
- PubMed, supportive maintenance for full-arch implant prostheses
- PubMed, current evidence review of full-arch fixed implant prostheses
- Dentagram, full-mouth dental implants
This guide provides general information and does not replace an individual clinical examination, diagnosis or treatment plan.