What Is the Difference Between All-on-4 and All-on-6 Dental Implants?

All-on-4 and All-on-6, full-mouth dental implant restorations involve the placement of hybrid prosthetic tooth groups fixed on 4 or 6 implants at certain angles, depending on the chosen method, in the lower or upper jawbone or full mouth. Thanks to the implants, the pressure distribution during chewing and biting is optimised.

Implant treatment is applied with an aesthetic appearance that resembles natural teeth to patients who have lost their natural teeth due to periodontal diseases, trauma or other reasons or who are unable to be treated. Healthy gums and appropriate bone tissue are required for successful implant treatment. Instead of applying implants for each tooth separately, fixed hybrid dentures are placed by applying 4 or 6 implants to the lower or upper jaw or both jaws.

Teeth are important for the health of the jawbone. The jawbone without teeth melts over time and forms depressions. The sagging of the face due to depressions causes the person to look older than he/she is. The patient is affected both physically and psychologically.

The number of implants to be applied varies depending on the health of the jawbone.  As a result of the examination and controls, the dentist decides which treatment will be applied. In order for the treatment to be successful, it is important to apply the necessary procedures by a dentist specialised in the field.

All-on-4 treatment method is preferred for patients with poor bone health, while All-on-6 is preferred for patients with healthy bone structure. Both methods have similar treatment procedures. At the beginning of All-on-4 and All-on-6 treatment, a frame, usually made of titanium material, is prepared in which artificial teeth are placed according to the smile design and bone structure suitable for the person. A hybrid prosthesis is fixed on the frame. This prevents the prosthesis from coming out during speaking, biting and chewing. It does not need to be removed while sleeping. Since the palate is not closed, it does not make a difference in perceiving the taste of food.

All-on-4 implant treatment is performed by placing prosthetic teeth with artificial gums by applying dental implants to the jawbone at 4 points. Since it has a one-piece structure, it is thicker to increase its resistance to fracture. Due to the thickness, the bone may need to be partially removed in order for the placement to be smooth. The incompatibility between artificial gums and natural gums is noticeable and aesthetically does not resemble the appearance of natural teeth. Cleaning of food residues and plaque trapped between the gum and the prosthesis is carried out by completely removing the implant screws during 6-month controls. 

In All-on-6, fixed hybrid prosthetic teeth without artificial gums are placed with a total of 6 implants on a frame divided into 3 parts or a single piece. Small deformations in the jawbone are removed by applying bone graft. Then the implant stage is started. It looks aesthetically similar to the natural tooth structure and feels like natural teeth while eating. It is more expensive than All-on-4 as two extra implants and bone grafting procedures may be required.

In order to understand the differences between all-on treatments, the comparison in Table 1 can provide preliminary information for patients. However, the dentist will decide on the appropriate treatment for the patient.

Table 1. Comparison of All-on-4 and All-on-6 treatments

Following the dentist’s oral care and dietary recommendations to prevent damage to the implants and accelerate healing after all-on treatments facilitates the process. Soft, easily chewed foods and plenty of water consumption are recommended, while it is recommended to avoid spicy, acidic, sugary, sticky, hard foods and drinks.