All-On-Four and All-On-Six

Tooth loss is a serious problem that profoundly impacts not only chewing function but also speech ability, aesthetic appearance, and even self-confidence. Especially in cases of complete edentulism, traditional dentures may not always provide adequate comfort. This is where two powerful solutions offered by modern dentistry come into play: All-On-Four and All-On-Six implant systems .

These methods are innovative implant applications with a high success rate, designed to place fixed prosthetics in edentulous jaws. Unlike traditional implant systems, they allow for the placement of fixed teeth in larger areas with fewer implants. Furthermore, in many cases, patients can receive their fixed teeth the same day.

All-On-Four and All-On-Six systems offer highly effective and long-lasting solutions for both aesthetic and functional needs. However, there are some important differences between these two methods. So, which one is right for you? Which system is more durable, more aesthetic, or more economical?

In this article, we’ll explore the All-On-Four and All-On-Six implant systems, their application, the differences, and patient experiences in detail. If you’re looking for a permanent solution to your edentulous condition, this article is for you.

What are All-On-Four and All-On-Six? Basic Definition and Approach

Complete edentulism is a condition that significantly impacts the quality of life for individuals who have lost teeth in both the upper and lower jaws. All-On-Four and All-On-Six systems are modern implant treatments that offer permanent, stable, and aesthetic solutions to this problem. Both methods support fixed dentures through implants placed in the jawbone. However, there are some differences in the number of implants, their placement angles, and application details.

What is the All-On-Four System?

All-On-Four is a technique that allows a fixed prosthesis to be placed in an edentulous jaw by placing just four implants . Posterior implants are placed at a 30–45-degree angle, avoiding the sinus cavities and nerve areas. This reduces the need for additional surgery (sinus lift or bone graft).

• Advantage: Reduces costs with fewer implants and, in most cases, a fixed temporary prosthesis can be placed on the same day.

• Suitable patients: Ideal for individuals with limited bone volume, stable systemic conditions, and aesthetic/functional prosthesis expectations.

What is the All-On-Six System?

All-On-Six works on a similar principle, but involves placing six implants in the jawbone to create a fixed prosthesis . More implants provide a larger support area for the prosthesis and optimize load distribution.

• Advantage: It creates a more solid structure in the long term and is especially preferred in patients with high chewing strength.

• Suitable patients: Recommended for individuals with sufficient bone volume who desire longevity and maximum durability.

Who is it suitable for?

Both systems are generally preferred in the following situations:

• Individuals who have lost all their teeth in their lower and/or upper jaw

• Those who do not want or cannot use removable prosthesis

• Those who are older and looking for a shorter and more comfortable treatment process

• Patients whose systemic health is suitable for implants (diabetes under control, adequate bone health, etc.)

Additionally, factors such as smoking, bone density, oral hygiene, and overall health also play a significant role in system selection. Therefore, the suitability of either method can only be determined after a detailed examination by a qualified dentist.

How Does the Treatment Process Work? Stages and Durations

All-On-Four and All-On-Six treatments are multi-step processes that require disciplined planning, surgical precision, and aesthetic expertise. With a well-managed treatment plan, patients can receive their permanent temporary teeth the same day. This is one of the reasons these systems are so popular.

Inspection and Planning Phase

Everything begins with a detailed examination and imaging. At this stage:

• Jaw bone structure and volume are analyzed with panoramic x-ray and CBCT (dental tomography) .

• The physician evaluates bone thickness, the location of the sinuses, and nerve pathways.

• The closure of the teeth, aesthetic needs and jaw relationship are examined in detail.

• The treatment plan is tailored to the individual: Is All-On-Four or All-On-Six more suitable?

Surgical Stage

Surgery is performed under local anesthesia, with sedation if necessary. Four or six implants are placed in the jawbone. Posterior implants are usually placed at an angle (in All-On-Four) to bypass anatomical obstructions such as the sinus cavity.

• Processing time: It usually takes 1–2 hours.

• Same-day temporary prosthesis: If the patient’s bone is suitable, a temporary fixed prosthesis can be placed on the same day (immediate loading).

• Pain and swelling: Minimal and can usually be controlled with prescription painkillers.

Healing Process and Permanent Prosthesis Application

The healing process typically lasts between three and six months . During this period, the implants fuse with the bone (osseointegration). A temporary prosthesis is used during this period, ensuring aesthetic and functional recovery.

Once healing is complete:

• A permanent fixed prosthesis (usually zirconium or porcelain-supported acrylic) is designed and secured by screwing it onto the implants.

• Final checks are made and the patient has his permanent new smile.

Things to Consider During the Process

• During the recovery period , smoking should be avoided and soft nutrition recommendations should be followed.

• Oral hygiene must be maintained meticulously.

• Check-ups should not be neglected , and cleanings under the dentures should be done at the times recommended by the physician.

All-On-Four and All-On-Six treatment processes are highly successful, comfortable and quickly completed implant solutions with good teamwork and patient cooperation.

Differences Between All-On-Four and All-On-Six

The All-On-Four and All-On-Six systems are two innovative implant approaches developed to provide fixed prosthetics for edentulous jaws. Both offer fixed, aesthetic, and functional solutions. However, they differ in several ways, particularly the number of implants. Understanding these differences is crucial when making treatment choices.

Number of Implants and Placement Angle

• All-On-Four: As the name suggests, the fixed prosthesis is placed on four implants. The posterior implants are placed at an angle of approximately 30–45 degrees to bypass anatomical obstacles such as the sinus cavity or nerve line.

• All-On-Six: Six implants are placed to create a larger support surface. All implants are positioned in the traditional way, usually at a right angle to the jawbone.

More implants provide a wider load distribution, meaning less stress and fewer complications in the long run.

Durability and Longevity

• All-On-Four: The load placed on four implants can sometimes create greater stress. However, with quality materials and proper planning, they can last for many years.

• All-On-Six: Two additional implants distribute the load more evenly. It’s especially preferred for patients with high chewing strength. It creates a more durable structure in the long term.

Aesthetic and Functional Differences

• All-On-Four: Because fewer implants are used, the design may be more limited. If there is a lack of support in the posterior regions, the extension of the prosthesis may increase.

• All-On-Six: Provides aesthetically more natural and functionally stronger results. Chewing pressure is distributed more evenly.

Cost and Surgical Requirements

• All-On-Four: Fewer implants means lower costs. Patients with bone deficiency generally do not require additional surgery.

• All-On-Six: Costs increase because it requires more implants and more advanced laboratory processes. However, the likelihood of long-term revisions is low.

Which One Is More Suitable For Whom?

Criterion	All-On-Four	All-Ten-Six
Bone density	Low – Medium	Medium – High
Budget	More economical	More costly
Function requirement	Normal level	For individuals with high chewing power
Aesthetic priority	Sufficient	More natural and stable results
Age/General health status	Those looking for a solution in a shorter time	Those who make long-term plans

Advantages, Disadvantages, and Patient Experience

All-On-Four and All-On-Six systems offer much more comfortable, aesthetically pleasing, and durable solutions for edentulous jaws than traditional dentures. However, as with any treatment method, these systems have their own advantages and limitations. Real-life patient experiences also provide invaluable insights into the practical impact of these systems.

Advantages

Common advantages of All-On-Four and All-On-Six systems:

•  Fast solution: The procedure can be completed with a fixed temporary prosthesis on the same day.

•  Surgical simplicity: Additional procedures such as sinus lift or bone grafting may not be necessary.

•  High aesthetics: Self-confidence gain with natural-looking fixed teeth, especially in the front area.

•  Comfort: Problems such as dislocation, movement or speech difficulties in removable prostheses are eliminated.

•  Long life: With quality materials and good maintenance, it offers a lifespan of 15–20 years or more.

•  Fewer implants, more efficiency: All-On-Four is especially a lifesaver for patients with limited bone volume.

Disadvantages and Things to Consider

 Cost: More expensive than traditional dentures. All-On-Six is more expensive.

 Need for sensitive care: Fixed dentures must be cleaned regularly to avoid damaging the tissues underneath.

 Smoking and systemic diseases: May negatively affect the success of the implant.

 Expected bone volume: May not be suitable for every patient. Adequate bone structure or support is required.

 Prosthesis revisions: The prosthesis may break or bone loss may develop around the implant over time.

Which System Is Right for You? Expert Opinions and Selection Criteria

Choosing between the All-On-Four and All-On-Six systems requires much more than just a cost comparison. Each of these two systems is optimized for different patient profiles, jaw structures, and expectations. Therefore, the best decision can only be made through a detailed evaluation, expert guidance, and a personalized needs assessment.

How is a Physician Evaluation Done?

Before starting treatment, a detailed examination by a periodontist, oral surgeon, or implantologist forms the basis of the treatment plan. During this process:

• Radiological analysis (CBCT tomography): Bone height, thickness and density are measured.

• Systemic health status is evaluated: Risk factors such as diabetes, osteoporosis, and smoking are taken into account.

• Aesthetic expectations and functional needs are analyzed.

• Decision on the type of prosthesis (fixed/porcelain/acrylic): Determined according to the patient’s preferences and jaw structure.

While doctors often recommend the All-On-Six system for individuals who have high chewing strength, have lost teeth at a young age, or want a longer-term solution, they prefer the All-On-Four system for patients who are older, looking for an economical solution, or have limited bone volume.

System Selection Based on Personal Needs

Evaluation Criteria	All-On-Four Choice	All-On-Six Choice
If bone volume is low
More economical solution
High chewing power
Long-term durability
Same day fixed teeth	(in appropriate cases)	(more controlled)
Aesthetic priority

Conclusion

All-On-Four and All-On-Six implant systems offer revolutionary solutions, both aesthetically and functionally, for individuals experiencing edentulousness. Instead of the limited comfort offered by traditional removable dentures, it’s now possible to achieve fixed, natural-looking, and long-lasting teeth.

The All-On-Four method offers a more economical and faster treatment with fewer implants, while the All-On-Six method provides more support and a more durable and stable structure in the long term. Both systems can allow for the placement of fixed temporary teeth on the same day, but ultimate success is closely linked to the patient’s bone structure, overall health, and the dentist’s expertise.

In this article, we’ve detailed the differences, advantages, treatment processes, and expert opinions of both systems, starting with their definitions. Now, all that remains is to determine the most appropriate method for you and take the first step by consulting a specialist.

Remember: A healthy smile isn’t just about aesthetics; it’s also key to your quality of life.
And this key is now within your grasp with the All-On-Four and All-On-Six systems offered by advanced implant technologies!