All-on-4 vs All-on-6: Which Full Mouth Implant Is Best for You?

Short answer: All-on-4 is often preferred for limited posterior bone because of angled implants.

• How it works: Angled implants use denser anterior bone and avoid sinus/nerves.
• When All-on-6 helps: If premolar bone is adequate, All-on-6 gives extra support — otherwise grafting is needed.
• Patient step: CBCT identifies usable bone so we choose the correct plan.

Short answer: All-on-4 uses four anchors (often 2 angled); All-on-6 uses six mostly axial anchors.

• All-on-4: 4 implants — posterior tilted to use existing bone.
• All-on-6: 6 implants — added premolar anchors improve load distribution.
• Design tradeoff: More anchors = less stress per implant, but only if bone is present.

Short answer: Angled posterior implants (All-on-4) avoid critical anatomy; straight implants (All-on-6) add support if bone permits.

• Angled: 30–45° tilt to reach denser bone and avoid sinuses/nerves.
• Straight: Axial placement in premolar area gives direct vertical support.
• Surgical note: Planning software and guides improve accuracy for both strategies.

Short answer: All-on-6 reduces peak implant stress compared to four implants in models and lab studies.

• Quantified: Finite element studies often show ~20–30% lower peak stress per implant with six supports.
• Clinical meaning: Useful for bruxism/heavy-chewers when bone quality is good.

Short answer: Yes — All-on-6 requires sufficient premolar bone; missing bone drives grafting or sinus lift.

• Implication: Grafting adds cost, time (3–6 months healing) and some surgical intervention.
• Strategy: If grafting is extensive, All-on-4 may avoid extra surgery and shorten timeline.

Short answer: Similar invasiveness; All-on-6 can be slightly more invasive due to extra sites or grafts.

• Surgical time: All-on-6 might add 15–30 minutes for extra implants.
• Guided surgery: Reduces invasiveness and improves placement accuracy for both.

Short answer: Recovery is comparable; All-on-6 may give slightly more swelling for a couple days.

• Healing: Osseointegration ~3–6 months for both.
• Immediate function: Temporary teeth same day; soft diet recommended during early healing.
• Aftercare: Pain control, antibiotics if needed, and follow-ups are standard.

Short answer: All-on-4 ~1.5–2 hours/arch with guides; All-on-6 adds roughly 15–30 minutes for extra implants.

• Guide vs freehand: Guided surgery shortens time and increases precision.
• Single vs both arches: If both jaws treated same day, total theatre time increases accordingly.

Short answer: Possible but not ideal — it requires extra surgery and prosthetic changes.

• Tradeoffs: Additional cost, healing time and potential prosthesis remakes.
• Best practice: Plan with CBCT to avoid later changes when possible.

Short answer: Yes — temporary fixed teeth are commonly delivered the same day for both techniques.

• Temporary prosthesis: Designed to protect implants and provide function until final prosthesis.
• Final teeth: Delivered after osseointegration (3–6 months) and occlusion checks.

Short answer: Yes — dentist removes the prosthesis for repair; most repairs are quick in-clinic jobs.

• Typical time: 1–2 hours for screw/porcelain repairs.
• Emergency: We can often repair same day to restore function.

Short answer: All-on-6 usually costs more due to two extra implants; exact price depends on brand and graft needs.

• Indicative ranges: All-on-4 ~₹2.5–4.0L per jaw; All-on-6 ~₹3.5–5.5L per jaw (varies by implant system & clinic).
• Grafting: Adds ₹50k–2L+ depending on material and extent; budget for contingencies.
• Value advice: Consider long-term value and maintenance, not only front-end cost.

Short answer: Value is case-dependent: All-on-4 is better if it avoids grafting; All-on-6 can be better when bone and bite demand it.

• ROI view: Avoiding future complications and re-treatment gives best return, even if initial price is higher.
• Ask: Request a staged cost breakdown: implants, prosthesis, grafts, follow-ups, and warranty terms.

Short answer: Yes — grafting increases cost and treatment time significantly.

• Costs: Autograft/allograft/xenograft options affect price; minor grafts are cheaper than large sinus lifts.
• Time: Grafting often adds 3–6 months before final implants/prosthesis.
• Tradeoff: Sometimes All-on-4 avoids grafting — discuss both clinical and financial tradeoffs with your surgeon.

Short answer: All-on-6 offers more redundancy; All-on-4 loses 25% support if one implant fails and may destabilize the prosthesis.

• All-on-4: Failure often requires removing prosthesis, replacing implant and reloading — downtime and cost result.
• All-on-6: Prosthesis often remains stable while the failed implant is managed, reducing urgent rework.
• Prevention: Good hygiene, smoking cessation and regular checkups lower failure risk.

Short answer: All-on-6 reduces peak loads and can lower fracture risk, but good design is essential.

• Design factors: Material quality, reinforcement, and occlusal scheme are as important as implant count.
• Clinical tip: Use reinforced frameworks and balanced occlusion to protect the prosthesis.

Short answer: Both have high long-term success when matched to the patient and executed well.

• Reported outcomes: Modern literature shows 10-year survival commonly in the mid-90% range for both techniques.
• Main predictors: Case selection, surgical execution, implant brand, prosthetic design and maintenance.

Short answer: Yes — controlled diabetes is compatible with implants; each case must be assessed individually.

• Medical requirement: Good glycemic control (HbA1c target discussed with surgeon) reduces complications.
• Surgical choice: All-on-4 may be preferred by some clinicians for shorter surgical time (may not always be true).
• Close follow-up: Essential to detect infection or delayed healing early.

Short answer: Slightly — more posts mean more areas to clean, but correct tools make both manageable.

• Tools: Water flosser, interdental brushes, and special floss techniques are essential.
• Time: All-on-6 may require extra minutes daily but prevents long-term peri-implantitis when done correctly.
• Clinical support: Routine professional cleanings every 3–6 months recommended.

Short answer: Yes, food can trap under both; hygiene and prosthesis design reduce this risk.

• Hygiene gap: Properly shaped prosthesis with a hygiene gap allows effective flushing.
• Daily routine: Rinse after meals and use a water flosser to remove debris.
• Maintenance: Periodic relines or adjustments help keep the fit optimal.

Short answer: Every 3–6 months is recommended, more often if gum issues exist.

• Standard plan: 3–6 month checkups to monitor peri-implant health.
• High risk: Smokers, diabetics or history of peri-implantitis may need 3-monthly visits.
• What we do: Professional cleaning, soft tissue checks and X-ray when indicated.

Short answer: A CBCT scan and bite analysis determine the best option.

• Step 1: CBCT to map bone volume and anatomy.
• Step 2: Bite force/bruxism assessment and medical review.
• Step 3: Surgeon explains pros/cons with costs and timeline for each plan.

Short answer: All-on-6 tends to be preferred for high bite forces if bone allows it.

• Reason: Extra implants reduce load per anchor, lowering mechanical risk.
• Alternative: All-on-4 with reinforced prosthesis and night guard may still be adequate.

Short answer: Long arches often benefit from All-on-6 to reduce cantilever forces.

• Reason: Longer spans risk cantilever loading unless posterior support is provided.
• Plan: CT and prosthetic planning determine safe tooth counts and cantilever limits.

Short answer: Both preserve bone by loading it functionally; correct occlusion and hygiene are key.

• Principle: Functional loading prevents bone resorption better than leaving an edentulous ridge.
• Implant count: Six implants may distribute load more evenly, but hygiene and occlusion control are decisive.

Short answer: Possible but not preferred — it needs extra surgery and prosthetic work.

• Costs & healing: Additional implants add price and healing time; prosthesis may need modification.
• Best approach: Plan once using CBCT so you avoid later changes when possible.

Short answer: All-on-4 can be easier for older patients due to shorter surgery and simpler daily care.

• Benefit: Fewer posts to clean and often no grafting reduces visits and surgical stress.
• Consider: Manual dexterity, caregiver support and systemic health when choosing the plan.