If you are facing full-arch restoration, you will run into All-on-4 and All-on-6 quickly, usually presented as competing products. They are not. They are the same technique with a different number of implants, and which one is right for you is a clinical decision made from a 3D scan. Here is what actually separates them.
What full-arch implant treatment is
Full-arch implant solutions replace an entire upper or lower set of teeth. Unlike a conventional denture, the prosthetic arch is carried by implants integrated into the jawbone — fixed, not removable.
Two things follow from that. Stability: the arch is anchored to bone rather than resting on gum tissue, so there is no slipping and no adhesive. Immediate function: with appropriate case selection, a fixed provisional arch can be fitted the same day as surgery, so you leave with teeth.
To be precise about that last point: what is fitted on the day is a fixed provisional. Your definitive prosthesis is made and placed after the implants have integrated, over the following months.
All-on-4: the original approach
The All-on-4 concept established that a complete arch could be carried on four strategically placed implants. It has decades of clinical use and research behind it.
How the placement works: two implants placed vertically at the front, two placed at the back angled up to around 45 degrees. Angling the posterior implants lets them engage denser bone further forward, which is what allows the technique to work in jaws where vertical placement at the back would not be possible.
What that buys you: fewer implants, often no need for extensive bone grafting, shorter surgery, and a lower cost than approaches using more implants.
Wide candidacy. The angled design means many patients with limited bone volume can be treated who would not qualify for a conventional approach.
All-on-6: more support points
All-on-6 adds two implants, typically in the premolar regions.
Force distribution. Six support points rather than four spread chewing forces more widely, which reduces the load any individual implant carries.
Redundancy. If one implant were to encounter a problem, five remain to support the prosthesis.
Prosthetic design. More support points can give the laboratory more freedom in designing the arch, including gum contours and how the teeth emerge.
The trade-off is that it requires adequate bone in more locations, and the surgery is longer.
Side by side
| All-on-4 | All-on-6 | |
|---|---|---|
| Implants per arch | Four | Six |
| Surgery time | Shorter | Longer |
| Healing to final restoration | Three to six months | Three to six months |
| Bone requirements | More flexible | Needs adequate bone in more sites |
| Force distribution | Good | Spread across more support points |
| Relative cost | Lower | Higher |
Which one is likely to suit you
All-on-4 may be the better answer if budget is a primary constraint, your bone volume is limited, you want to minimize surgical time, or your functional demands are moderate.
All-on-6 may be the better answer if you have adequate bone volume, maximum stability is your priority, you have high bite forces or a grinding habit, or you are optimizing for the longest-term result.
But note the framing. These are indications, not a decision. Both approaches produce excellent results in the right case and disappointing ones in the wrong case. The determining inputs are your anatomy and your bite, which come from an examination and a CBCT scan — and sometimes the answer is a hybrid that is neither four nor six.
The treatment process
Phase 1 — planning. 3D CBCT imaging, digital smile design and prosthetic planning, fabrication of the surgical guide, preparation of the provisional arch.
Phase 2 — surgery and immediate loading. Any necessary extractions, implants placed according to the digital plan, and the fixed provisional attached where appropriate. You leave with teeth.
Phase 3 — healing and integration. Three to six months. Regular follow-ups, a soft diet initially, careful hygiene, and planning of the final prosthesis.
Phase 4 — final restoration. Digital scans or impressions, fabrication of the definitive prosthesis, fitting and adjustment, and maintenance instructions.
What determines long-term success
On your side: consistent oral hygiene, keeping professional maintenance appointments, not smoking, and following post-operative instructions during healing.
On ours: accurate planning, a surgical guide that reflects it, quality components, and ongoing monitoring rather than discharge after the final fit.
Both matter. Neither compensates for the other.
Start at the full-arch treatment page for how this runs at our Canandaigua office.