Tooth loss is not merely an 'empty space.' Edentulism is considered the final stage of oral health and has serious effects, particularly in the elderly population. After teeth are extracted, the jawbone begins to rapidly resorb because it is no longer stimulated by chewing forces. This is where All-on-6 treatment comes in: it not only replaces missing teeth but also preserves bone structure and restores facial aesthetics.

In this comprehensive article prepared by Dento Dream, we will explain what All-on-6 treatment is, how it is applied, and other details.

What is All-on-6?

All-on-6 is a procedure in which six dental implants are placed in the jawbone and a fixed prosthesis is mounted on top for patients who are completely edentulous or whose existing teeth are in an irreversible state of poor health (terminal dentition).

This concept is based on the principle that these six strategically placed implants create a strong and secure foundation to support the entire dental arch. Once the implants are placed, the patient can chew and speak as if they had their own natural teeth.

Why 6 Implants Instead of 4?

• Support and stability: All-on-6 distributes chewing forces over a wider area of bone because more implants are used.
• Upper jaw difference: The upper jaw (maxilla) has lower bone density than the lower jaw. Therefore, 6 implants are generally preferred in upper jaw restorations to reduce biomechanical stress.
• Biomechanical advantage: Studies show that 6-implant systems reduce the load per implant compared to 4-implant systems and offer higher success rates, especially in areas with bone resorption.

Where Does Technology Fit into All-on-6?

Modern All-on-6 treatment is entirely technology-focused.

• CAD/CAM: Computer-aided design and manufacturing enable prostheses to be prepared with micron-level precision.
• Photogrammetry: This method digitally captures the position of implants in the mouth, eliminating measurement errors and ensuring a passive fit for the prosthesis.
• Guided surgery: Ensures that implants are placed according to digital planning rather than freehand, reducing surgical risks.

What is the Difference Between All-on-4 and All-on-6?

The main distinction is how many implants are used. All-on-4 involves four implants, which are usually put in at an angle to stay away from areas with low bone density. All-on-6 uses two extra implants, which gives it more support and spreads the force better. Your dentist will decide which one is better for you based on the shape of your bones.

Who Would Be a Good Fit for All-on-6?

• Those who have lost all of their teeth in the upper and/or lower jaw.
• People whose teeth are so badly damaged or rotten that they can't be fixed and need to be taken out.
• People who are unhappy with removable dentures that shift, cover the roof of the mouth, or make it hard to eat or speak.
• Those whose jawbone has resorbed but who don't want bone grafting.
• Those who want fixed dentures with more support than All-on-4.
• People whose overall health is good enough for surgery.

Who is Not a Suitable Candidate for All-on-6?

The following are not deemed appropriate or provide a significant risk for All-on-6 treatment:

• People whose overall health does not allow for surgery or who have issues that could make the healing process much worse.
• Diabetes (particularly Type 2), vascular problems, or a weak immune system may make osseointegration harder and raise the risk of peri-implantitis.
• Severe cardiac and vascular disorders may heighten surgical risks.
• Radiation therapy to the head or neck in the recent two years can slow down bone recovery.
• Significant jawbone resorption without suitability for bone grafting or sinus lifting.
• Grinding or clenching teeth can put extra stress on the implants.
• Inability to follow routine cleaning and care (interdental brushes, special floss, etc.) after surgery.

Why Choose All-on-6?

All-on-6 offers strong benefits over removable dentures and can be the right step up from All-on-4 when more support is needed:

Considerations After All-on-6

Disadvantages of All-on-6 Treatment

The All-on-6 treatment is effective but has some drawbacks:

• Cost: Higher than removable dentures; includes surgery, tests, materials, and follow-up.
• Skill required: The procedure needs experienced surgery and careful laboratory work.
• Bone requirement: Enough good bone (e.g. at least 10 mm thickness) is needed where implants will go.
• Severe bone loss: May require bone grafting or sinus lift, increasing cost and healing time.
• Surgical risks: As with any surgery: infection, bleeding, nerve damage, or sinus involvement.
• If the smile line is too high, minor bone trimming may be needed for aesthetics.

Step-By-Step All-on-6 Treatment Process

The treatment follows a clear path from planning to permanent teeth. Below are the main steps.

What Should Be Considered After All-on-6 Treatment?

Key points during recovery and with the permanent prosthesis:

Early Postoperative Period

Follow your dentist's instructions: take prescribed medication (e.g. corticosteroids, antibiotics, painkillers), use chlorhexidine mouthwash, and have stitches removed about two weeks after surgery.

Diet and Chewing

During osseointegration (3–6 months), eat soft meals and avoid hard foods. After the permanent prosthesis, avoid excessive chewing force to help it last.

Oral Hygiene

Use interdental brushes and super floss in addition to daily brushing. Plaque around the prosthesis can cause inflammation and implant loss.

Professional Check-Ups

For the first year, check-ups every three months; then every six months. Professional cleaning and periodic X-rays help monitor bone and osseointegration. Avoid smoking and manage bruxism.

Should I Choose All-on-4 or All-on-6?

Both are excellent for replacing missing teeth. The best choice depends on your bone condition, needs, and expectations.

Jawbone Condition

Think about All-on-4 if you have moderate bone loss; angled back implants often avoid bone grafting. Think about All-on-6 if your jawbone is in better shape or you have had bone grafting; six implants give more support.

Safety and Durability

• All-on-4: Stress on four implants is higher; mechanical stress can be worse with grinding or hard foods.
• All-on-6: Load is spread over six implants; often a safer choice for long-term durability, especially for active patients with strong chewing force.

Support and Price

All-on-4 is supported by four points and may have a slight cantilever at the back; initial cost is lower. All-on-6 gives more even support along the prosthesis; initial cost is higher (two more implants) but may be more durable and cost-effective long term.

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