All-on-4 or All-on-6: choosing a full-arch implant bridge

A full-arch implant bridge is a fixed set of teeth for the upper or lower jaw, screwed onto implants rather than resting on the gums like a denture. It does not come out at night. 'All-on-4' and 'All-on-6' describe how many implants support it: four or six.

Neither is automatically better. The right number is decided by the scan, not by the name of the technique.

How All-on-4 works

Four implants are placed in the jaw, usually with the back two angled. Angling lets longer implants use the denser bone further forward, which can avoid bone grafting in some people who have lost bone at the back of the mouth.

It suits many people with reduced bone volume who want a fixed result without a long grafting phase first.

How All-on-6 works

Six implants spread the load across more supports. Where there is enough bone, the extra implants add redundancy — if one ever has a problem, the bridge may still be supported — and can help with heavier bites or the upper jaw, where bone is often softer.

What decides between them

• How much bone you have, and where — shown on a 3D (CBCT) scan
• Upper or lower jaw: upper bone is usually less dense
• Grinding, clenching or a strong bite
• Gum health and any remaining teeth that need to come out
• General health, smoking and diabetes control
• Your priorities: fewest procedures, or maximum support

The usual stages

• Consultation, examination and 3D scan
• Written plan with options, risks, alternatives and the full fee
• Removal of any failing teeth and implant placement
• A provisional fixed bridge, often fitted soon after placement where the implants are stable enough
• A few months of healing while the implants bond with the bone
• The definitive bridge, then regular hygiene and review visits

Alternatives worth weighing

Implant-retained dentures clip onto two to four implants and come out for cleaning; they cost less and are easier to maintain for some people. Conventional dentures need no surgery. For people with some healthy teeth left, smaller implant bridges may be enough. A good consultation compares these honestly, including doing nothing for now.

Risks

As with any implant surgery there is a risk of swelling, bruising, infection, nerve or sinus involvement and, occasionally, an implant that does not integrate. Long-term success depends heavily on cleaning around the bridge and attending maintenance visits.

Full-arch implants in Twickenham

Dr Sundeep Solanki plans full-arch cases from a 3D scan and sets out every option in writing before anything is agreed. Patients come to 2 London Road, Twickenham TW1 3RY from across Richmond, Teddington, Hampton, Kingston and Hounslow.