What Is the All-on-6 Implant Technique and How Is It Applied?

Where there is complete tooth loss, or where all the teeth in a jaw have to be removed, there are fixed solutions as well as removable dentures. What these approaches have in common is that a certain number of implants placed in the jaw carry the entire row of teeth. All-on-6 is the member of this family that uses six implants. In this article we look at what the technique means, when it comes into consideration, its treatment stages and the healing process.

What Is All-on-6?

All-on-6 is the restoration of all the teeth in a single jaw with a fixed prosthesis built on six implants. The "all" in the name refers to the whole row of teeth and the "6" to the number of implants carrying that row. The prosthesis is not an appliance the patient can remove; it is screwed or cemented onto the implants by the dentist and stays fixed in the mouth.

The reasoning is this: a separate implant is not needed for every missing tooth. A small number of correctly positioned implants can distribute chewing forces to the jawbone through the single structure built on top of them. For general implant concepts see our implant treatment page, and for a comparison of options in complete tooth loss see our article on implant treatment in the edentulous jaw.

How Does It Differ From All-on-4?

The two techniques rest on the same principle; the difference lies in the number of implants and the planning details that follow from it. All-on-4 uses four implants, with the posterior implants placed at an angle to make use of the denser bone in front of the sinus cavity or the nerve canal in the lower jaw. All-on-6 adds two more implants, increasing the number of supporting points for the prosthesis and allowing forces to be distributed over a wider area.

This does not mean All-on-6 should be preferred in every case. Placing two additional implants requires sufficient bone volume in those regions. Where bone is reduced, either grafting comes onto the agenda or the four-implant tilted approach becomes more suitable. For a detailed comparison see our article on All-on-4 or All-on-6, and for how All-on-4 works see the All-on-4 implant technique.

Who Is It Considered For?

• People who have lost all the teeth in one jaw
• People for whom extraction of all remaining teeth is planned because of advanced damage
• Denture wearers who report movement of the denture and reduced chewing capacity
• People who want a fixed solution without palatal coverage
• People with bone volume and quality able to carry six implants

By contrast, uncontrolled systemic disease, untreated gum disease, heavy smoking and the use of certain bone metabolism medications directly affect planning. These headings do not mean treatment is ruled out; they mean timing and approach need to be reconsidered individually.

Treatment Stages

1. Assessment and Planning

Alongside clinical examination, cone beam computed tomography (CBCT) is used to examine bone height, thickness and the distance to neighbouring anatomical structures in three dimensions. Where each implant will be placed, and at what angle and length, is planned at this stage. In cases where bone is insufficient, sinus lifting and bone grafting options are also assessed here.

2. Surgical Stage

Any teeth requiring extraction are removed, bone is contoured if necessary, and six implants are placed in the planned positions. The procedure is carried out under local anaesthesia; where the dentist considers it appropriate it may also be performed with sedation.

3. Temporary Prosthesis

If the initial stability of the implants is adequate, a temporary fixed prosthesis can be fitted within a short time. During this period the prosthesis takes on aesthetic and speech function, but chewing load is kept limited and a soft diet is advised.

4. Healing (Osseointegration)

Integration of the implants with the bone is a biological process taking several months. The duration varies with bone quality, the region treated and the person's general health. Regular check-ups are carried out during this period.

5. Definitive Prosthesis

Once integration is complete, impressions are taken and the definitive prosthesis is made. Material choice (acrylic, zirconia-supported or metal-framework options) is determined by the bite relationship, aesthetic expectations and the situation in the opposing jaw.

What Should Be Considered During Healing?

• Soft and lukewarm foods are preferred in the first days; hard and sticky foods are avoided.
• Smoking is among the leading factors that adversely affect tissue healing.
• Oral hygiene continues, and the surgical site is cleaned in the way the dentist describes.
• Prescribed medication is used as directed.
• Follow-up appointments are kept — the relationship between implant and bone can only be assessed through monitoring.

For detailed advice, see our article on implant aftercare and the healing process.

Long-Term Care

A fixed prosthesis does not mean daily cleaning is unnecessary. The gum beneath the prosthesis and the area around the implants is a region open to plaque accumulation. An inflammatory process developing there can over time affect the bone surrounding the implant; this picture is called peri-implantitis and is the most important long-term risk of implant treatment. For details we recommend our article on peri-implantitis.

Daily care involves aids such as interdental brushes, special flosses and the water flosser your dentist recommends. The prosthesis may also need to be removed by the dentist at intervals so the area beneath it can be cleaned. The check-up interval is determined individually.

Two Frequently Asked Questions

Can the prosthesis be felt in the mouth? Because fixed prostheses do not cover the palate, they offer a different experience of use compared with a removable denture. Even so, a period of adjusting to a new structure is usual; speech and chewing habits can take time to settle.

Does a higher number of implants give a better result? Number alone is not decisive. The position of the implants, their distribution relative to one another, their relationship with bone and the bite fit of the prosthesis are assessed together. Four well-planned implants can give a more suitable result than six poorly positioned ones.

Summary

All-on-6 is the restoration of all the teeth in a jaw with a fixed prosthesis built on six implants. Placing six implants requires sufficient bone volume; where bone is reduced, grafting or the four-implant tilted approach comes into consideration. What determines the long-term result is not only the prosthesis itself but the health of the gum around the implants and regular monitoring.

This article is for general information. Determining the technique that suits you requires clinical examination and assessment with three-dimensional imaging.