If you're researching full-arch implants, you've probably seen both terms: All-on-4 and All-on-6. They're similar procedures with one obvious difference, the number of implants used to anchor the full-arch prosthesis.
So which is right for your case? The honest answer: it depends on your bone density, your bite forces, and the surgeon's assessment of your specific anatomy. Here's how to think about the choice.
What both procedures have in common
Both procedures replace an entire arch of teeth (upper or lower) with a permanent fixed prosthesis anchored to dental implants. Both are typically performed:
- Under full general anesthesia at our surgical center
- With same-day temporary teeth (immediate-load)
- Using Neodent (Straumann) implants
- With computer-guided surgery and 3D planning
- In a single surgical visit, with permanent prosthesis delivered 3–6 months later
The procedures look almost identical to the patient. The difference is structural, not experiential.
All-on-4: Four implants, strategic placement
The All-on-4 technique was pioneered by Nobel Biocare in the 1990s. Two implants placed straight (vertical) at the front of the arch, two more placed at angled (tilted) positions at the back. The angled placement allows the back implants to anchor in denser bone areas without hitting the sinus or nerve,
Why four works: The full-arch prosthesis distributes chewing forces across all four implants. Decades of clinical data show 95%+ long-term success rates with four implants for the average patient.
When All-on-4 is preferred:
- Average bone density (most patients)
- Standard bite forces
- Cost-conscious patients (fewer implants = lower price)
- Patients with reduced bone where placing more implants risks complications
All-on-6: Six implants, more distributed support
All-on-6 uses six implants instead of four, distributed across the arch. The additional two implants provide more anchor points and distribute chewing forces over a larger area.
Why six works better in some cases: More implants = more stability, especially for patients with strong bite forces or specific anatomical considerations.
When All-on-6 is preferred:
- Higher bone density (can support more implants without compromise)
- Heavy chewers, bruxism (teeth grinding), or strong bite forces
- Patients who want maximum long-term redundancy (if one implant has issues, five remain)
- Specific anatomical situations where four-implant placement is suboptimal
Side-by-side
| All-on-4 | All-on-6 | |
|---|---|---|
| Implants | 4 | 6 |
| Surgical complexity | Standard | Slightly more complex |
| Same-day teeth? | Yes | Yes |
| Long-term success | 95%+ at 10 years | 96%+ at 10 years |
| Force distribution | Adequate for average bite | Better for strong bite |
| Bone requirement | Works with reduced bone | Needs more bone for placement |
| Cost (Apex) | $12,500/arch | Custom quote (typically higher) |
| Recovery | Same | Same |
| Final prosthesis | Identical | Identical |
The practical reality
For 80% of full-arch implant patients, All-on-4 is the right answer. It provides excellent long-term stability, costs less, and is supported by 30+ years of clinical research. We don't recommend All-on-6 over All-on-4 just to charge more, we only recommend it when there's a specific clinical reason,
Reasons we might recommend All-on-6 specifically:
- Heavy bruxism (teeth grinding). The additional implants better distribute the unusual forces from grinding.
- Strong bite forces. Some patients (often men with naturally large jaw muscles) generate significantly more force than average. Six implants handle this better.
- Excellent bone density that supports it. If your bone is dense and there's room for additional implants without compromising sinus or nerve safety, six provides more redundancy,
- Specific anatomical reasons. Sometimes the geometry of your jaw favors six implants over four, usually identifiable from the 3D CT scan.
What about All-on-8 or more?
Some clinics market All-on-8 or even All-on-10 procedures. The clinical evidence supporting more than 6 implants per arch is thin, additional implants beyond 6 don't materially improve outcomes for most patients. We don't routinely place more than 6 per arch except in very specific situations.
Don't pay for implants you don't need
This is the conversation that matters. Some clinics default to All-on-6 for every patient because the higher implant count means higher revenue. We default to All-on-4 because it's the right answer for the average patient, and we only step up to 6 when there's a clinical case for it.
If a clinic recommends All-on-6 to you, ask:
- Why specifically, what about my bone density or bite forces makes 6 better than 4?
- What's the cost difference?
- Is the additional cost justified by the marginal stability improvement?
A confident, specific answer suggests honest recommendation. A vague “more is better” suggests revenue motivation.
At your free consultation, the 3D CT scan tells us definitively whether All-on-4 is sufficient for your case or whether stepping up to All-on-6 makes sense. We give you the recommendation and the reason, and the cost difference if applicable.
Schedule your free consultation: (916) 886-1806 or read more about our All-on-4 procedure.