All-on-4 / All-on-6. What the literature actually says.

All-on-4 is a full-arch fixed prosthesis supported by four implants — two anterior, two posterior, the posterior pair tilted distally to engage dense cortical bone without sinus or nerve encroachment. All-on-6 uses the same geometry with two additional anterior implants for cases where bone permits and the patient prefers the load redundancy. Both protocols deliver an immediate, fixed provisional prosthesis at surgery — the patient walks out with fixed teeth that afternoon.

The protocol exists because edentulous arches that lack posterior bone height — the typical late-stage edentulous mandible or atrophic maxilla — historically required bone-graft procedures with six-month healing windows. Tilted posterior implants engage existing bone without grafting, compressing what was a year of staged surgery into a single procedural visit plus a definitive prosthesis at three to six months.

An EFP-credentialed prosthodontist plans the case on CBCT with full-arch virtual surgical planning. The Maló protocol — established 1998, refined across 25 years of single-centre case data — specifies anterior implant positions roughly at the lateral incisor sites, posterior implants tilted 30°–45° distally with their emergence at the second-premolar position. This geometry distributes occlusal load across the full arch from only four fixtures.

Two daycase visits cover the work: day one is surgery — extractions where required, implant placement, immediate impression, fixed provisional in PMMA fitted before the patient leaves the suite. The provisional is in light occlusion (anterior contact only) for the osseointegration period to limit posterior cantilever load.

Day two — typically three to six months later — is the definitive prosthesis: scan-based design, milled titanium or zirconia framework, ceramic teeth, intaglio fit verified, screw-retained for retrievability. No intervening inpatient stay, no overnight admission.

Maló et al. (2019, Clinical Implant Dentistry and Related Research) reported the longest single-centre cohort: 471 patients followed 10–18 years, 1,884 implants in immediate function, cumulative prosthesis survival 98.8% at endpoint. Implant-level survival was lower at the implant level (because individual fixture loss did not always equal prosthesis loss — the four-implant geometry tolerates one failure without prosthesis remake in many cases).

Soto-Penaloza et al. (2017, Journal of Clinical and Experimental Dentistry) systematically reviewed the All-on-4 literature beyond the Maló group and found cumulative prosthesis survival 99.8% at three years across the included independent cohorts, with implant-level survival in the 94–99% range depending on arch and bone quality.

Marginal bone loss across the published cohorts averages 1.5–2.0 mm at five years from the initial baseline, then stabilises — consistent with the wider implant literature when the prosthesis is screw-retained and hygienically accessible. Prosthetic complications (chipping, screw loosening, fracture of the provisional) are common; biological complications (peri-implantitis, implant loss) are uncommon.

The unresolved long-term question is patient-level peri-implant disease across the 15-to-20-year horizon. The Maló cohort is single-centre with strict follow-up. Independent multi-centre cohorts at the same horizon do not yet exist at adequate sample size — the protocol was popularised globally only after 2010, and 15-year multi-centre data is still being accumulated.

The other unsettled question is whether All-on-6 meaningfully outperforms All-on-4 across the long term. The biomechanical argument for redundancy is intuitive but small published cohorts have not detected a survival difference. The decision in practice rests on bone availability and patient-specific load factors — not on a survival-rate gradient.

Full-arch rehabilitation at Hektor follows the Maló All-on-4 protocol — surgery, immediate fixed provisional, screw-retained definitive prosthesis at three months — across two daycase visits. The case is led by an EFP Member prosthodontist with an audited per-surgeon volume above 200 full-arch cases. No overnight admission, no hospital ward; the recovery happens in a daycase suite with the patient discharged the same day as surgery.

• ·Four implants (Straumann BLX or Nobel Biocare) + multi-unit abutments
• ·CBCT 3D imaging + virtual surgical planning
• ·Extractions of remaining teeth in the treated arch (where required)
• ·Immediate fixed PMMA provisional prosthesis fitted same-day
• ·Definitive screw-retained prosthesis at month 3–4 (titanium framework + ceramic teeth or monolithic zirconia)
• ·Post-op medication kit (antibiotics, chlorhexidine rinse, analgesia)
• ·Suture removal + scheduled video reviews at week 2, month 1, month 3
• ·Translator (8 languages) + airport transfers + hotel night for both visits
• ·10-year implant warranty + 5-year prosthesis warranty (subject to maintenance compliance)

Pricing is per arch. Dual-arch cases (upper + lower simultaneous) are quoted with a multi-arch package rather than 2× single-arch. UK/US/EU figures are 2025–2026 publicly published private-clinic ranges for equivalent premium implant systems and definitive prostheses, not Hektor quotes.

Our Istanbul figure includes the definitive prosthesis — many advertised low prices include only the implants and the provisional, with the definitive prosthesis invoiced separately at the second visit. We disclose the comparison transparently and do not split-quote.

Zirconia definitive prosthesis is at the upper end of the range; titanium-framework with composite teeth is at the lower end. The choice is discussed at consultation on aesthetic preference, opposing dentition, and parafunction history.

Book this procedure.

A specialist-signed plan in 24 hours, with the bibliography for your specific candidacy attached. The deposit holds the day; the package is one number.