All-on-4, all-on-6, or full-mouth implants — the full-arch decision.
Whether four implants, six, or a full set is right for you is a bone-and-bite decision a surgeon makes from a CT scan — not a package tier. Here is how the choice is reasoned, and what the long-term data actually says.
All-on-4 rehabilitates a full arch on four implants — two straight at the front, two angled at the back to engage available bone and avoid the sinus or nerve. All-on-6 adds two for more support in specific bone situations. Neither is automatically better; the number is dictated by your bone volume, bite force, and arch, read from a CBCT scan.
The long-term evidence is genuinely strong: a 10-to-18-year cohort reports high implant and prosthesis survival for the All-on-4 concept (Maló 2019), and systematic reviews confirm the protocol across studies (Soto-Penaloza 2017). This is a mature, evidence-backed technique — when it is planned and maintained properly.
The honest counterweight is peri-implantitis: a population-level study found it affects a meaningful minority of implant patients over time (Derks 2016). The variable that controls it is not the brand of implant — it is surgical planning, bite design, and lifelong maintenance. That is the conversation a serious clinic has with you before the scan, not after.
Why the number of implants is a scan decision, not a tier.
All-on-4, all-on-6, and individual implants are sometimes presented as ascending product tiers. They are not. The number of implants needed to carry a full arch is determined by how much bone you have, where it is, your bite force, and which arch (the upper jaw is softer and often asks for more support than the lower). That is read from a cone-beam CT scan, not chosen from a menu.
All-on-4 works because of geometry: two implants placed straight at the front, two angled posteriorly to engage denser bone and bypass the sinus (upper) or the inferior alveolar nerve (lower). That angulation is what lets four implants carry a fixed arch without bone grafting in many cases — and it is precisely why the planning, not the part count, is the skilled step.
All-on-4, all-on-6, individual implants — when each applies.
All-on-4 suits most fully edentulous or soon-to-be-edentulous arches with adequate anterior bone. All-on-6 is indicated when the bone or the bite calls for more distributed support — heavier occlusal load, certain upper-jaw cases, or where the extra implants reduce cantilever stress. The choice is biomechanical, and a surgeon should be able to show you on the scan why yours was selected.
Individual implants (one tooth, one implant) are a different problem entirely — they are for replacing specific missing teeth in an otherwise sound arch, not for rehabilitating a whole jaw. And where a tooth still has a sound root, the comparison is implant versus crown: a crown restores a tooth you keep; an implant replaces one you have lost. They are not interchangeable, and a clinic that pushes extraction-and-implant where a crown would serve is over-treating.
| What it does | Indicated when | |
|---|---|---|
| All-on-4 | Fixed full arch on 4 implants | Edentulous arch, adequate anterior bone |
| All-on-6 | Fixed full arch on 6 implants | Heavier bite / softer bone / upper-jaw load |
| Individual implants | Replace specific missing teeth | Otherwise sound arch, isolated gaps |
| Crown (not an implant) | Restores a tooth you still have | Sound root present — don't extract to implant |
What the long-term survival data actually shows.
Full-arch implant rehabilitation is one of the better-documented procedures in dentistry. A longitudinal study of the All-on-4 concept with 10 to 18 years of follow-up reports high cumulative implant and prosthesis survival (Maló 2019), and a systematic review of the protocol confirms the pattern across independent studies (Soto-Penaloza 2017). A consensus statement sets out the surgical and prosthetic protocols and where the complications cluster (Peñarrocha-Diago 2017).
Immediate loading — leaving the clinic with a fixed provisional arch on the same day the implants are placed — is also evidence-backed when the implants achieve sufficient primary stability, supported by Cochrane-level review (Esposito 2013). That is what makes a same-day fixed-arch outcome legitimate rather than a marketing claim: it is contingent on the bone, and the surgeon decides on the day whether the stability supports it.
Peri-implantitis — the risk that is rarely mentioned.
The complication that matters over the long run is peri-implantitis: inflammation and progressive bone loss around an implant, the implant-equivalent of gum disease. A study of a Swedish population found it affects a meaningful minority of implant patients over time (Derks 2016), and the 2017 World Workshop consensus defined how it is classified and managed (Berglundh 2018).
What controls it is not the implant brand or the country it was placed in — it is the quality of the surgical placement, the design of the bite, the cleanability of the prosthesis, and lifelong maintenance. This is the question to ask a full-arch clinic that most do not volunteer: how is my prosthesis designed to be cleaned, and what is the maintenance schedule? A clinic that has an answer is planning for year ten, not just for the photograph at week one.
Be wary of a clinic that quotes a number of implants before it has taken a CBCT scan, or that treats all-on-6 as a paid upgrade rather than a clinical indication. The implant count is an output of your anatomy. If it is presented as a price tier, you are being sold a package, not planned a treatment.
How the full-arch plan is built at Hektor.
Every full-arch case at Hektor is planned by a prosthodontist from a CBCT scan: the implant number and positions are derived from your bone and bite, and the reason for the choice — four or six, immediate load or staged — is explained to you with the scan in front of you. Where primary stability supports it, a fixed provisional arch is placed the same day; where it does not, we stage it and say so.
The plan includes what most full-arch marketing omits: a cleanable prosthesis design and a written maintenance schedule, because the long-term survival the literature reports is conditional on maintenance. The number of implants is never an upsell tier here — it is a finding.