Dental implants offer a fixed, permanent alternative to traditional removable dentures for individuals who have lost most or all teeth in a dental arch. The All-on-6 procedure is an advanced method designed for full arch rehabilitation. It utilizes six precisely placed titanium anchors to secure an entire row of prosthetic teeth, providing a stable foundation in the jawbone. This efficient approach restores function and aesthetics with a minimal number of fixtures.
Defining the All on 6 System
The core concept of the All-on-6 system involves securing a full prosthetic bridge, which contains a complete set of replacement teeth, onto six individual titanium implant fixtures. Each fixture is a biocompatible post surgically placed into the jawbone, acting as an artificial tooth root. This design creates a fixed, non-removable solution that mimics the stability and feel of natural teeth.
The strategic placement of the six implants is a defining characteristic of the system. Two implants are typically positioned vertically in the anterior (front) region where bone density is naturally higher. The remaining four implants are strategically placed in the posterior (back) regions of the jaw.
To maximize contact with existing bone and often avoid extensive bone grafting, the posterior implants are frequently placed at an angle, sometimes up to 45 degrees. This angulation allows the surgeon to anchor the implants into denser bone structures toward the front of the jaw, even in cases where significant bone loss has occurred further back.
The mechanical stability achieved immediately upon placement is often sufficient to support a temporary set of teeth. This immediate loading capability is often referred to as “Teeth in a Day,” allowing patients to walk out of the surgical appointment with a functional, albeit temporary, full arch of teeth. The six anchor points evenly distribute the forces of chewing across the jaw, promoting the long-term health of the surrounding bone structure.
The Surgical Procedure and Timeline
The process begins with an initial consultation and comprehensive diagnostic imaging. Three-dimensional cone-beam CT scans are performed to provide the surgical team with a detailed view of the jawbone structure, nerve pathways, and sinus cavities. This imaging allows for meticulous treatment planning, ensuring the precise location and angulation for all six implants are mapped digitally beforehand.
On the day of surgery, any remaining non-restorable teeth are extracted, and the six titanium implants are precisely inserted into the predetermined locations. The entire surgical process for one arch generally takes between two to four hours, depending on the complexity of the case. The patient is typically under local anesthesia with conscious sedation to ensure comfort throughout the procedure.
After placement, abutments are attached to the posts to serve as connectors for the prosthetic arch. A temporary bridge is then secured to these abutments, completing the immediate function phase. This temporary set provides a fixed smile and limited chewing function while biological healing begins.
The most time-intensive phase is osseointegration, the biological process where the titanium fixtures fuse directly with the living jawbone. This fusion provides the implants with their long-term, permanent stability. Osseointegration typically requires a healing period of three to six months. During this healing phase, the patient must adhere to a strict soft-food diet to prevent excessive force from disrupting the fusion process.
Once osseointegration is complete and the implants are fully stable, the final stage begins. Impressions are taken to fabricate the final, custom-designed, permanent prosthetic bridge, which is then securely fastened to the implants.
Key Differences from All on 4
The primary distinction between the All-on-6 and the All-on-4 system is the number of implants and the resulting distribution of mechanical forces. The All-on-6 uses two additional posterior implants per arch, providing a greater margin of support and stability for the prosthetic bridge.
These extra implants allow for a more balanced distribution of chewing pressure across the entire arch. This improved force distribution reduces mechanical stress on any single implant, benefiting patients with stronger bite forces or wider arches.
The All-on-6 approach is often favored for patients who have more robust bone volume in the posterior jaw regions. The presence of six fixtures provides increased stimulation to the jawbone tissue, which helps mitigate the natural bone atrophy that occurs when teeth are missing.
The four-implant protocol is often used for patients with significant bone loss, as its highly angled implants anchor into the densest available bone. Conversely, the six-implant design is often preferred for the upper jaw, where bone quality can be less dense than the lower jaw, making the extra anchors valuable for security. The choice depends on the patient’s anatomical structure, bone density, and the surgeon’s assessment of stability requirements.
Post-Procedure Care and Longevity
Long-term success depends heavily on meticulous post-procedure care and hygiene. Since the prosthetic bridge is fixed, the cleaning regimen must focus on maintaining the health of the gum tissue and the area beneath the restoration. The primary goal is preventing plaque and bacteria accumulation around the implant fixtures.
Patients must use a soft-bristled toothbrush and specialized cleaning tools, such as water flossers, to irrigate the space between the bridge and the gum line. Interdental brushes or specialized implant floss are also necessary to clean the sides of the titanium posts. Maintaining this hygiene is necessary to avoid peri-implantitis, an inflammatory condition that can lead to bone loss and implant failure.
Regular professional check-ups and cleanings are required to monitor the health and integrity of the prosthetic. These appointments, typically scheduled every three to six months, allow the hygienist to clean difficult areas and check for signs of inflammation or wear.
The titanium implants themselves have a high success rate, often remaining functional for many decades, and can last a lifetime with proper care. The prosthetic bridge attached to the implants, however, is subject to wear and tear from daily function. This bridge may require maintenance or replacement approximately every 10 to 15 years, depending on the material used and the patient’s habits.