All-on-6 Dental Implants

Tooth loss is a serious health problem that deeply affects not only masticatory function but also the social life and self-confidence of individuals. The limitations of traditional treatment options have led to the development of innovative approaches in dentistry. In this context, the ALL-on-6 implant technique represents a turning point for edentulous patients.

This prosthesis system, which is fixed to the jaw with only six implants, offers patients the comfort of using close to natural teeth while at the same time eliminating aesthetic concerns. The most important aspect of the application is that successful results can be obtained in most cases without the need for additional bone grafting.

What is the all-on-6 treatment?

The All-on-6 dental implant technique provides a permanent solution for patients who have lost all or most of their teeth. In this procedure, six titanium implants are surgically placed into the jawbone to serve as stable anchors for a fixed prosthesis. Unlike removable dentures, the All-on-6 solution offers patients a natural-looking, non-removable set of teeth that restores both function and aesthetics.

In which cases is All-on-6 applied?

Cases where All-on-6 treatment is applied:

Complete edentulism:

• It is an ideal solution for patients who have no teeth left in the upper and/or lower jaw.
• It offers a more stable and comfortable alternative to traditional full dentures.

Tooth loss due to caries or periodontal disease:

• It is preferred in cases where most teeth require extraction due to advanced caries or gum disease.
• Even if there are a few teeth remaining intact, they can be extracted, and All-on-6 can be applied for long-term health.

Patients dissatisfied with removable dentures:

• A fixed alternative for those who experience mobility, speech difficulties or chewing difficulties with removable dentures.
• Those with mouth sores due to friction of prostheses are also candidates.

Cases with bone loss but no graft:

Patients with insufficient bone volume for traditional implants (especially in the posterior regions) can be treated without bone grafting thanks to the curved implant design of All-on-6.

Those who need a quick solution:

With the "Same-Day Teeth" protocol, it is suitable for cases where implants and temporary prostheses can be placed in a single session.

What is the difference between All-on-4 and All-on-6?

All-on-4:

In this method, 4 dental implants are used. Usually, the two anterior implants are placed straight (axial), and the two posterior implants are positioned at an inclination of 30-45 degrees. The exit point of the posterior implants in the prosthesis usually coincides with the second premolar area. This concept aims to avoid bone grafting and reduce surgical time and costs.

All-on-6:

This method uses 6 dental implants. Compared to all-on-4, two more distal implants are usually placed. In most cases, the two anterior implants are placed axially, while the four posterior implants (two on each side) can be axial or inclined. All-on-6 aims to utilize more existing bone and avoid bone regeneration procedures.

Differences between All-on-6, All-on-4, and traditional implants:

Those who are not suitable for All-on-6 treatment:

All-on-6 implant treatment may not be an ideal option for every patient. In the following cases, this treatment may be risky or may require additional procedures:

Severe bone loss:

All-on-6 implants require sufficient quantity and quality of bone structure to be successful. Although it can be performed in patients with moderate bone loss, those with advanced bone loss (atrophy) may require additional procedures such as bone grafting, sinus lifting, or bone augmentation. This may increase the duration and cost of treatment.

People with uncontrolled systemic disease:

Some chronic diseases may adversely affect the osseointegration process of implants. In particular:

• Uncontrolled diabetes (slows wound healing),
• Autoimmune diseases (risk of the immune system rejecting the implant),
• Serious cardiovascular problems (increases the risk of surgery) ,
• Untreated infections (risk of complications at the implant site),
• Patients with uncontrolled bleeding disorders (such as hemophilia) should first stabilize these health problems.

Patients who do not maintain oral hygiene or do not attend regular checkups

• The long-term success of All-on-6 implants is directly related to regular oral care and physician checkups.
• Poor oral hygiene increases the risk of peri-implantitis (infection around the implant).
• Patients who cannot maintain dental care due to dementia, disability, or mental disorders are more prone to implant complications.
• Smoking can reduce implant success by delaying healing.

Patients who have recently undergone chemotherapy or radiotherapy:

In patients who have received cancer treatment (chemotherapy/radiotherapy) within the last 12 months, implant placement should usually be postponed, as bone metabolism and wound healing may be adversely affected.

All-on-6 treatment process:

All-on-6 treatment is a comprehensive procedure involving the strategic placement of six dental implants for a fixed prosthesis. The process begins with a detailed planning phase and ends with the placement of the permanent prosthesis.

Preparation and planning:

Clinical examination:

• The patient's general health is assessed; uncontrolled systemic diseases (diabetes, heart disease, etc.) are identified.
• Gum health (periodontal status) is checked.
• It is decided whether the existing teeth will be extracted or not.

3D Imaging and digital planning:

• Bone density, nerve pathways, and anatomical risks are analyzed in detail.
• The most appropriate implant angles and positions are determined by computerized implant planning.

Denture design:

• Lip support, tooth color, and form are planned according to the patient's facial features.
• Temporary and permanent dentures are designed digitally.

Surgical procedure:

Anaesthesia:

The procedure is performed under local anesthesia, sedation, or general anaesthesia, depending on the patient's condition.

Implant placement:

• Anterior region: 4 implants are usually placed vertically.
• Posterior region: 2 implants are positioned 30-45° inclined according to the nerve and sinus anatomy.
• If necessary, implants can be placed in the same session after extraction (immediate implant).
• If there is bone insufficiency, bone grafting can be performed.

Temporary denture placement (same day):

• Patients can leave the clinic immediately after the surgical procedure with a temporary denture.
• This denture provides the patient's chewing function and aesthetics while helping to mold the tissues around the implant.
• The osteointegration (fusion with bone) process takes 3-6 months. During this period, the patient uses a temporary denture.

Healing process (osteointegration)

• It takes 3-6 months for the implants to integrate with the bone.
• At the 1st week, 1st month, and 3rd month controls, implant stability is evaluated.
• If necessary, adjustments are made to the temporary denture.

Permanent denture stage:

• After osteointegration is completed (after 6-8 months), measurements are taken for the permanent denture.
• A special denture is prepared for the patient using durable materials such as zirconia.
• The denture is fixed to the implants with a screw system.
• Bite and aesthetic tests are performed, and final adjustments are made.

 

Aftercare for All-on-6 Implants:

Proper care after All-on-6 surgery is crucial for healing, preventing complications, and ensuring your implants last for years. Follow these guidelines at each stage of recovery.

First 48 hours:

Your mouth will be sensitive right after surgery. Here’s what to do:

Oral hygiene:

• Avoid brushing for the first 24 hours.
• Instead, rinse gently with saltwater (1 tsp salt in a glass of warm water).
• Starting on day 2, brush very gently with a soft toothbrush.

Bleeding management:

• Light bleeding is normal. Bite down on sterile gauze with light pressure.
• Avoid spitting—swallowing a little blood is harmless.

Swelling and pain pelief:

• Use an ice pack (10 minutes on, 10 minutes off) for the first day.
• Take prescribed painkillers as directed.
• If antibiotics are prescribed, complete the full course.

Diet:

• Stick to cold, soft foods (yogurt, pudding, mashed potatoes, smooth soups).
• Avoid hot foods/drinks and anything hard or crunchy.

First 2 weeks:

• During this phase, focus on gentle care while your mouth heals:
• Use a soft-bristle toothbrush or an implant-specific brush.
• Clean around implants carefully with an interdental brush.
• Rinse daily with an antibacterial mouthwash.
• Chew slowly and distribute pressure evenly across your teeth.
• Avoid hard, sticky, or chewy foods (nuts, gum, tough meats, crusty bread).
• Cut food into small pieces to avoid damaging the temporary denture.

3-6 Months: Osseointegration (healing phase)

• Your implants are fusing with your jawbone—handle them with care:
• Visit your dentist at 1 week, 1 month, and 3 months post-op.
• They’ll check implant stability and tighten prosthesis screws if needed.
• Floss daily using superfloss or a water flosser (gentle on implants).
• Consider an antibacterial mouthwash to reduce infection risk.
• Smoking and alcohol slow healing and triple the risk of implant failure.
• If possible, quit or reduce these habits during recovery.

Long-Term care (After permanent dentures)

• Once healed, maintain your implants like natural teeth—but with extra care:
• Use a low-speed electric toothbrush (gentler on implants).
• Choose a non-abrasive toothpaste (avoid whitening or harsh formulas).
• Get a dental checkup every 6 months for professional cleaning.
• Have your dentures screws checked annually to prevent loosening.
• Never chew ice, pens, or hard objects (can crack implants).
• Limit extremely hard foods (jerky, hard candy, crusty bread).

What are the advantages and disadvantages of All-on-6?

Advantages of All-on-6 Implants

Immediate functionality:

Patients receive a fixed temporary prosthesis on the same day as surgery, allowing them to eat and speak almost immediately.

Stronger chewing power than dentures:

The six-implant design distributes bite force evenly, providing 80-90% of natural chewing ability (compared to 20-30% with removable dentures).

Bone preservation:

Implants stimulate the jawbone, preventing the bone loss that occurs with traditional dentures.

No Need for extensive bone grafting:

Unlike All-on-4, the two additional implants provide better stability in moderate bone loss cases, often avoiding the need for bone grafts.

Long-term solution:

With proper care, All-on-6 implants can last 20+ years, far longer than removable dentures (5-10 years).

Natural look and Comfort:

The fixed prosthesis looks and feels like natural teeth, with no slipping or irritation from denture adhesives.

Faster healing than individual implants:

Fewer implants mean less surgical trauma compared to full-mouth individual implants (e.g., All-on-8 or 12).

Disadvantages of All-on-6 Implants:

Higher cost than dentures:

All-on-6 is more expensive than removable dentures (though cheaper than full individual implants).

Not Suitable for severe bone loss:

Patients with advanced jawbone deterioration may need bone grafting or alternative solutions (e.g., zygomatic implants).

Irreversible procedure:

Implant placement requires drilling into the jawbone, making it a permanent commitment.

Risk of complications:

Possible issues include infection, implant failure, or nerve damage (though rare with experienced surgeons).

Temporary diet restrictions:

Patients must avoid hard, sticky, or crunchy foods for several months during healing.

Requires excellent oral hygiene:

Poor care can lead to peri-implantitis (gum disease around implants), risking failure.

Not everyone qualifies:

Smokers, uncontrolled diabetics, or those with certain medical conditions may have higher failure rates.

Comparison: All-on-6 vs. alternatives:

All-on-6 prices:

Prices may vary depending on the clinic, city, materials used, and extent of treatment, so average ranges are given:

(Per upper/lower jaw, average prices)

F.A.Q:

Is there an age limit for All-on-6?

It can be done to anyone over 18 years of age. There is no upper age limit (if the health condition is appropriate).

Do implants create a magnetic field?

• Titanium is not magnetic
• It does not affect airport security systems
• There is no problem in MRI shots

Is the All-on-6 procedure painful?

Since the procedure is performed under local anesthesia, no pain is felt during the procedure. There may be mild pain and swelling during the recovery period; these are normal.

Will my speech be affected after All-on-6?

• Slight lisp is normal for the first 1-2 weeks
• Natural speech improves from the 3rd week
• Adaptation can be accelerated with language exercises

How long does it take to complete All-on-6 treatment?

• Examination & Planning: 1-3 days
• Surgical Procedure: 1 day
• Temporary denture: Same day
• Bone Fusion :Time 3-6 months
• Permanent denture: +1-2 weeks
• Total: 3-6 months
• Total duration: 6-8 months if bone grafting or sinus lifting is required.

Can I travel by plane with All-on-6?

You can travel by plane within 1 week after the implant. Pressure change does not cause any problem.

Do implants have an odor?

There is no odor if regular cleaning is done. Bad odour may be a sign of infection.

Will I have problems with All-on-6 during pregnancy?

• If it was done before pregnancy, there is no problem.
• Implant application is not recommended during pregnancy
• Treatment can be done during breastfeeding

Can the dentures be removed?

All-on-6 dentures are usually fixed, i.e., not removable. However, cleaning is easy, and oral health is maintained with professional care.

When can I return to my normal life after All-on-6?

Most patients can return to their daily activities within 1-2 days after the procedure. As the pain and swelling decrease, eating and speaking return to normal.

What materials are used for All-on-6?

Implants are made of titanium or titanium alloys; prosthetic teeth are made of durable materials such as acrylic, porcelain, or zirconium.

Can teeth whitening be done with All-on-6?

• Denture teeth cannot be whitened (colour does not change)
• If you have natural teeth, whitening should be done first
• Denture colour can be adjusted according to whitened teeth