Full-arch implant surgery — All-on-4 / All-on-6

Full-arch rehabilitation replaces a complete failing or missing dentition with a fixed bridge on four to six implants. Surgically it is the most demanding routine work in implant dentistry: extraction, site preparation, placement and load management in one coordinated operation.

Author: Dr. Barış Kipritoğlu, Oral & Maxillofacial Surgeon Reviewed: 7 August 2026 Verified credentials

When full-arch treatment is indicated

Candidates typically have terminal dentitions — teeth failing from periodontal disease, decay or fracture — or are already wearing complete dentures they cannot tolerate. The decision to move to a fixed implant-supported arch weighs bone volume, opposing dentition, hygiene capacity, general health and what the patient actually wants from the result.

Planning: where the engineering happens

On the CBCT scan, implant positions are chosen to use the best available bone and avoid the nerve canal and sinus. Tilting the posterior implants — the hallmark of the All-on-4 concept — lets longer fixtures engage dense anterior bone and shortens cantilevers without grafting. Where anatomy allows six well-distributed implants, load is spread further. The provisional bridge is designed before surgery so conversion can happen the same day when primary stability permits.

The surgical day

Remaining failing teeth are removed and sockets debrided.
The ridge is prepared and implants are placed at the planned positions and angulations, each torqued to measure primary stability.
If stability thresholds are met, multi-unit abutments are fitted and impressions or scans are taken for the provisional fixed bridge — usually attached within 24 hours.
If stability is insufficient, the case converts to a delayed protocol — a planned fallback, not a failure.

Limits, contraindications and honest fallbacks

Severe maxillary atrophy can leave too little bone even for tilted implants; the alternatives are staged grafting or zygomatic anchorage. Bruxism, limited hygiene capacity and the risk factors above may argue for a removable or staged solution instead. A fixed bridge also demands maintenance: professional review, cleaning access and eventually prosthetic renewal.

Risks and recovery

Beyond the general risks of implant surgery, full-arch cases add the load-management risks of immediate function: provisional fracture, screw loosening and — rarely — loss of an implant during integration. Recovery follows the same arc as single implants, scaled up: swelling and a soft diet in the early weeks, with remote review possible for patients who travel, before the definitive bridge is made at 3–6 months.

Common questions

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

The number and distribution of implants supporting a fixed full-arch bridge. Four implants (with the back pair tilted) suit many resorbed jaws; six implants spread load further and can be preferred where bone volume and quality allow. The right number is an engineering decision made on the CBCT, not a package choice.

Are the "same-day teeth" permanent?

The teeth fitted on the day of surgery are a fixed provisional bridge, worn during the 8–12 week integration period with a softer diet. The definitive bridge is made afterwards, on integrated implants.

Who is not a candidate?

Patients with uncontrolled diabetes, heavy smoking habits, prior head-and-neck radiotherapy or high-dose antiresorptive medication carry substantially higher risk, and in some cases fixed full-arch treatment is the wrong choice. Assessment exists to find that out before surgery, not after.

What happens if an implant fails to integrate?

It is removed, the site heals or is grafted, and a replacement strategy is planned — sometimes a new implant, sometimes redistributing load on the remaining fixtures. This risk and its management are part of informed consent.