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All on Four vs All on Six - Which option is best for me?

Antlara Dental Clinic - Lara, Antalya, Turkey

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All on four and All on six treatments are fixed prosthesis procedures used for patients with extensive tooth loss and the remaining teeth being loose. Despite the abundance of sources detailing these two treatments, it is challenging to find a comprehensive source that clearly explains the distinction between them and helps you determine which treatment method would be more effective for your specific needs. In this post, we address these questions and provide helpful hints regarding the dentist's decision-making process and which treatment would be best for you.

Comparing the implementation of All on four and All on six

Both the all-on-four and all-on-six treatments are highly effective and durable, and both have high success rates. Assessing the patient's horizontal and vertical bone loss as well as their gum and palate structure is the initial step in determining which treatment is most appropriate.

In all-on-six treatment, the linear palatal line must be preserved. It is only feasible to guarantee the correct alignment of the implants due to the higher number of implants that will be placed. If there is enough bone in the horizontal gum, then it will work. Put simply, all-on-six treatment becomes more challenging and potentially less successful when the gum is shrunken inward because it requires extensive bone augmentation surgery. Additionally, unlike All-on-four, the All on six procedure utilizes shorter implants, so it is crucial that the patient's nerves and sinus cavity are not in the treatment area.

On the other hand, the All on four method uses two implants that are 15-16 mm long. These implants can be angled to fit snugly into the jawbone without penetrating the sinuses or local nerves. With All on Four, the strongest jawbones are used, which means the implants have a better chance of healing and integrating with the bone.

Comparing the durability of All on four and All on six

Theoretically and clinically, the all-on-six treatment is superior to the all-on-four in terms of stress distribution and force exposure to the implants during chewing. This is based on the widespread belief among dentists and researchers in the field. Yet, in the scientific study conducted in July 2023, it was noted that while the stress on the outer parts of the bones was lower in the all-on-six treatment, the stress on the porous inner parts of the bones was lower in the all-on-four treatment.

Considering these assessments, it may appear that all-on-four is not as long-lasting as all-on-six. There hasn't, however, been a long-term comparison of these two therapies. It is worth noting that there are a few advantages that the all-on-four method has over the all-on-six.

Advantages of All on four

First of all, the All on Four technique uses the patient's strongest bones to support implants that are 1.5 to 2 times longer than a typical implant. These implants are stronger than all-on-six implants, despite being subjected to greater stress.

Furthermore, the jawbone gets softer and more porous in the posterior regions. The quality of the implant's adhesion in these areas also decreases in the all-on-six procedure. Consequently, the pros and cons of all-on-six treatment are dependent on the patient's bone structure.

Besides that, all-on-four treatment is most suitable if the patient has undergone a significant number of tooth extractions. Because too many tooth extractions make it hard for the area to fully heal, the risk of all-on-six treatment rises.

Advantages of All on six

On the other hand, for some patients, all-on-six treatment may be a better option if their bones are already pretty healthy, especially in the back, and if it can be done without too much bone augmentation surgery. If any of the implants are lost, opting for all-on-six treatment is a more secure solution. This is due to the fact that the patient will have enough time to wear his prosthetics with the five implants that are still available. But in All-on-four treatment, the remaining implants will be under more stress, so the patient has to visit the dentist quickly in such a case.

Comparison in terms of aesthetics and care

Each treatment produces comparable aesthetic outcomes, but there are major distinctions that can influence your decision. Due to the reduced spacing between the implants in the all-on-six treatment, the prostheses are affixed firmly, further minimizing the possibility of food getting stuck between the gums and the prosthesis.

Aesthetically, the All on Six and All on Four treatments are identical; however, the All on Six procedure employs a smaller amount of porcelain gum. In all-on-six procedures, this can improve the aesthetics by focusing on the patient's own gums.

You cannot go wrong with either the all-on-four or all-on-six procedure. Extensive analysis of intraoral three-dimensional scans determines the optimal course of treatment. Only after this thorough evaluation can the dentist determine which treatment is best for you. Some patients may not be able to tolerate the same conditions as others.

Factors that contribute significantly to the treatment's success include the technique itself, the materials utilized, the dentist's level of expertise, and the diagnostic tools available at the clinic. Our clinic's skilled dentists, each with 20 to 30 years of experience in these treatment areas, use leading implant brands such as Straumann. The latest 3D x-ray and intraoral scanning technology enables us to accurately measure intraoral bone and provide the best treatment options.

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