Patients who are interested in full arch dental implants using 4 dental implants (i.e., All-on-X, 4-on-1 dental implants) may have seen other “all-on-X” procedures available (e.g., all-on-6, all-on-8). It’s common for patients to have questions about the varying all-on procedures, how they differ, and how a patient can make sure they get the right procedure for their unique needs.
Below, we’ll describe those differences, the benefits of the different procedures, and how oral surgeons determine which procedure is right for patients.
What Are 4 on 1 Dental Implants?
4-on-1 (aka full mouth, full arch, all-on-X) dental implants refers to the surgery to replace an entire row of teeth with new, custom-designed prosthetics using only 4 titanium implants. The result is a set of firmly secured, custom-fitted teeth that feel and operate just as your natural teeth would.
Advantages of 4-on-1 Dental Implants
4-on-1 dental implants have numerous advantages when patients have many missing or severely damaged teeth, which is one of the reasons our oral surgeons specialize in this specific procedure.
As with any dental implants, full arch dental implants are permanent, and you’ll only need to follow normal oral hygiene habits (like brushing your teeth) and go to dental cleanings. The titanium implants can stimulate jawbone growth and allow for a secure, comfortable bite. Full arch dental implants also look very natural, and most people won’t be able to tell that they aren’t your original, natural teeth.
As you might have guessed, all-on-6 implants are just like 4-on-1 implants, except instead of securing a full arch of teeth using 4 titanium screws, all-on-6 uses six screws. All-on-6 implants also require surgery and are used to replace whole rows of teeth.
Since an all-on-6 surgery uses more titanium screws, it can help your new teeth to feel stronger and more secure. Usually, patients will choose all-on-6 dental implants if their arch is long or wide enough that it would put structural stress on an 4-on-1 full arch prosthetic bridge, or they grind their teeth heavily and constantly. Most people do not need more than four screws and 4-on-1 full arch implants are an excellent choice for them.
Patients who have degraded jawbone health may also look to all-on-6 dental implants, as they may need more anchoring and support than 4-on-1 full arch dental implants may provide.
4-on-1 vs All on 6 Dental Implants
Now that you have a general idea of what each of these procedures are, let’s take a look at some of the notable differences between full arch dental implants that use 4 versus 6 dental implants.
The most notable difference between these two surgeries is that all-on-6 dental implants require two extra screws per arch. That means the prep beforehand will need to be more thorough (to make sure screws are placed properly), and the surgery will be longer.
There’s also a difference in how the implant screws are placed. For full arch that use 4 implants, the implant screws are usually set at an angle, which helps to distribute the pressure of the bite across the jawbone. Since all-on-6 uses more implants, they often don’t always need to be angled, though placement requirements can vary. Some patients will have angled implants regardless of if they have 4-on-1 full arch or all-on-6.
One of the biggest differences between full arch procedures that use 4 versus 6 implants is the cost. With more screws come higher cost. All-on-6 dental implants are generally thousands of dollars more expensive than procedures using 4 dental implants. It takes more time to prepare the surgery, and the surgery itself is more complex and takes longer to complete, which will increase the cost.
The materials required for each procedure also makes a difference in the cost. All-on-6 require more screws, and those screws are made of titanium. Titanium itself is expensive, and the tools required to shape the extremely hard titanium into screws are also costly.
Given the extra cost and more invasive procedure, oral surgeons don’t recommend patients get all-on-6 dental implants unless they need them. Oral surgeons will usually recommend all-on-6 dental implants if patients have wide arches that would provide stability issues for standard full arch implants that use 4 implants, or if they otherwise need the added stability of extra implants due to heavy teeth grinding. Typically, if patients need to apply for financing, it is easier to qualify for the full amount for full arch using 4 implants than full arch using 6 implants.
4-on-1 Full Arch dental implants are easier on your body (and wallet), but not all patients are eligible for them. Since there are only four implant screws, your jawbone needs to have enough bone to properly anchor the screws. Some patients require bone grafts to help anchor implant screws,
Remember, your doctor will tell you which procedures is best for you based on your needs and level of oral health.
4-on-1 and all-on-6 are both permanent. As long as you brush your teeth, use a mouth rinse, and regularly see your dentist for cleanings, your dental implants will likely last as long as you do. The biggest reason dental implants fail, however, is that whoever performed the dental implant surgery was not qualified to do so.
Always make sure you have an oral surgeon place implants, regardless of which all-on procedure you get.
Comfort between full arch dental implants using 4 and 6 implants is comparable, though all-on-6 can provide a stronger, more comfortable fit more easily. If you choose an oral surgeon with experience in placing full arches using 4 implants, you won’t have an issue with comfort regardless of which implant style you end up with.
Full arches using 4 and 6 implants are the two most popular procedures. However, some patients might also consider all-on-8 dental implants. As the name implies, eight dental implants are used instead of four or six to secure an arch of teeth. While some offices offer all-on-8, the vast majority of oral surgeons see the procedure as excessive and unnecessary and will rarely recommend it to patients.
All-on-8 dental implants are the most expensive of the all-on procedures. They require the most planning, the most materials, and the longest surgery. While the cost can vary widely, it’s not uncommon to see this procedure start at $40,000 per arch (or more). Unless this is the only option to restore your smile, our oral surgeons will usually recommend another option.
If your jawbone is dense enough to support all-on-8 dental implants, you will get a very secure, comfortable fit. The pressure of your bite will be distributed across eight implants, which will help you bite firmly without discomfort. As with all dental implants, all-on-8 are permanent, and as long as you follow basic oral and dental care, they will also last a lifetime.
Keep in mind that for the vast majority of patients (>90%), 4-on-1 dental implants offer a comparable, comfortable fit, and is less invasive and costly. It is uncommon to recommend all-on-8 implants for any reason, including for reasons regarding comfort.
4-on-1 vs. All on 6 vs. All on 8 Dental Implants
All-on-X procedures all provide a similar benefit: a permanent, comfortable, natural-looking solution to damage, failing, or missing teeth. These different surgeries exist because the needs of each patient are unique. Full arch dental implants using 4 implants is an excellent fit for the vast majority of patients, while others might want the extra support of additional implants.
The drawbacks to all-on-8 are significant, though. There is typically very few reasons for a patient to get all-on-8 implants (100% of patients will find a solution with either 4 or 6implants). Below, we’ll talk about why all-on-8 implants may have been suggested, and what better alternatives there are.
There are several reasons all-on-8 implants may have been suggested in the past. Here are some specific reasons why they may have been offered, and why other all-on-X procedures might be better alternatives:
If you have a very wide jaw, that means an oral surgeon may not be able to easily put in implant screws for support. This may require more screws than usual. However, even if more screws are needed, all-on-6 will usually provide an adequate fit.
You may have enough jawbone to support implant screws, but your jaw may not be dense enough to handle the pressure of your bite if you only use four dental implants. Placing more dental implants will help even out the pressure applied to the jaw, making for a safer, more comfortable bite. Again, if density is an issue, all-on-6 will be a better alternative. Patients can also consider 4-on-1 full arch implants with a bone graft to resolve this issue, too.
If you struggle with constant teeth grinding, an all-on procedure with more screws may be a better choice. Again, all-on-6 will provide sufficient support for your implants even if you struggle with clenching or grinding. All-on-8 will be a more expensive, more invasive option that is likely unnecessary.