All-on-4 vs All-on-6: how the procedures differ

The core difference: 4 tilted implants vs 6 spread implants

In All-on-4, four implants support the arch. The two front implants are placed vertically; the two rear implants are tilted (angled up to 45°) so they engage more bone and avoid the sinus cavities in the upper jaw and the nerve canal in the lower jaw. This clever geometry is exactly what lets All-on-4 work without bone grafting in many cases.

In All-on-6, six implants are distributed more evenly along the arch, with the rearmost implants usually placed more upright. This puts a fixture directly beneath the molar region rather than relying on a cantilever, which improves load distribution at the back of the mouth — but it generally needs more posterior bone height.

Surgery: what actually happens on the day

The surgical workflow is similar for both, and is typically completed under local anaesthetic with optional IV sedation:

1. A CBCT (3D) scan and digital planning to map bone, nerves and sinuses.
2. Removal of any failing or remaining teeth in the arch.
3. Placement of the implants — four for All-on-4, six for All-on-6.
4. Attachment of a fixed temporary bridge, usually the same day or within 24–72 hours.
5. A healing period of about 3–6 months, then the final, permanent bridge.

The main practical difference is time and intensity: All-on-4 surgery usually takes around 1.5–2 hours per arch, while All-on-6 adds roughly 30–60 minutes because there are two more osteotomies to prepare and implants to place. That can mean slightly more post-operative swelling, though most patients describe recovery from either procedure as comparable — manageable discomfort, soft foods for a couple of weeks, and a return to normal life quickly.

Bone grafting: more likely with All-on-6

Because All-on-4 relies on tilted implants and the existing bone, grafting is often avoided entirely. All-on-6's upright posterior implants need more vertical bone, so if you have resorbed ridges you may need a sinus lift or minor graft — adding cost and a few months of healing. This is one of the most common reasons a clinician recommends All-on-4 even when a patient asks for "the one with more implants". The decision is covered in detail on who needs which.

Trips and timeline

Both typically involve two visits to Turkey: a first trip of 5–10 days for surgery and the temporary bridge, then a second trip of 5–7 days a few months later for the final bridge. Some clinics offer accelerated single-trip protocols for suitable cases. The timeline does not differ meaningfully between All-on-4 and All-on-6 — what changes is the surgical complexity on the day, not the calendar.

Which procedure is right for your mouth?

You cannot decide this from a website, and any honest clinic will tell you the same. The procedure that suits you depends on your bone volume and density, your bite force and whether you grind, and how long a bridge your arch needs. A specialist reviews your CBCT scan and recommends the safest durable option. For a free remote assessment and a clear explanation of which procedure your anatomy supports, speak to the team at Taki Dent, led by Specialist Prosthodontist Dr. Sadık Taki.