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All-on-4 vs All-on-6: Which Costs Less Over Ten Years?
Medically reviewed byDt. Beyza İlistir, DDSQuick answer
Over ten years, the biggest extra costs of a full-arch bridge usually come from the bridge itself, not from losing an implant. In a long-term All-on-4 study, about 5% of patients lost an implant over up to ten years, while mechanical problems affected over a third of final bridges over up to 18 years. Six implants protect you against the rarer, costlier event. The bridge material and a night guard protect you against the common one.
What actually goes wrong over ten years?
| Event | How often, in long-term studies | Source |
|---|---|---|
| Losing at least one implant, All-on-4 lower jaw | 13 of 245 patients (about 5%) over up to 10 years; 99.2% of bridges still in use | Maló 2011[1] |
| A mechanical problem with the final bridge, All-on-4 lower jaw | 36.7% of final bridges over up to 18 years; 29.5% of temporary bridges | Maló 2019[2] |
| A mechanical problem, another 10-year cohort | 27.1% of cases, more common in people who grind | Grandi 2022[3] |
| Implant survival with four vs five or more implants | Similar in a systematic review | Polido 2018[4] |
Mechanical problems are mostly chipped or broken teeth on the bridge and loosened screws.[5] They are usually repairable, but each repair is a visit, and abroad, possibly a trip.
What does each event cost with four or six implants?
| If this happens | With All-on-4 | With All-on-6 |
|---|---|---|
| One implant fails | A new implant is needed before the bridge is fully supported again; the bridge may need modifying, occasionally remaking (a zirconia final bridge is about £1,500–£3,500 per arch) | Five implants usually keep the bridge in use; the implant can be replaced later, or not at all |
| A tooth on the bridge chips or breaks | Same for both designs: cost depends mainly on the bridge material | Same |
| A screw loosens | Same for both: usually a short visit | Same |
The long-term data are reassuring for four implants: in the Maló cohort, almost every bridge stayed in use even though some implants failed. Losing one of four is usually manageable. It still means surgery and extra visits, which matter more when the clinic is a flight away.
Where does the ten-year money really go?
- Implant number protects you against an event that affects roughly one patient in twenty over ten years.
- Bridge material and a night guard protect you against an event that affects roughly one bridge in three. Acrylic teeth wear and break more readily than zirconia; grinding raises the risk for every design.
For many people, choosing the final bridge carefully, and wearing a night guard if they grind, does more for the ten-year bill than adding two implants. The upfront trade-off is set out in our All-on-6 cost and grafting breakdown.
Which design fits your bone and bite?
| Moderate bite | Heavy bite or grinding | |
|---|---|---|
| Limited bone at the back | All-on-4 is the rational choice | All-on-4 with a short cantilever, a strong framework and a night guard, or grafting for six; discuss both |
| Good bone at the back | Either works; six adds redundancy if the budget allows | All-on-6 is usually worth the extra cost |
The All-on-4 guide and All-on-6 guide set out the candidacy criteria for each.
What should you ask?
- What material will the final bridge be, and what does a repair or remake cost?
- Will I get a night guard, and is it included?
- If one implant fails in the first five years, what do I pay, and how many trips does it take?
- Which implant system will you use, and can my home dentist get its parts? See endosteal implants.
References
- Maló P, de Araújo Nobre M, Lopes A, Moss SM, Molina GJ. A longitudinal study of the survival of All-on-4 implants in the mandible with up to 10 years of follow-up. J Am Dent Assoc. 2011;142(3):310–320.
- Maló P, de Araújo Nobre M, Lopes A, Ferro A, Botto J. The All-on-4 treatment concept for the rehabilitation of the completely edentulous mandible: a longitudinal study with 10 to 18 years of follow-up. Clin Implant Dent Relat Res. 2019;21(4):565–577.
- Grandi T, et al. Rehabilitation of the completely edentulous mandible by All-on-Four treatment concept: a retrospective cohort study with up to 10 years follow-up. Medicina. 2022;58(1):10. doi:10.3390/medicina58010010
- Polido WD, Aghaloo T, Emmett TW, Taylor TD, Morton D. Number of implants placed for complete-arch fixed prostheses: a systematic review and meta-analysis. Clin Oral Implants Res. 2018;29(Suppl 16):154–183. doi:10.1111/clr.13312
- Nobel Biocare. Interview with Prof. Miguel de Araújo Nobre on long-term All-on-4 outcomes.