All-on-4 and All-on-6 dental implants in Antalya, Turkey

What All-on-4 is

All-on-4 is a full-arch implant bridge: one fixed set of 10–12 teeth for the upper or lower jaw, screwed onto four implants. The two front implants stand upright; the two back implants are tilted. Tilting lets a longer implant use the dense bone at the front of the jaw while avoiding the sinus in the upper jaw and the nerve in the lower jaw.

All-on-6 works the same way with six implants. You do not take the bridge out; only your dentist removes it for cleaning or repairs. Where bone and gum have been lost, a gum-coloured part restores lip support.

Who is a candidate, and who is not

All-on-4 suits:

• People who have lost most or all of the teeth in one or both jaws
• People whose remaining teeth are loose or failing because of advanced gum disease
• Denture wearers who want fixed teeth that do not move
• Patients told elsewhere that they do not have enough bone for implants

Extra care, a letter from your doctor or a different plan may be needed if you:

• smoke — smoking raises the risk of implant failure and of gum infection around implants
• have diabetes that is not well controlled
• take or have taken bisphosphonates or similar bone medication, or have had radiotherapy to the head and neck
• have active gum disease in the opposite jaw, which is treated first
• would find daily cleaning under a bridge difficult, for example because of limited hand movement

When a more conservative option is better

If several of your teeth are still healthy or can be saved with gum treatment, keeping them and replacing the gaps with single implants or bridges may be the better plan. Extracting teeth that could be kept is a one-way decision. A periodontist assesses each tooth on the 3D scan before recommending a full arch.

In a small number of cases the bone is too limited even for tilted implants. A bone graft or sinus lift is then discussed, which lengthens healing.

All-on-4, All-on-6, overdenture or denture?

All-on-4 suits reduced bone, especially in the lower jaw. All-on-6 suits good bone volume, the upper jaw and a strong bite, and leaves more reserve if one implant ever has a problem. An overdenture is a middle way when budget matters most, and a conventional denture needs no surgery. Your periodontist decides on the 3D scan which option gives your teeth secure support.

Your two trips to Antalya

First trip: 5–7 days

• Day 1: examination, 3D cone-beam CT scan and final digital plan with your periodontist. Records are taken for your temporary bridge.
• Day 2: extraction of failing teeth and placement of the implants under local anaesthesia, about 2–3 hours per jaw.
• Day 3–4: your fixed temporary bridge is screwed onto the implants.
• Day 5–7: check-up, bite adjustment and cleaning instructions.

Healing at home: 3–6 months

The implants fuse with the bone while you wear the temporary bridge. You eat soft food, clean carefully and stay in touch with your coordinator; a photo or an X-ray from your dentist at home helps us confirm the date of your second trip.

Second trip: 5–7 days

Your periodontist checks the implants and takes digital impressions. A try-in lets you and your dentist check the tooth shape, shade, bite, lip support and speech before the final bridge in zirconia or acrylic on a titanium frame is made and fitted. A bite check and cleaning lesson end the visit.

Temporary and final bridge materials

The temporary bridge fitted on the first trip is usually made of acrylic resin. It is light and easy to adjust while the gums and bone heal, but it is not built for years of hard chewing, so you eat soft food until the final bridge is fitted.

Zirconia suits patients who want a durable, stain-free bridge. Acrylic on titanium can suit heavy grinders, an opposing denture, or a tighter budget. Your plan states which material is used and why.

Cleaning under the bridge

Plaque collects between the bridge and the gum; cleaning there daily keeps the implants healthy.

• Brush the bridge twice a day with a soft or electric toothbrush, angled towards the gum.
• Use a water flosser under the whole bridge once a day.
• Clean around each implant with an interdental brush in the right size or with threaded floss (super floss).
• A small single-tuft brush reaches the back implants.
• Have the bridge removed and professionally cleaned once or twice a year, as your dentist advises.

Bleeding, a bad taste or swelling around an implant is a warning sign: send your coordinator a photo and see a dentist.

Risks and disadvantages

After surgery

Swelling, bruising and soreness for 3–5 days are expected. In the lower jaw there is a small risk of temporary or lasting numbness of the lip if a nerve is irritated; implant positions are planned on the 3D scan to keep a safe distance.

Implant failure

In about 2–5 % of cases an implant does not fuse with the bone. It is removed and replaced after healing; with All-on-6 the bridge may still be supported in the meantime. Your written plan explains how this is handled.

Peri-implantitis

Peri-implantitis is an infection of the gum and bone around an implant, similar to gum disease around natural teeth. Over years it can cause bone loss and, if untreated, the loss of the implant. The main risks are plaque left under the bridge, smoking, poorly controlled diabetes and a history of gum disease. Early signs are bleeding, swelling and pus around an implant. Daily cleaning and regular check-ups are the main protection, and early treatment by a periodontist can usually stop it.

Technical problems

Screws can loosen, acrylic teeth can wear or chip, and zirconia can crack under heavy grinding. Food trapping or a change in speech can occur in the first weeks, especially with an upper bridge.

Disadvantages

• Surgery is needed, and remaining teeth in the jaw are removed for good.
• You cannot take the bridge out yourself; cleaning under it takes a few extra minutes each day.
• It costs more than a denture or an overdenture.
• Two trips are needed, 3–6 months apart.

What affects the cost

• One jaw or both
• All-on-4 or All-on-6
• The number of extractions
• Bone grafting or a sinus lift, if needed
• The final bridge material: zirconia or acrylic on titanium
• The implant system used

Your written plan states the implants, materials, both trips and the total price before you travel; you pay for each stage when it is done. See prices.

Living with your new teeth

While you wear the temporary bridge, eat soft food that needs little chewing, so the implants can heal undisturbed. With the final bridge you can bite into most foods again; avoid very hard items such as bones, nutshells and ice. Speech usually adapts within days to a few weeks.

Wear a night guard if you grind your teeth, and avoid smoking. Your treatment report lists the implant system, sizes and serial numbers and includes your X-rays, so your dentist at home can check and maintain the implants. With good cleaning the implants can last for decades; the final bridge typically lasts 10–20 years depending on the material, your bite and how well it is cleaned.