Most people who come to us for full arch implants have already read about All-on-4. It's the best known name in the field, and for good reason. It changed what was possible for people with bone loss. What surprises many patients is that we usually recommend six implants instead, and that the decision is made on a scan rather than in a brochure.
Both approaches replace a full upper or lower set of teeth with a fixed bridge that never comes out. The difference is how many implants hold that bridge and where they go. That difference matters more than it sounds.
What four implants do well
All-on-4 places two implants straight up at the front of the jaw and two at an angle further back. The angle is the clever part. Bone at the back of the jaw tends to shrink after teeth are lost, and in the upper jaw the sinus sits just above it. Tilting the back implants lets them anchor in denser bone further forward, which means many patients avoid bone grafting altogether.
For someone who has worn a denture for ten or fifteen years, that can be the difference between fixed teeth this year and fixed teeth after a year of grafting and healing. It's a real advantage, and when the bone is limited, four implants are often the smartest choice.
Why we prefer six when the bone allows it
A full arch bridge takes the force of every bite. With four implants that load is shared across four points, and the back of the bridge extends past the last implant like a small cantilever. With six, the force is spread wider and the bridge is supported closer to its ends.
In practice that gives us three things. Each implant carries less stress over the years. The bridge can be made thinner and shaped more like real teeth, because it doesn't have to be as bulky to stay strong. And if one implant ever has a problem, five others are still holding the arch while it's treated.
Patients notice the second point most. A slimmer bridge feels less noticeable to the tongue, is easier to speak with, and sits more naturally against the lips and gums. When we pair six implants with a zirconia bridge, it's the combination we choose when we want the result to last as long as possible.
What the scan tells us
The decision starts with a 3D CBCT scan at your first visit. It shows the height and width of bone across the whole arch, the position of the sinus and the nerve, and the density of the bone in each area. Your doctor can place virtual implants on the scan and see exactly where six will fit and where they won't.
If there's enough bone for six, that's usually the recommendation. If the back of the jaw has thinned too much, angled implants and an All-on-4 layout often solve it without grafting. And if the picture is uneven, with good bone in some places and very little in others, we plan an All-on-X layout with whatever number and angle of implants your anatomy calls for.
Bite, habits and the long view
Bone isn't the only factor. People who grind or clench their teeth put far more force on a full arch, and they benefit from the extra support of six implants and a zirconia bridge. The opposing arch matters too. A full arch that bites against natural teeth or another implant bridge works harder than one that bites against a denture.
Age and health play a part as well. Diabetes, smoking and some medications affect how bone heals around implants. None of these rule treatment out on their own, but they shape the plan, and your doctor will talk through them with you.
Is one cheaper than the other
Four implants cost less than six, so All-on-4 is usually the lower fee for the surgical part. The bridge itself costs about the same either way. Where All-on-4 avoids a bone graft that six implants would need, it can be the less expensive plan overall. You'll get a written quote for the specific plan your scan supports, and we're happy to price both when both are possible.
You don't have to choose before you come in
Patients sometimes arrive set on one approach because of something they read. We'd rather you came in open. Bring your questions, your old X-rays if you have them, and a clear idea of what bothers you about your teeth now. The scan and the conversation that follows will show which option fits, and why.
Have questions about your own case? Book a complimentary consultation at our Brentwood office on San Vicente Boulevard or our Burbank office on West Alameda Avenue. We see patients from across Los Angeles, including Beverly Hills, Santa Monica, Glendale and Pasadena.