All on 6

All-on-6 is one of the most comprehensive and life-changing solutions developed by modern dentistry for extensive tooth loss. So, who exactly is this treatment suitable for? What circumstances might lead you to consider All-on-6?

At Aesthetic Dental Turkey, we always emphasize that this decision is personal and requires a detailed examination to be finalized. However, in general, if one or more of the following situations reflect your circumstances, All-on-6 treatment may be an ideal option for you.

Complete tooth loss

If you have no natural teeth left in your upper or lower jaw and are using or will need to use a removable full denture, All-on-6 provides you with a permanent solution.

Freedom from dentures:

You are freed from all the disadvantages of dentures, such as putting them in and taking them out, using adhesive, playing with them, or having a palate covering.

Root sensation:

Implants replace your lost tooth roots, providing natural stimulation to your jawbone and stopping bone loss.

Having numerous ‘loose’ or irreparable teeth

You may still have teeth in your jaw, but:

• If many of your teeth are loose due to advanced gum disease (periodontitis),
• If numerous teeth need extraction due to extensive decay, fractures, or failed root canal treatments,

All-on-6 is an excellent protocol for extracting these problematic teeth and immediately providing a permanent, healthy, and fixed solution in the same session.

Dissatisfaction with removable dentures

If you use removable partial dentures (clasp dentures) or full dentures and suffer from the following complaints, All-on-6 can help you overcome this situation.

Constant fear of slipping and falling out: Lower dentures, in particular, can shift out of place with tongue movement.

Painful sores: Friction from the dentures can cause sores on your gums.

Difficulty chewing: Chewing hard or sticky foods becomes impossible.

Decreased sense of taste: Upper dentures cover your palate, preventing you from tasting food.

Speech problems: Dentures moving around in your mouth cause slurred speech.

Lack of confidence: The fear that your dentures might come loose during a meal, meeting, or while laughing can restrict your social life.

Moderate bone loss (atrophy) has begun in the jawbone.

Each year following tooth loss contributes to bone resorption in your jawbone. This condition:

Leads to facial collapse, thinning of the lips, and an aged appearance.

May result in insufficient bone for traditional implant procedures.

One of the greatest advantages of All-on-6 is that it can make the most efficient use of existing bone through strategically angled implant placement. In many cases, implants can be placed directly without the need for additional and costly surgeries such as bone grafting (additional bone powder) or sinus lifting. All-on-6 also preserves your existing bone tissue by stopping bone loss.

Previous unsuccessful implants or prostheses

If you have previously had single implants or a different fixed prosthesis (e.g., a bridge made with fewer implants) and these structures are no longer functional, ‘starting over’ with All-on-6 may be the most robust solution. Failed implants can be removed, bone repair can be performed if necessary, and you can transition to All-on-6, a stronger, more balanced system.

The pursuit of both aesthetic and functional perfection

All-on-6 is not just about ‘making teeth.’ It is a complete oral rehabilitation. Not just for chewing, but also for:

• Achieving a natural, youthful smile that suits you,
• Supporting your facial contours and looking younger,
• Clarifying your speech,
• Regaining your self-confidence.

This treatment has the power to meet all these expectations at once. At our clinic, we use digital smile design to show you the result before we begin and obtain your approval.

All-on-6 treatment is not just a dental procedure; it is a comprehensive journey that offers you a new smile, new confidence, and a whole new quality of life. At Aesthetic Dental Turkey, we manage a carefully designed process to make every step of this journey transparent, comfortable, and safe for you.

Preliminary Examination and Planning Stage

Clinical Examination:

The patient's oral health, current tooth/root condition, gum health, occlusion, and jaw relationship are examined in detail.

Radiological Imaging:

Panoramic X-ray: For a general preliminary assessment.

3D computerized tomography (CBCT):

The thickness, height, density, and exact location of the jawbones, nerves, and sinus cavities are determined to the millimeter. The most suitable positions for the implants are planned virtually.

Treatment Planning:

The surgeon and prosthodontist work together. The positions, angles, and sizes of the implants, as well as the design of the prosthesis, are prepared digitally. If necessary, templates called ‘guided surgical guides’ are produced. This guide ensures that the implants are placed accurately, as planned.

Patient consent and preparation:

The entire process, cost, possible risks, and alternatives (All-on-4, traditional prostheses, individual implants, etc.) are shared with the patient. The patient's general health is assessed (smoking, diabetes, use of bone loss medication, etc.).

Surgical stage (Implant placement)

The procedure is usually performed under local anesthesia. Sedation or general anesthesia may also be preferred.

Anesthesia administration: The surgical area is completely numbed.

Tooth extractions (if necessary): All remaining natural teeth or roots are removed.

Bone contouring (if necessary): Bumps on the bone may be smoothed to create a level surface for the prosthesis.

Placement of the guided surgical template: The template prepared during the planning phase is fixed to the patient's jaw.

Preparation of the implant sites: Using special drills through the holes in the template, sockets are created in the bone for the implants. Bone temperature is controlled with continuous cooling (irrigation).

Placement of implants: Six titanium implants (usually two straight and four angled 30-45 degrees backwards) are screwed into the planned positions. Angled implants allow for the avoidance of anatomical structures such as nerves or sinuses in the rear region and the use of longer implants, which increases stability.

Attachment of temporary abutments: Connection elements are placed on top of the implants, to which the temporary prosthesis will attach.

Suturing: The gum incisions are closed with stitches.

Fabrication and loading of the temporary prosthesis

One of the most significant advantages of All-on-6 is that it can generally offer the ‘same-day teeth’ (immediate loading) concept.

Taking impressions: Immediately after the implants are placed, digital or conventional impressions are taken using special impression materials and transfer heads attached to the abutments.

Preparing the temporary prosthesis: Dental technicians attach acrylic teeth, prepared according to the impressions taken beforehand, to a metal frame or directly onto the implant.

Placement of the temporary prosthesis: On the same day, usually a few hours after surgery, temporary fixed teeth (bridge) are placed in the patient's mouth. This prosthesis is only intended to reduce chewing force and protect healing; it is not suitable for chewing hard and dry foods like normal teeth.

Healing and osseointegration period

3-6 Months: During this period, osseointegration, the fusion between the implants and the bone, takes place. This is vital for the implant to firmly attach to the bone.

During this period, the patient should eat soft foods, refrain from smoking, and pay close attention to oral hygiene (using special interdental brushes and an oral irrigator).

Check-ups: The patient is called in for check-ups at regular intervals, stitches are removed, and healing is monitored.

Fabrication of the permanent prosthesis

The permanent prosthesis is fabricated after osseointegration is complete.

New measurements: Once healing is complete, much more precise measurements are taken.

Trials: The gum color, shape, color, size, and occlusion of the teeth are determined by conducting trials on a wax model together with the patient.

Permanent prosthesis fabrication: The permanent prosthesis is usually a ‘hybrid’ design. Aesthetic and natural-looking ceramic or acrylic teeth are added to a sturdy frame made of titanium or zirconium in the substructure. This prosthesis cannot be removed by the patient for cleaning and is completely fixed.

Fitting and delivery: The permanent prosthesis is screwed onto the implants, the closure is checked, and it is made ready for patient use.

Maintenance and long-term follow-up

Professional care: Patients should attend check-ups every six months. The prosthesis is removed, the implants and gum pockets are measured and checked, and professional cleaning is performed.

Home care: Cleaning around the implant using special dental floss (superfloss), interdental brushes, and an oral irrigator (waterpik) is vital. Otherwise, there is a risk of peri-implantitis (inflammation around the implant).

All-on-4 and All-on-6 are both fixed prosthesis solutions developed for completely edentulous patients. The most significant difference between them is the number of implants used and the resulting difference in the application strategy.

All-on-4

As the name suggests, it is based on the principle of placing four implants in one jaw. Two of these four implants are typically positioned at a 30-45 degree angle in the rear region. The purpose of this specific angulation is to ensure the most efficient use of the existing bone, even if the patient's bone structure is limited (e.g., near the sinus cavity or with reduced bone height), without the need for complex surgeries such as additional bone grafting or sinus lifting. Therefore, All-on-4 is often an ideal and more economical starting option for patients with low bone volume who wish to avoid additional surgical procedures.

All-on-6

This is a more comprehensive protocol involving the placement of six implants in one jaw. The presence of two extra implants creates a wider support area for the prosthesis and superior mechanical balance. The forces generated during chewing are distributed more evenly and balanced among the six implants, reducing the load on each individual implant. All-on-6 generally offers higher bite force, better long-term bone preservation, and exceptional stability. It is a recommended treatment for patients who have sufficient bone volume even if the bone structure is moderately resorbed, who wish to regain chewing function to the highest degree, and who seek maximum assurance of longevity.

Advantages of All-on-6 Treatment

Mechanical stability and function:

The broad support area provided by six implants gives the prosthesis exceptional balance and durability. This provides chewing performance closest to that of natural teeth. You can comfortably consume foods such as hard fruits, meat, or nuts, and you will notice a significant increase in your biting force. There is no movement or slippage in the prosthesis, and your speech becomes clearer.

Excellence in bone preservation:

Implants provide mechanical stimulation to your jawbone, similar to natural tooth roots, halting the resorption process that begins after tooth loss. This means your facial contours are preserved, lip support is maintained, and a more youthful facial appearance is retained in the long term. Since bone loss is prevented, the lifespan of the treatment is also extended.

Strategic placement to avoid additional surgery:

One of the greatest advantages of All-on-6 is that the implants can be placed at specific angles. This means that even in areas with limited bone volume (e.g., near the sinus cavity), treatment can usually be carried out without the need for additional, costly, and lengthy surgical procedures such as bone grafting (additional bone powder) or sinus lifting.

Rapid rehabilitation with ‘same-day teeth’:

Immediately after the surgical procedure, a temporary but fixed prosthesis can be fitted. You will never be without teeth. You regain your aesthetic appearance and basic chewing function almost immediately. This is psychologically extremely motivating and provides an instant improvement in quality of life.

Comfort compared to removable dentures:

You are free from all the disadvantages of removable dentures, such as putting them in and taking them out, using adhesive, covering the palate, or causing discomfort or irritation. Your denture becomes an integral, fixed part of your mouth. Your sense of taste (for the upper jaw) remains completely unaffected.

A long-term, predictable, and economical solution:

With proper planning, high-quality materials, and regular maintenance, All-on-6 prostheses can provide decades of trouble-free service. Considering the additional costs associated with removable dentures, such as periodic replacement and the need for liners, All-on-6 implants offer a more economical and definitive solution in the long term. The radical improvement in quality of life is the most valuable return on investment.

Disadvantages of the All-on-6 treatment

Relatively high initial cost:

All-on-6 requires a complex surgical procedure, multiple high-quality implants, and a carefully prepared prosthesis. Therefore, the initial investment cost is higher compared to traditional removable dentures or protocols involving fewer implants. However, considering its long-term durability, comfort, and lack of additional expenses, it is considered a cost-effective option.

It is a comprehensive surgical procedure.

Although performed using minimally invasive techniques, the placement of six implants is a surgical operation. It requires local anesthesia or sedation. Swelling, slight bruising, and discomfort lasting a few days after the procedure are normal. This process can be easily managed with the correct medication and care.

Specific bone volume requirement:

The notion that ‘All-on-6 always eliminates the need for additional bone grafting’ is not absolute. In patients with very advanced and widespread bone loss (severe atrophy), there may not be sufficient bone to safely accommodate six implants. In this case, either preparation with bone grafting is required, or an alternative protocol such as All-on-4, which works with fewer implants, can be considered. Your dentist's analysis using 3D tomography will determine the final decision in this regard.

Risk of complications (present, albeit low):

As with all surgical procedures, there are theoretical risks such as infection, temporary numbness due to nerve damage, or failure of the implant to fuse with the bone (osseointegration failure). However, when performed by an experienced surgeon under sterile conditions and with meticulous planning, these risks are minimized to a great extent. Factors such as smoking or uncontrolled diabetes may increase these risks.

Requires careful and regular maintenance:

All-on-6 prostheses do not decay like natural teeth, but there is a risk of inflammation of the surrounding tissue (peri-implantitis). Therefore, it is essential to maintain regular and proper oral hygiene using special implant brushes and interproximal cleaners. In addition, professional checkups at least once a year are key to ensuring a long lifespan.

All-on-6 cannot be applied in some specific cases or requires very careful evaluation.

Those who are not suitable:

• Those with uncontrolled systemic diseases: diabetes, heart disease, or untreated bleeding disorders.
• Young people whose bone development is not complete (usually under 18-20 years of age).
• Those with severe substance addiction (more than one pack of cigarettes per day, alcohol addiction).
• Those with severe psychiatric disorders or dementia who are unable to comply with treatment.

Those requiring careful evaluation:

• Those with very advanced bone loss may require prior bone grafting or consideration of All-on-4.
• Individuals with a controlled chronic condition (diabetes, osteoporosis) (a doctor's consultation is required).
• Those with severe teeth grinding/clenching (bruxism) must use a night guard.
• Those who will not maintain good oral hygiene or attend regular check-ups.
• Pregnant women and breastfeeding mothers (treatment should be postponed).

All-on-6 dental implant prices may vary depending on the clinic, materials used, and additional procedures. Average prices:

Is the All-on-6 procedure painful?

No pain is felt as it is performed under local anesthesia or sedation. Mild swelling and discomfort may occur during the recovery period.

How many sessions are required for All-on-6?

• Session: Examination and planning
• Session: Implant placement
• Session: Prosthesis fitting

How long does All-on-6 treatment take?

A temporary prosthesis is usually fitted within 1-3 days. A waiting period of 3-6 months is required for the permanent prosthesis.

How long do All-on-6 implants last?

With regular maintenance, they can last 20-30 years. Bone health and oral hygiene affect their lifespan.

Can All-on-6 be applied to those with bone loss?

Yes, angled implants and special techniques can be used without requiring bone grafting.

How is the All-on-6 prosthesis cleaned?

Cleaning the All-on-6 prosthesis involves a comprehensive oral care routine that includes daily brushing with special tools and flossing, as well as regular dental check-ups to ensure the implants remain durable and healthy.

Does speaking become difficult with All-on-6?

Slight slurring is normal for the first 1-2 weeks.

The tongue muscles adapt to the new denture within 7-10 days.

Temporary difficulty may be experienced, particularly with the letters ‘s,’ “t,” and ‘z.’.

Can the All-on-6 denture be replaced?

Yes, if the prosthesis material wears out (on average after 10-15 years), it can be replaced. The implants do not change; only the superstructure is replaced.

Can smile design be done with All-on-6?

Yes, the shape, color, and alignment of the teeth are custom designed (can be combined with a Hollywood smile).

Do All-on-6 implants damage the jawbone?

No, titanium is biocompatible and fuses with the bone. On the contrary, it has an effect that slows down bone resorption.