All-on-4 vs. All-on-6

5D Smiles does not place All-on-4. We place All-on-6 on every full-arch case, sometimes eight, on the same single-day surgery. The four-implant design was settled on in the 1990s for surgical speed and lower cost — not for longevity.

A table on four legs falls when one leg slips. Six holds. Your jaw cycles through more than 80,000 chews a year. We build for the cycle count, not the brochure.

The surgery is the same length, the same sedation, the same same-day fixed arch. The only thing that changes is whether a single implant complication can defeat your entire restoration thirty years from now.

Picture a table built on four legs. It works fine — until one leg slips. The whole table comes down. That is what a single implant failure does to an All-on-4 arch: lose one of the four, and the entire bridge is at risk. The remaining three implants were never designed to carry the load alone.

Now picture six legs. Lose one and the table still stands on five. You can repair the failed leg without taking the whole structure apart. That is the margin of safety we want every patient to have for the next thirty years of chewing — not five.

The math is not subtle. With six implants instead of four, you have two extra anchor points absorbing bite force, two extra integration sites, and two extra fallbacks if one ever fails. That is the biology-first call.

Published 10-year survival on All-on-4 is in the 94–97% range. That sounds high until you look at what happens on the cases that fail: an All-on-4 failure means losing the whole arch, not one implant. The all-or-nothing geometry is the problem.

Six-implant full-arch designs consistently show higher long-term implant-level survival in peer-reviewed cohorts — often 98%+ at 10 years — and far better tolerance for the inevitable biological variation across six sites. When one of six implants has a problem, the prosthesis is almost always salvageable. When one of four does, it usually is not.

Our practice tracks our own outcomes: 98.6% 10-year implant survival on the six-implant design. The number that matters more is that we have never had a patient lose an arch.

The original All-on-4 protocol was developed in the 1990s when implants were expensive, CT planning was rare, and the goal was to get edentulous patients out of dentures as cheaply as possible. Four implants was the minimum viable count that met that goal. The technique was a major step forward for its time.

Three decades later, the math has changed. Implants are cheaper, CT planning is standard, and surface treatments have made integration far more reliable. The case for four-as-a-floor is much weaker now. The reason it persists in the industry is institutional inertia and a marketing brand — not biology.

Most large corporate implant chains still default to All-on-4 because it is faster to produce, easier to bill, and protected by a name patients recognize from advertising. We made a different choice.

Every full-arch case at 5D Smiles is planned as All-on-6 from the CT scan forward. Six implants per arch, two-stage planning, surgical guide printed from your specific anatomy, IV sedation, same-day temporary bridge, final zirconia bridge at the 4-month mark.

For patients with limited posterior bone, we do not retreat to four implants — we add bone. Sinus lifts, ridge augmentation, and tilted posterior implants let us reach six anchor points in almost every case. Bone grafting, when needed, is included in the All-on-6 price; we do not charge it separately the way most offices do.

For patients with extreme upper-jaw atrophy where even grafting cannot rebuild the posterior, we place zygomatic implants anchored in the cheekbone. The geometry still gets to six anchor points. The principle does not bend.

All-on-6 starts at $24,000 per arch, all-inclusive. That covers the $145 consultation, 3D CBCT scan, surgical guide, all six implants, IV sedation with an in-house anesthesia provider, same-day temporary bridge, every post-op visit, and the final zirconia bridge. The zirconia carries a lifetime warranty against fracture or wear.

Bone grafting and sinus lifts, when needed to reach the six-implant geometry, are included in the All-on-6 price — not itemized as a separate line on the treatment plan. We made this call because the surgical complexity is part of giving you six anchor points, not an add-on for a fancier option.

Financing up to $60,000 at 0% APR brings the monthly cost to roughly $333 per arch. The exact number, based on your CT scan and case complexity, is written down at your $145 consult.

If you have been quoted All-on-4 by another office, you do not have to take it. Bring the imaging and the treatment plan to your $145 consult — we will walk you through the difference on your specific anatomy. The CBCT we take here will show you exactly where the six anchor points would go and what the biological margin looks like compared to four.

We do not lecture and we do not push. We tell you what we would do for ourselves, why, and what the long-term data says about the choice. Then you decide. The $145 deposit applies to your treatment when you book — book treatment.

Forty-five minutes with Dr. Qiu personally — not a treatment coordinator. You leave with a written plan, exact pricing, and a clear understanding of why six holds when four would not.