All-on-4 vs All-on-6 — Which Is Right for You?

The choice between All-on-4 and All-on-6 depends on your bone anatomy, arch dimensions, opposing dentition, and clinical preference — not on which sounds better. This guide explains the evidence behind each, the cost difference, and how Dr. Sethi makes the recommendation.

Head-to-Head Comparison

Factor	All-on-4	All-on-6
Implants per arch	4	6
Cost per arch at SD	CAD $5,500–$8,000	CAD $6,500–$9,000
Both arches at SD	CAD $10,000–$14,000	CAD $12,000–$16,000
Posterior implant design	Tilted 30–45°	Vertical or slightly tilted
Cantilever length	Longer (extends further back)	Shorter (more conservative)
Force distribution	Concentrated on 4 points	Distributed across 6 points
Bone requirement	Less (tilting bypasses atrophy)	Slightly more
Evidence base	Largest (30+ years, 98.2% @ 18yr)	Growing (15+ years, 97%+ success)
Suitable for majority?	Yes — most edentulous patients	Yes — if bone permits

When All-on-4 Is the Better Choice

Standard to moderate arch dimensions
Adequate anterior and posterior bone for tilted posterior placement
Posterior implants can be successfully tilted to avoid sinuses and inferior alveolar nerve
Cost-conscious patients seeking optimal value without compromising outcomes
Patients suitable for either protocol — All-on-4 is efficient and proven
The majority of fully edentulous Canadian patients

When All-on-6 Is Preferred

Larger arch dimensions requiring extended posterior support
Opposing natural dentition creating higher occlusal forces (>80 N biting)
Cases where longer cantilever (All-on-4) would create excessive stress
Bruxism or clenching history — six implants distribute forces more conservatively
Bone quality and density adequate for six implants without compromising implant spacing
Patient preference for additional implant redundancy and long-term margin of safety

The Decision Process at Stunning Dentistry

Protocol selection is based on clinical analysis, not cost pressure or marketing preference.

Analysis includes: 3D CBCT bone volume and density mapping, digital arch dimension measurement, opposing dentition assessment (natural teeth vs dentures), bite force analysis, and patient preference discussion.

Most Canadian patients are suitable for either All-on-4 or All-on-6 — the choice depends on your specific anatomy and clinical factors.

Dr. Sethi provides a clear recommendation based on evidence and your case specifics — you then choose based on budget and preference.

Both protocols deliver excellent long-term outcomes (>95% success at 10+ years). The difference is biomechanical optimization, not success/failure.

Cost Comparison

Scenario	All-on-4	All-on-6
One arch at SD	CAD $5,500–$8,000	CAD $6,500–$9,000
Both arches at SD	CAD $10,000–$14,000	CAD $12,000–$16,000
Travel (flights + hotel)	CAD $1,500–$2,500	CAD $1,500–$2,500
Total from Canada	CAD $11,500–$16,500	CAD $13,500–$18,500
Canadian alternative (both arches)	CAD $50,000–$70,000	CAD $56,000–$80,000
Typical savings	CAD $33,000–$63,000	CAD $37,500–$66,500

Frequently Asked Questions

Is All-on-6 inherently better than All-on-4?

No. Both are evidence-based protocols with excellent outcomes. All-on-6 offers more conservative force distribution, which benefits some patients (larger arches, heavy bite). All-on-4 is efficient and optimal for standard anatomies. The 'better' choice is the one matched to your anatomy and goals.

Can I switch from All-on-4 to All-on-6 later?

Theoretically possible but not routine. Better to get the recommendation right at assessment. If you have a clinical reason to add implants later (bone loss, implant failure), this can be discussed. Most patients are satisfied with their initial choice for 20+ years.

Does All-on-6 cost more because it's better?

All-on-6 costs more because you're getting two additional implants (and associated lab costs). More implants = higher cost. But 'more' doesn't always mean 'better' — it means better for specific anatomies. Your case determines the optimal choice, not budget.

What is the biggest difference between them functionally?

For patients suitable for either: All-on-4 has longer posterior cantilever (extends further), All-on-6 has shorter cantilever with more implant support points. Both feel and function identically to patients — the difference is biomechanical, not experiential. Long-term outcomes are essentially equivalent.