Batna Journal of Medical Sciences
Volume 13, Numéro 1, Pages 128-135
2026-05-01

Comparison Of All-on-4 And All-on-6 Techniques In Implant-supported Rehabilitation: Scientific Analysis Of The Literature

Authors : Houari Hakima . Amroun Linda . Houari Fatima Zohra . Bouheka Ali . Benchaa Chourouk . Benkhouda Nadia . Bendouma Chahra . Chorfi Abd-elkader .

Abstract

Introduction Implant-supported rehabilitation of edentulous arches has evolved considerably with the introduction of the All-on-4 and All-on-6 protocols. By relying on immediate loading strategies and a reduced number of implants, these concepts have contributed to improved functional outcomes, prosthetic stability, and patient comfort. In this context, the present article provides a comparative analysis of both techniques based on recent findings from the international literature. Methods A structured bibliographic search was performed using PubMed and Google Scholar databases, including publications in both English and French. Only clinical studies addressing the All-on-4 and All-on-6 protocols were considered eligible. Among the 83 articles initially identified, 16 met the predefined inclusion criteria and were selected for detailed analysis. The evaluated outcomes included osseointegration, implant and prosthetic survival, marginal bone loss, biological and mechanical complications, and patient satisfaction. Results Comparable osseointegration rates were reported for both protocols, ranging from 94.6% to 100%. Overall implant survival exceeded 95% in most studies, with no consistent or statistically significant differences observed between the two techniques. The All-on-6 concept may demonstrate a slight advantage in some studies and specific clinical situations such as atrophic maxillae, bruxism, and extended cantilevers, although this finding is not consistently reported across the literature. Prosthetic survival approached 100% for both techniques; however, the rate of strict success, defined as prostheses requiring no maintenance or repair, was occasionally lower with the All-on-4 protocol. Biological complications, including peri-implantitis and mucositis, were reported in some studies more frequently in All-on-4 configurations (10.3%) compared with All-on-6 (1%). Mechanical complications such as fractures and screw loosening occurred at comparable rates in both groups, although rigid splinting was associated with a reduction in their incidence. Patient satisfaction remained high for both approaches (86–97%), with a slight tendency reported in some studies in favor of All-on-6, particularly in complex clinical cases. Conclusion Overall, both All-on-4 and All-on-6 can be considered reliable options for full-arch implant-supported rehabilitation. The All-on-4 protocol remains a less invasive and more cost-effective approach, but may be associated with increased biomechanical stress and a slightly higher incidence of complications. In contrast, the All-on-6 concept may provide improved force distribution, lower complication rates, and greater predictability in situations involving increased biomechanical risk. Consequently, protocol selection should be based on the individual clinical profile of the patient, with All-on-4 being particularly suitable for cases of severe posterior atrophy, and All-on-6 preferred when bone volume permits or when risk factors such as bruxism, low bone density, or long cantilevers are present.

Keywords

All-on-4 ; All-on-6 ; dental implants ; complete rehabilitation ; implantology