The difference between All-on-4 and All-on-6 is not mainly the number of implants but the safety reserve. If one of four implants is lost, a fixed bridge is no longer possible; with six, five remain and the bridge can stay. At TB Dent in Trebinje, All-on-6 costs €1,534 (3,000 KM) more per jaw: from €6,650 compared with €5,110 for All-on-4. Visits, healing time and warranty are the same. Whenever there is enough bone, we recommend six.
What is the difference between All-on-4 and All-on-6?
All-on-4 and All-on-6 are both fixed bridges for a whole jaw, screwed onto four or six implants instead of replacing each tooth separately. With All-on-4 the two back implants are placed at an angle, so they avoid the area where bone is often missing and the sinus. That is why, for most patients, All-on-4 works without bone grafting. All-on-6 needs enough bone for six implants and spreads the chewing force over more support points.
At TB Dent we do around 60 All-on-4 and 40 All-on-6 treatments a year. Everything except price, surgery time and the safety reserve is identical.
What do you really pay for with All-on-6?
With All-on-6 at TB Dent you are not paying €1,534 for two extra implants. You are paying for the option to stay on a fixed bridge if something goes wrong.
With All-on-4 the whole jaw rests on four support points. If one implant is lost, a fixed bridge cannot be made on the remaining three, and you would move to some form of denture. With All-on-6, losing one implant still leaves five, which is enough to keep the fixed bridge.
For a patient who lives across an ocean, that reserve is worth more than for someone who can reach us within a week. A problem far from home is harder to fix quickly, so the extra margin matters more.
Do All-on-6 implants last longer than All-on-4?
We have no measurable data showing that a bridge on six implants lasts longer than one on four, when both are done properly and checked regularly. The advantage of six is how the force is spread and the reserve, not a promise of a longer life. We would not claim more than that.
When do we recommend All-on-4, and when All-on-6?
At TB Dent we recommend All-on-6 whenever there is enough healthy bone for six implants, and All-on-4 when the bone does not allow six or when the patient chooses four for financial reasons.
Can it be five implants?
Yes. The number of implants is not always four or six. When the anatomy allows five but not six, we place five. The number follows the bone, not a fixed concept, and you get the exact plan after a CBCT scan, before you pay anything.
Is the choice different for the upper and lower jaw?
No. The deciding factor is the amount and quality of bone, the same for both jaws. What does differ is healing: the lower jaw takes about four months, the upper jaw three to four.
What are the downsides of each?
The downside of All-on-4 is the missing reserve: if one implant fails, the fixed bridge cannot stay. The downsides of All-on-6 are a higher price, a longer surgery (about 1.5 hours per jaw instead of about 1 hour) and the need for enough bone for six implants.
Neither option is painful during surgery, because both are done under local anaesthetic. Pain afterwards varies from person to person; most patients have little or none, and a standard painkiller is enough when it does appear. Swelling usually lasts a few days and is minimal, because we give a dexamethasone injection during surgery.
What if there is not enough bone?
For All-on-4, bone grafting is rarely needed, because the angled back implants avoid the areas where bone is missing. When grafting is needed, it costs 200 KM (€102) per gram of bone, and a sinus lift 200 KM. Whether you need either shows on the CBCT scan, so you know the exact price before treatment.
How many trips to Trebinje do both options take?
Both All-on-4 and All-on-6 at TB Dent take two trips to Trebinje and seven working days in total. On the first trip, two days, any remaining teeth are removed, the implants are placed and a scan is taken. You spend one night without teeth while the technician makes the temporary fixed bridge, and you get it the next day.
The second trip, three to four months later, takes five working days for the final bridge. Prices include implants, abutments, the temporary bridge, the final bridge, anaesthesia and check-ups. A zirconia bridge costs €1,534 extra per jaw, and both jaws at once bring a 10% discount. How the trips work, entry rules and aftercare are covered in our guide to dental tourism in Bosnia and Herzegovina.
How is the decision made?
The decision between All-on-4 and All-on-6 at TB Dent is made on a CBCT scan, which shows how much bone you have and how dense it is. From it, the surgeon proposes the number of implants and gives you the exact price.
The plan is made and the surgery performed by Dr Darijo Pandžić, a specialist in oral surgery. If you live abroad, send your CBCT scan on WhatsApp and you get the plan and price before you buy flights. The consultation is free and can be in English.
Questions patients ask about All-on-4 and All-on-6
Which is better, All-on-4 or All-on-6?
When there is enough bone, All-on-6, because it keeps a fixed bridge possible even if one implant is lost. When the bone does not allow six, All-on-4 is the right choice and usually works without bone grafting.
How much more does All-on-6 cost than All-on-4?
At TB Dent, €1,534 (3,000 KM) more per jaw. All-on-4 starts at €5,110 and All-on-6 at €6,650 per jaw with Neodent implants.
What happens if one implant fails with All-on-4?
A fixed bridge can no longer be made on the remaining three implants, so you would move to some form of denture. With All-on-6, five implants remain and the fixed bridge can stay.
Do All-on-6 implants last longer?
There is no measurable data showing that six last longer than four when both are done properly and checked regularly. The advantage of six is the reserve and the spread of force.
Is All-on-6 more painful than All-on-4?
Both are done under local anaesthetic, so the surgery itself is not painful. All-on-6 takes about half an hour longer per jaw; recovery is similar.
Do All-on-4 and All-on-6 need the same number of trips?
Yes. Both take two trips to Trebinje and seven working days in total, with three to four months of healing in between.
