All-on-6 Dental Implants in Astana: Indications, Stages, and Results

Design: supports, bar, denture

Six screws are placed in the bone: usually four in the front and two in the back at an angle. The front ones go into the dense area that remains even when bone volume is lost. The back ones are tilted to avoid the sinuses and avoid grafting. The screws are connected by a bar. It redistributes force between the supports and holds the denture. The denture itself is a full-arch bridge: artificial teeth and a gum section on a single framework. The framework is attached to the bar with screws. The dentist can remove it for cleaning and examination. This scheme differs from single implants: there, each screw carries its own crown, while here the load is shared. The number of supports and their positions are chosen based on imaging and depend on the clinical picture. The bone thickness in the area of the planned sites and the course of the inferior alveolar nerve in the lower jaw are assessed separately.

Why the load is distributed differently than with a removable denture

A removable denture rests on the gums and is supported by them. Chewing pressure goes to the mucosa, not into the bone. This causes sore spots, movement when speaking, and loss of tissue volume over time. With supports, the mechanics are different. The force passes through the screws into the bone and is distributed across all six points. The bar works as a single frame: if one area is loaded, part of the force is transferred to the neighboring supports. The denture does not press on the gums like a cushion. It is held on the framework. That is why there is no daily shifting and no related restrictions on food. How evenly the load is distributed is decided by the dentist: the tilt angle of the back screws, bone density, and the precision of the bar fit all matter. With poor distribution, one support becomes overloaded, and this is visible on follow-up imaging.

Situations in which the protocol is considered

When the decision is made only after examination

The list above describes typical cases, but by itself it decides nothing. The final choice is made after an oral examination, imaging, and assessment of bone density in the areas of the planned supports. The dentist looks at how the chewing load will be distributed, whether there is enough room at an angle for the back implants, and whether there is inflammation in the gums. Sometimes a patient comes in with complete edentulism, but imaging shows that some roots can be preserved and less intervention will suffice. The opposite also happens: outwardly everything seems suitable, but the condition of the mucosa or the bite requires preparation first. The decision depends on the clinical picture, and it is made by the dentist, not by a questionnaire. That is why the same diagnosis in two people can lead to different plans.

Comparison of the two schemes by key criteria

What changes for the patient

For a person, the difference shows up in how chewing feels and in how the prosthesis sits on the jaw. Four supports hold the structure in place thanks to the tilt of the rear implants — the technique works, but the prosthesis cantilever extends further, and the load on the far end is higher. Six supports allow the implants to be placed straighter and the pressure to be distributed more evenly. That is where the difference in sensation comes from: for some people a four-support structure behaves calmly for years, for others it loosens sooner. What will suit a particular case is decided by the doctor after an examination and imaging. Sometimes anatomy dictates the choice: thin bone in the posterior regions, jaw shape, bite. The price of All-on-4 implantation is often lower, and that is a clear reason why patients ask specifically about four supports. But saving on supports is not always justified: if there is enough bone, a sixth support adds stability. If there is not, it will not be forced. Both schemes are not interchangeable templates but two different engineering solutions.

How the supports are distributed along the jaw

Why the number of supports is sometimes reconsidered

Six is not a dogma but a working scheme for a typical situation. If the volume and density of bone in some area are low, the doctor may add a seventh or eighth support to distribute the load and avoid relying on a weak zone. The opposite also happens: with good bone and a short arch, the number of supports is reduced — sometimes to four, and then it is already a different protocol. The doctor decides based on imaging and the clinical picture. How the patient clenches the jaw also matters: with pronounced bruxism, more supports may be needed than with a calm chewing pattern. The condition of the gums and how the prosthesis will seat are assessed separately. Sometimes the mandibular canal or the maxillary sinus gets in the way, and then the axis of the support is changed rather than the number. Reconsidering the number of supports is not a departure from the method but its adjustment to a specific jaw.

When there is enough bone tissue

The upper jaw is structured differently from the lower one. Under the maxillary sinus the bone is thin, and after tooth loss it resorbs faster. But there is not always a shortage. If the height of the ridge allows an implant of the required length to be placed at an angle, bypassing the sinus, a separate grafting operation is not needed. Sometimes it is enough to tilt the implant backward — this way the sinus is bypassed and the implant rests on the patient's own bone. The decision is made based on imaging, not on sensations. A CT scan shows the height and density of the bone at every point. The doctor looks at where the implant axis will run, whether it will touch the sinus, and whether there is enough bone tissue around it for stability. If yes, a sinus floor lift is avoided. If not, the operation is planned in advance, sometimes together with implant placement, sometimes as a separate stage. This depends on the clinical picture.

Options depending on the situation in the upper jaw

Complications that occur in practice

How each of them is handled

The approach depends on the clinical picture. In mucositis, plaque is removed, hygiene is adjusted, and the patient is monitored: if the gum calms down, nothing further is needed. Peri-implantitis requires more serious intervention — cleaning, antiseptic treatment, and sometimes flap surgery. The implant is usually preserved if possible. An implant fracture almost always means removal: the integrity of the body cannot be restored. Loosening is assessed on imaging: if the surrounding bone is preserved, the implant can be left under observation; if bone loss is significant, it is removed and a new one is planned. A prosthesis fracture is repaired or the structure is remade. A loosened screw is tightened, and if it loosens again, it is replaced with a new one. The decision is made by the doctor after examination and imaging. Sometimes correction is enough; sometimes the component needs to be replaced. The prognosis depends on how early the problem was noticed and what caused it. Regular check-ups help catch the process at the beginning, when it is easier to correct.

Home hygiene around the supports and prosthesis

Follow-up visits: what is checked at them

The frequency of check-ups is set by the doctor: it depends on the clinical picture, hygiene, and gum condition, so there is no universal schedule. At the appointment, the fit of the prosthesis and the condition of the supports are checked, the gums around them are assessed, and plaque and calculus are removed. The bite is checked separately: it changes over time, and uneven loading affects the structure. The screws connecting the prosthesis to the supports are checked for tightness and tightened if necessary. X-rays are taken as indicated — they show the bone around the implants, and that is what cannot be seen from the outside. If a person wears a removable prosthesis on supports, the visit includes checking whether sore spots have appeared and whether the attachments have loosened. If there are complaints of mobility, pain, or bleeding, the examination is performed earlier, outside the established interval. Between visits, the task is simple: do not skip home cleaning and do not postpone the visit if something changes. What exactly to do in a specific case is decided by the doctor after examination.

What to pay attention to when choosing a clinic

What questions to ask at the consultation

At the appointment, it is worth finding out what scope of diagnostics is needed in your case: whether CT is enough or additional tests are required. Ask who will perform the surgery and who will manage the patient afterward — these may be different specialists. Clarify what structure is planned: conditionally removable or fixed, what material it is made of, and how it will be fabricated. Separately discuss what to do in case of complications: peri-implantitis, loosening, or breakage of a component. Ask to see the contract before treatment begins and to explain each point. Ask what service life of the structure is considered normal and what it depends on. If the clinic offers installment payments, clarify the terms and the overpayment. It is useful to ask how the follow-up schedule is organized: when the first examination is and when the next one is. Finally, find out what is covered by the warranty and what is not. The answers to these questions show how ready the team is to discuss details, not just sell a service.

What determines the outcome

The outcome depends on several factors, and none of them works in isolation. The volume of bone in the posterior regions, its density, the condition of the gums, and hygiene before surgery. If there is not enough bone, it is augmented or the placement protocol is changed. This is decided by the doctor based on imaging, not by the patient's preference. Inflammation in the oral cavity is treated first, then surgery is performed: placing implants against a background of active periodontitis is risky. Smoking, uncontrolled diabetes, and the use of certain medications affect osseointegration, and this is discussed openly during the consultation. The precision of implant positioning and the quality of the prosthesis itself are also on the list. And one more thing: how the person cares for the restoration at home and whether they come in for follow-up visits. Here the outcome depends on the clinical picture and on discipline, not on the name of the system. The prognosis is discussed on an individual basis, and an honest answer sounds like "it depends on the case," not like a promise.

What remains the responsibility of the doctor and the patient

The doctor is responsible for diagnosis, the treatment plan, the surgical stage, and the prosthetic part. They evaluate the imaging, choose the protocol, monitor how osseointegration is progressing, and adjust the prosthesis if something is interfering. The doctor is obligated to warn about risks and about the fact that some of them do not depend on their actions. The patient is responsible for hygiene and for showing up to appointments. Cleaning around the implants, interdental brushes, an oral irrigator, and giving up the habit of biting hard objects. Smoking and missed visits are a common cause of problems that then have to be dealt with. Neither side can carry this work alone. The patient cannot see developing inflammation around an implant on their own, and the doctor cannot brush their teeth at home for them. That is why follow-up visits are not a formality but part of the treatment. If something is bothering them between visits, they should report it without waiting for the scheduled appointment.