Implant denture or fixed bridge (All-on-4)?

Two solutions, two principles

	Denture on implants	Fixed bridge on implants (All-on-4 / All-on-6)
Attachment	Snaps onto 2 to 4 implants and is taken out every day	Screwed onto 4 to 6 implants; only the dentist can remove it
Number of implants	Lower jaw: often 2. Upper jaw: usually 4	Usually 4 to 6 per jaw
Feel	Far more stable than a denture, but still removable	Close to natural fixed teeth, no plastic palate
Cleaning	Simple: the denture is cleaned outside the mouth	Brushes and water flosser under the bridge, regular check-ups
Bone needed	Less demanding	More demanding; sometimes a bone graft or zygomatic implants
Cost	More affordable	Higher

The implant denture: the standard in the lower jaw

A conventional lower denture often fits poorly: the tongue lifts it, the bone has shrunk and there is no suction as there is against the palate. Two implants are usually enough to stabilise it. The international McGill (2002) and York (2009) consensus statements therefore recommend the lower denture on two implants as the first-choice treatment for the toothless lower jaw, because it clearly improves chewing and quality of life with limited cost and surgery.

From the age of 70, these two implants may be partly reimbursed by INAMI/RIZIV under certain conditions: see Lower denture after 70: two implants reimbursed.

In the upper jaw, a denture usually holds better thanks to the palate. When it needs stabilising on implants, four are usually required, and the denture can then leave the palate free.

The fixed bridge: teeth that stay in

The full bridge is screwed onto the implants. It does not come out at night: for many patients, that is the main difference. It does not cover the palate, which preserves taste and the feel of food.

With the All-on-4 principle, four implants are placed, the back two often tilted to avoid the sinus in the upper jaw or the nerve in the lower jaw, which in some cases avoids a bone graft. The follow-up published by Paulo Maló's team over 10 to 18 years in the lower jaw shows high implant and bridge survival, provided there is regular follow-up. Depending on the bone available, six implants may be better, particularly in the upper jaw.

When the implants are stable enough at placement, a temporary bridge can be fixed the same day or in the following days. The final bridge is made after healing, usually a few months later.

How to choose?

The choice does not depend on the patient's preference alone. At the consultation, with a 3D scan, Dr Yousefpour assesses:

the bone available: height, width, proximity of the sinus and nerve. Very resorbed bone in the upper jaw may call for a bone graft, short implants or zygomatic implants;
lip and facial support: after major bone loss, the false gum of a denture supports the lip. A fixed bridge sometimes cannot provide that support;
daily hygiene: a denture is simple to clean; a fixed bridge needs more precision, especially later in life or with reduced dexterity;
general health, smoking and medication: see Who can have a dental implant?;
budget: the estimate lists the number of implants, any bone graft and the prosthesis.

A denture on implants can also be a first step: if the implants are well placed, it is sometimes possible to move to a fixed solution later by adding implants.

How it works

Consultation and 3D scan at the practice, with a digital impression.
Planning of the implant positions according to the future teeth, with the dentist who makes the prosthesis.
Surgery: any extractions and placement of the implants, under local anaesthesia, sedation or in hospital depending on the extent.
Temporary phase: adjusted denture or temporary bridge.
Final prosthesis after healing, then regular check-ups.

Frequently asked questions

Does a denture on implants still move?

Far less than a conventional denture. It stays removable: you take it out to clean it, and the small attachments wear and are replaced over time.

Is a fixed bridge always possible?

No. It depends on the bone, the space available, lip support and the ability to clean it thoroughly. When bone is lacking, a bone graft or other implants can be discussed.

How long do these solutions last?

Implants can last many years. The parts of the prosthesis need maintenance: replacing the clips of a denture, occasional repairs to a bridge. Regular check-ups are essential.

Can I have fixed teeth on the day of surgery?

Sometimes, with a temporary bridge, if the implants are stable enough at placement. That decision is made during surgery, according to the stability achieved.

In short

The denture on two implants is the standard solution for the lower jaw; it is easy to clean and more affordable.
The fixed bridge on four to six implants gives teeth that stay in, but needs more bone, more care and a larger budget.
The choice is made after a 3D assessment, according to the bone, facial support, hygiene and your expectations.

More on full-jaw solutions: Restoring a full arch with implants.

Sources

Feine JS et al. The McGill consensus statement on overdentures. Int J Oral Maxillofac Implants, 2002.
Thomason JM et al. Mandibular two implant-supported overdentures as the first choice standard of care for edentulous patients — the York Consensus Statement. Br Dent J, 2009.
Maló P et al. The All-on-4 treatment concept for the rehabilitation of the completely edentulous mandible: a longitudinal study with 10 to 18 years of follow-up. Clin Implant Dent Relat Res, 2019.

This article is general information. Only a consultation can determine which solution suits your situation.

Implant-retained denture or fixed bridge (All-on-4): how to choose?