Comparison of 4- or 6-implant supported immediate full-arch fixed prostheses: A retrospective cohort study of 217 patients followed up for 3-13 years.

Abstract

Choosing four or six implants to support immediate full-arch fixed prostheses (FAFPs) is still controversial worldwide. This study aims to analyze and compare the long-term results of All-on-4 and All-on-6. This retrospective cohort study enrolled 217 patients rehabilitated with 1222 implants supporting 271 FAFPs, including 202 prostheses supported by 4 implants (All-on-4 group) and 69 prostheses supported by 6 implants (All-on-6 group), and followed up for 3-13 years. Implant survival, prosthesis survival, complications, and implant marginal bone loss (MBL) were evaluated and compared between two groups. Patient characteristics including age, gender, jaw, opposite dentition condition, smoking habit, bruxism, bone quantity and quality, cantilever length (CL), prosthesis material, and oral hygiene were analyzed to assess their influence on the clinical results of the two groups. Six surgeons and three prosthodontists who performed FAFPs more than 5 years were invited for questionnaires, to assess patient- and clinician-related influences on implant number. In general, All-on-4 group indicated no significant difference with All-on-6 group in the implant survival (implant-level: hazard ratio [HR]=1.0 [95% confidence interval (CI): 0.8-1.2], P=0.96; prosthesis-level: HR=0.8 [95% CI: 0.3-1.8], P=0.54), prosthesis survival (odds ratio [OR]=0.8 [95% CI: 0.3-2.8], P=0.56), biological complications (OR=0.9 [95% CI: 0.5-1.8], P=0.78), technical complications of provisional prosthesis (OR=1.3 [95% CI: 0.7-2.3], P=0.42), technical complications of definitive prosthesis (OR=1.1 [95% CI: 0.6-2.2], P=0.33) and the 1st, 5th, and 10th year MBL (P =0.65, P =0.28, P =0.14). However, for specific covariates, including elderly patients, opposing natural/fixed dentition, smoking, bruxism, long CL, low bone density, and all acrylic provisional prostheses, All-on-6 was more predictable in some clinical measurements than All-on-4. The implant prosthodontists and the medium-experienced clinicians showed significant preference for All-on-6 (P <0.05). Based on this study, the long-term clinical results showed no significant difference between All-on-4 and All-on-6 groups in general. However, for some specific characteristics, All-on-6 seemed to be more predictable in some clinical measurements than All-on-4. For the clinicians' decision-making, medium-experienced clinicians and the implant prosthodontists showed significant preference for All-on-6.