Understanding the dental engineering behind a long-lasting and functional smile.
Key Points:
- Beyond Aesthetics: The success of a rehabilitation is not just seen; it is felt in the stability while chewing.
- Technical Personalization: The number of implants (4, 5, or 6) is not a random choice but a decision based on bone density and muscular power.
- The Biomechanical Factor: A patient with high bite force or bruxism requires more support points to avoid treatment failure.
- Precision Technology: 3D tomography allows for the simulation of loads before surgery to choose the ideal configuration.
- Smart Investment: Adding extra support today can prevent expensive repairs in the future.
I remember perfectly the day Ricardo walked into my office. He was a man in his 60s, robustly built, and with one of those personalities that fills a room. Ricardo had lost almost all of his upper teeth and had spent years struggling with a removable prosthesis that, in his own words, “was his worst enemy”. But what struck me most was not his missing teeth, but the massive wear on the few he had left and the unusual development of his masseter muscles. Ricardo didn’t just chew; he crushed with an extraordinary amount of power.
He came in convinced he wanted an “All-on-4” because he had read about it in a magazine. “Doctor, just put in the four screws and let’s get this done today,” he said confidently. However, my responsibility as an expert is not to deliver what the patient asks for initially, but what their biology needs to succeed. After analyzing his case, I knew that if I placed only four implants, we would be facing fractures or bone loss in less than two years. Ricardo didn’t need a standard technique; he needed an engineering solution tailored to him.
Why the Number of Implants Cannot Be a “Promotion”
In modern commercial dentistry, it is very easy to fall into the temptation of selling packages: “All-on-4 at a single price”. But the human mouth doesn’t work that way. When we talk about biomechanics, we are referring to how physical forces interact with biological structures.
Imagine for a moment that we are installing a very heavy marble table. If the table is small, four legs at the corners will be enough. But if the table is long and we also plan to put heavy objects on it constantly, any engineer would tell you that we need six legs so that the center doesn’t sag and the legs don’t break.
In Ricardo’s case, his bite force was the “weight” on that table. By opting for a protocol of 6 implants (All-on-6) instead of the traditional 4, we were able to distribute that massive load much more efficiently. Each of Ricardo’s implants now receives a lower load than if we had used only four. That is the difference between a treatment that lasts a couple of years and one that can last a lifetime.
Factors That Tip the Balance: 4, 5, or 6?
During the diagnostic phase, which in my clinic is always supported by 3D tomography and digital scanning, we evaluate three fundamental pillars to decide the number of supports:
- The Quality of the “Ground” (Bone): Not all bones are the same. The upper jawbone is usually softer and more porous than the mandible. In softer ground, we usually prefer 5 or 6 implants to increase the contact surface and ensure the prosthesis doesn’t move a millimeter.
- The Space of the Arch: Some people have wider mouths than others. A large arch requires more support points to prevent the ends of the prosthesis from acting like a lever that could loosen the central implants.
- Habits Like Bruxism: As we mentioned with Ricardo, if the patient clenches or grinds their teeth involuntarily, the biomechanical load triples. In these cases, All-on-4 can fall short; we need the robustness of a Full Arch with 6 implants to protect the patient’s investment.
Technology: The Map Before the Journey
To explain this to Ricardo, we didn’t just use words. We showed him his own mouth on a giant screen through virtual planning. We were able to simulate where the 6 implants would go and how his bone would react to the pressure.
This is the true “dentistry of the future” that we practice today. There are no guesses. When an independent expert suggests 5 or 6 implants instead of 4, it is not to increase the cost of treatment, but to increase your margin of safety. Success in implantology is measured by predictability: knowing today what will happen with that implant in many years.
Ricardo’s Outcome: A Lesson in Durability
Ricardo accepted the 6-implant plan. He understood that his physical power required a solid foundation. Today, years later, he comes in for his check-ups and always tells me the same thing: “Doctor, I forgot I have implants”. And that is the best compliment I can receive. His prosthesis has not fractured, his bone is intact, and most importantly, he has regained the ability to eat without fear.
If we had yielded to the pressure of the standard All-on-4 technique for speed or economy, Ricardo would likely be undergoing repair surgeries today.
Conclusion: Choose Science, Not Trends
If you are considering full rehabilitation, my invitation is for you to seek a serious biomechanical diagnosis rather than a fixed number of implants. Whether your case is perfectly solved with an All-on-4 or requires the robustness of an All-on-6, the decision must come from a deep analysis of your anatomy.
Your smile is the gateway to your nutrition, your social life, and your self-esteem. Do not leave it in the hands of a generic recipe. Allow us to design the engineering your life needs.
Do you feel your bite is strong or have you had problems with previous prostheses? Let’s talk about biomechanics and design a solution together that truly lasts. Contact us via WhatsApp to schedule your evaluation with 3D technology.
Dr. Iván Lindo – Expert in Oral Implantology and Rehabilitation, committed to your oral health.
