All-on-6 in Thailand

Both treatments replace every tooth in an arch with one fixed bridge screwed onto implants, and both are sold in Thailand under the same "full mouth dental implants" heading. The difference is the number of implants under the bridge and, with it, how the load is shared, how much bone the surgeon needs and how the bridge can be built. With six implants there are usually two at the front, two in the premolar region and two further back, most of them upright; with four, the back pair is tilted to reach forward into denser bone. Six implants leave a shorter unsupported stretch of bridge behind the last implant, so the back teeth flex less when you chew.

"Permanent dental implants in Thailand", which many readers search for, usually means one of the first two rows: a bridge that stays in your mouth and behaves like teeth. If a clinic answers with a clip-on overdenture, you are being quoted a different and cheaper treatment. The Thailand All-on-4 page covers the four-implant version and the general Thailand dental implants page covers single implants and full-mouth costs.

All-on-6 suits people whose teeth in an arch are gone or beyond saving: long-term denture wearers, people with advanced gum disease, and people with a mouthful of failing crowns and root canals. Because six implants are spread along the arch, the surgeon needs usable bone further back than for All-on-4. In the lower jaw that is usually available. In the upper jaw the sinus sits above the back teeth, so a patient who has worn an upper denture for years may need a sinus lift or bone graft before six implants will fit, which adds time and a stage to the plan; the alternative is All-on-4 with tilted implants, or zygomatic implants in severe cases.

Thai surgeons tend to suggest six rather than four when:

• the upper jaw is being treated, because its bone is softer and the extra implants share the load
• you grind or clench, or have a strong bite, and the bridge will take heavy forces
• the arch is long and you want back teeth that do not sit on an unsupported stretch of bridge
• you want a margin: if one implant fails, a six-implant bridge can often stay in place while it is replaced
• you want the bridge made in segments, or as three separate bridges, which is easier to repair

They will usually accept you if your general health is stable and any diabetes is controlled, you do not smoke or will stop through the months of healing, you are not on intravenous bone medication and have told the clinic about osteoporosis tablets, and your gums are free of active infection on the day or the infection can be treated as the teeth come out. You also need to accept a temporary bridge, a soft diet and a second trip, not a finished result on the first visit.

The final bridge is what you chew with for years, and the material is usually the largest single line in a Thai quote after the implants themselves.

• Acrylic teeth on a titanium bar. A milled titanium frame with acrylic teeth and pink gum. Lighter, easier to repair if a tooth chips, and the lower-priced option.
• Monolithic zirconia. A bridge milled from one block of zirconia, often on a titanium base. Harder wearing and stain resistant, heavier, and more expensive; a chip usually means remaking the bridge rather than repairing it. "Zirconia All-on-6" is what most Thai clinics mean by their premium quote.
• Segmented bridges and 3 on 6. Six implants make it possible to split the arch into two or three bridges, or to make three separate bridges with no artificial gum at all. Segments are easier to remove and repair one at a time, and a bridge without pink acrylic looks more like natural teeth, but it only works if you have not lost much gum and bone height; otherwise the teeth come out too long.

Ask which material the quote assumes, whether the temporary bridge is included, whether the bridge will be one piece or segmented, and what the clinic charges to remake a bridge if it fractures in the first years. That last answer tells you how confident they are in their laboratory.

"All-inclusive dental holidays in Thailand" are sold by agencies and by a few clinics. A package normally bundles the treatment with airport pickup, a hotel near the clinic and a coordinator; it does not normally include flights, and it rarely includes the second trip. Ask what the clinical price is on its own, what the hotel is worth, and what happens to the package price if the plan changes on the first morning because the scan shows something the emailed X-rays did not.

Insurance is worth a paragraph. The NHS does not pay for treatment abroad and British dental plans rarely do; Australian private health extras almost never cover treatment overseas and Medicare does not; American dental insurance has annual limits that would not reach a full arch anyway. Budget as if nothing will be reimbursed, then be pleased if something is.

Before you book

Send a recent panoramic X-ray or, better, a CBCT scan, photographs and a list of medicines. The clinic replies with a plan and a quote per arch. Ask in the same email whether the plan is six implants or four, whether a sinus lift is expected, which implant system and bridge material are assumed, and what the second trip costs.

First trip

Plan on staying about a week to ten days. The first days are the scan, extractions and implants; the temporary bridge follows once the laboratory has made it; the last days are for bite adjustments and a check that everything is healing. If a graft is done at the same time, the stay can be longer. Do not book the flight home for the day after surgery.

Between trips

The implants fuse with the bone over the following months. You eat soft food, clean carefully under the bridge and keep an eye on the temporary teeth, which can chip. A dentist at home can check the bridge if something worries you, but most clinics ask you to send photographs and to contact them first.

Second trip

Usually a week. The temporary bridge comes off, new impressions or a scan are taken, the final bridge is tried in and adjusted, and it is screwed on with new screws. A segmented or zirconia bridge may need an extra try-in, so ask how many days the clinic wants.

After that

Annual check-ups, cleaning under the bridge and, every so often, the bridge removed, cleaned and refitted, all at home, which is why the records matter.

A fixed bridge on six implants traps food underneath it, and the gap between the bridge and the gum is where trouble starts. Daily cleaning means a water flosser or floss threaded under the bridge, small interdental brushes around each implant, and a soft brush on the bridge itself. Professional cleaning under the bridge once or twice a year is normal; every few years the dentist removes the bridge, cleans it and the abutments, checks the screws and refits it with new ones. Ask the Thai clinic to show you the routine before you leave, and ask your dentist at home whether they will do the removal and refit, which needs the screwdriver and screws for your implant system.

All-on-6 is major dental surgery and the risks are the risks of implants, multiplied by six or twelve. "All-on-6 problems" is a common search, and the ones people mean are these:

• An implant that does not fuse. It is removed and, after healing, replaced. With six implants the bridge can often stay in place meanwhile, which is one of the arguments for six over four.
• Infection around the implants, early or years later as peri-implantitis. Cleaning under the bridge is the defence, and smokers are at higher risk.
• Sinus problems in the upper jaw if a back implant reaches into the sinus, and the added healing of a sinus lift when one was needed to fit the six.
• Nerve injury in the lower jaw, causing numbness of the lip or chin, usually temporary; the back implants are planned from the scan precisely to avoid the nerve.
• Loose screws, chipped teeth and bridge fractures, far more common on the temporary acrylic than on the final bridge, and easier to fix on a segmented bridge.

Ask what the clinic does when something goes wrong after you have flown home: whether they will consult by video, whether they will pay a local dentist for emergency work, and whether a failed implant is replaced free and on what conditions.

1. Who places the implants and who makes the bridge, and what are their registrations?
2. Is my plan six implants or four, and what in my scan decided it?
3. Will I need a sinus lift or bone graft, and does the quote include it?
4. Which implant system, and will the brand, model and sizes be written on my plan?
5. Is the bridge made in-house, one piece or segmented, and what is the temporary bridge made of?
6. Does the quote include the final bridge, and in which material?
7. Will I fly home with a fixed temporary bridge or a healing denture?
8. What is the warranty, and does it require me to return to Thailand?
9. If an implant fails, who pays for its replacement and for any work on the bridge?
10. Will you give me the scan, X-rays and design files, and what do you charge for cleaning and a bridge remake in later years?

Thailand is one of three places most English-speaking readers compare, and which one makes sense depends mostly on where you fly from.

The Flymedi pages for All-on-6 in Turkey and All-on-6 in Mexico cover those markets. If your question is which of the three costs least, the honest answer is that the differences between the countries are smaller than the differences between clinics within each, and that the second trip and the maintenance at home cost the same wherever the implants went in.