All-on-6 FP1 Case: Natural-Looking Full Arch Implants After Gum Disease

Summary: This patient had lost much of the bone around the upper teeth to periodontal (gum) disease, with uneven gum levels and a gummy smile. The goal was teeth that look natural, not just fixed teeth. Dr. Nalat placed an All-on-6 on the upper jaw with digital guided surgery, bone grafting and fixed temporary teeth on the day of surgery. About four months later, Dr. Worawan fitted the final FP1 bridge, a design in which the teeth emerge directly from the patient’s own gums with no artificial pink gum. The lower teeth were restored with crowns, a bridge and veneers.

The patient’s concerns

• Upper jaw: a history of periodontitis, with significant bone loss
• Uneven gum levels: too much gum showing when smiling
• Lower jaw: crowded teeth and some missing teeth
• Goal: natural-looking teeth and balanced gum levels, with good chewing function

What are All-on-6 and FP1?

All-on-6 uses six implants to support a fixed bridge for a whole jaw. It is used for people who have lost, or need to lose, most of their teeth in one arch.

FP1 (Fixed Prosthesis type 1) describes how the final teeth are designed. The teeth are shaped to look like natural teeth coming out of the gums, without pink porcelain or acrylic replacing the gum. FP1 needs enough bone and gum to work, so careful planning, and often bone grafting, is part of the treatment.

Why this plan was chosen

• Six implants support the entire upper arch
• The FP1 design gives a natural tooth-and-gum appearance
• Digital planning allowed the gum line to be balanced as part of the design
• Fixed temporary teeth meant the patient was never without teeth

Treatment steps and timeline

1. Digital planning: an intraoral scan (Shining Aoralscan Elite) and a facial scan (Shining Metismile) were combined to build a 3D model, and a surgical guide was designed from it.
2. Surgery day: teeth that could not be saved were removed, implants (Neodent) were placed through the surgical guide, and bone grafting was done at the same time.
3. Fixed temporary teeth the same day: the patient left with fixed temporary teeth.
4. Healing, about 4 months: the implants bonded with the bone while the patient used the temporary bridge.
5. Final restorations (Dr. Worawan): the FP1 implant bridge on the upper jaw, and crowns, a bridge and veneers on the lower teeth.

Treatment summary

Does All-on-6 surgery hurt, and how long does it take?

Implant surgery is done under local anaesthesia. A surgical guide can reduce how much the gum needs to be opened, which may mean less swelling afterwards. Most patients return to normal daily activities within about a week. From surgery to final teeth usually takes around 4–6 months, and in this case the patient had fixed temporary teeth from the first day.

Planning this treatment from abroad?

This patient lives in Thailand. For international patients, full-arch treatment is usually planned around two stays in Bangkok: one for surgery and fixed temporary teeth, and one for the final bridge after healing. The length of each stay depends on your case. You can send your X-rays or a CBCT scan before you travel for a preliminary plan.

Questions about this treatment

What is the difference between All-on-4 and All-on-6?

Both support a fixed full-arch bridge on implants. All-on-6 uses six implants instead of four, which spreads the load over more implants. Which one fits you depends on your bone volume and jaw shape, assessed with a CBCT scan.

Can I have FP1 teeth without pink gum?

FP1 is possible when there is enough bone and gum to support a natural tooth shape. When bone loss is severe, a design with artificial gum (FP3) may give a better result. Dr. Nalat will explain which design suits your case after the assessment.

How do I look after an All-on-6 bridge?

Brush twice a day, clean under the bridge with Superfloss or an interdental brush, and attend check-ups and professional cleaning every 6 months.

How much does All-on-6 cost?

The cost depends on the implant system, the bridge material and whether bone grafting is needed. See the dental implant cost page for full-arch prices.

Photos shared with the patient’s permission. Treatment results vary from person to person. This case is for information and does not replace an examination by a dentist.