Full-Arch Implants: Upper, Lower or Both Arches?

You only need full-arch implants on the jaw that has no teeth, or only failing teeth. Many people treat one arch and keep their natural teeth or a denture on the other. Others treat both. The decision depends on the health of the opposing teeth, your bone in each jaw, your bite and your budget.

Full-arch treatment is planned and priced per arch, which means "upper or lower or both?" is one of the first questions to settle. This article explains how the two jaws differ, when one arch is enough, and when it makes sense to treat both, at the same time or one after the other.

What "per arch" means

An arch is one full row of teeth, upper or lower. A full-arch restoration replaces every tooth in that row with a fixed bridge on implants. Treating the upper arch does nothing to the lower teeth, and the reverse. That is why full-arch pricing, including our own on the full mouth dental implants page, is quoted per arch.

How the upper and lower jaws differ

The upper jaw

• The bone is generally softer, and the sinuses sit above the back teeth. When back teeth have been missing for a while, the bone below the sinus can be thin.
• That is one reason the All-on-4 approach tilts the back implants: a 2017 consensus statement on the technique recommended angling them 30 to 45 degrees and checking the position of the sinus wall on the CBCT scan to avoid perforating the sinus lining.
• A conventional upper denture covers the roof of the mouth. A fixed upper bridge does not, which many people notice with taste, temperature and speech.

The lower jaw

• The bone is usually denser, but a nerve runs through the jaw, and its exit point near the premolars limits where the back implants can go.
• Conventional lower dentures are usually the harder ones to live with. A 2011 review in the Journal of Medicine and Life noted that while most patients can tolerate an upper denture, the lower denture is a different situation, because there is far less to hold it in place.

When one arch is enough

• The opposite arch has healthy teeth, or teeth that can be restored with fillings, crowns or a few individual implants.
• You wear a denture you are happy with on the other jaw. Many people are comfortable with an upper denture and only struggle with the lower.
• The other arch can be treated with something simpler, such as a dental implant bridge for a gap of several teeth, or a snap-in implant denture.

When it makes sense to treat both

• Both rows of teeth are failing from gum disease, decay or wear.
• You already wear full dentures top and bottom and want fixed teeth on both.
• Your bite has collapsed, and rebuilding it means planning both rows together so the new teeth meet properly.

Does it matter what the new teeth bite against?

Yes. Full-arch implant teeth are strong, and the teeth they bite against need to cope with that. A fixed zirconia bridge biting against a loose lower denture may push the denture around. Biting against heavily worn or broken natural teeth can damage them further. Part of planning one arch is checking whether the opposing teeth will be stable and comfortable against the new ones, and sometimes that means treating them too, even if not with a full arch.

Both at once, or one at a time?

Treating both arches together

• One surgery and one healing period instead of two.
• The upper and lower teeth are designed together, so the bite, smile line and proportions are planned as one.
• The day is longer and recovery is more involved, so your general health and preference for sedation come into it. Our article on sedation for implant surgery covers the options.

One arch at a time

• A shorter surgery and recovery each time.
• The cost is spread over a longer period, which can also help with insurance annual maximums if your plan contributes.
• The overall treatment takes longer, and the second arch has to be designed to match the first.

Either way, the steps for each arch are the same. Our full-arch implant timeline walks through them.

Looking after the arch you keep

If you keep your natural teeth on one arch, they matter more than ever, because they are what your new implant teeth bite against. Regular cleanings, treating gum disease early and protecting the teeth from grinding all help them last. Our dental implants guide links to more on keeping implants and natural teeth healthy side by side.

Bone, health and the order of treatment

The CBCT scan often settles the question of order. If one jaw needs bone grafting and the other does not, it may make sense to start with the one that is ready. Active gum disease or infection is treated first. Our article on implants with bone loss explains what happens when bone is thin.

Cost: one arch vs two

Because pricing is per arch, treating both arches costs more than treating one. Ask how the price for two arches is calculated and what is included for each. Our article on what a full-arch quote should include lists the questions worth asking, and our article on paying for full mouth implants covers financing.

Deciding in Burke, VA

At a consultation at Shield Dental Care, Dr. Ghorbani looks at both jaws, takes a CBCT scan and digital impressions, and tells you whether one arch, both arches or a different treatment makes most sense for you. For what full-arch treatment includes, see our full-arch implant page, or read about the All-on-4 technique. Call (703) 250-5072 to book.