Full-arch implant prosthesis: acrylic or zirconia? How to choose

A full-arch implant prosthesis can be made of acrylic resin over a metal bar or of zirconia. The difference lies in how it looks over the years, in resistance to wear, in weight, in how easy it is to repair and in the space each material needs. Neither one suits everyone: the choice depends on the space between the arches, bite force, bruxism, cosmetic expectations and upkeep.

The full-arch prosthesis, known in Brazil as 'protocolo' and often called All-on-4 or All-on-6, is a fixed prosthesis for the whole arch, screwed onto 4 to 6 implants. It replaces all the upper or all the lower teeth and is only removed by the dentist, at check-ups. That is why the material weighs on the decision: the prosthesis stays with the person for many years and defines what hygiene, repairs and replacements will be like.

In this article, Dr. Cléo Salustiano (CRO-SP 170844) explains what a full-arch implant prosthesis is, compares acrylic and zirconia point by point, shows what determines the cost and describes the stages of treatment, from planning with a CT scan to the final prosthesis.

This article comes from Dr. Cléo Salustiano's dental office in Mooca, São Paulo (care in English, Portuguese and Spanish). See the dental implants page to learn how the treatment is done here and book your assessment.

Step by step

1. Assessment and planning. Clinical exam, photos and a CT scan to measure the bone and the space between the arches. This is where the number of implants, the need for a graft and the material are defined.
2. Implant surgery. Placement of 4 to 6 implants. If they are firm enough, the temporary prosthesis can be screwed on within a few days (immediate loading); if not, healing comes first.
3. Temporary prosthesis. An acrylic prosthesis worn while the implants integrate with the bone, usually for 3 to 6 months. It is used to test appearance, speech and chewing.
4. Try-in and final prosthesis. Impression or scan, try-in of the framework and the teeth, adjustments to color and bite, and placement of the acrylic or zirconia prosthesis.
5. Upkeep. Periodic check-ups with removal of the prosthesis for cleaning, screw replacement when indicated, follow-up X-rays and a night guard if there is bruxism.

What is the difference between an acrylic and a zirconia full-arch prosthesis?

The acrylic full-arch prosthesis has a metal bar, usually titanium or cobalt-chrome, covered with acrylic resin that imitates the gums, with resin teeth. In the hybrid version, the teeth are ceramic or high-density resin. The zirconia prosthesis is milled by computer from a single block: monolithic, in one piece with the color applied on the outside, or layered, with ceramic applied to the visible part to gain translucency.

In appearance, zirconia tends to keep its color and shine longer. Acrylic resin is porous: over the years, it stains with coffee, wine and cigarettes and loses its polish. On the other hand, monolithic zirconia can look opaque if it is not well characterized, and the ceramic on the layered version is more prone to chipping. Well-made acrylic looks natural at first but needs more upkeep to stay that way.

In strength, zirconia is much harder and resists wear far better; resin teeth wear down with chewing and usually need replacing after a few years. That hardness has a flip side: zirconia is heavier, makes more noise when the teeth touch and, because it does not absorb impact, usually calls for a night guard in people with bruxism. Acrylic cushions part of the load and is lighter, but it breaks and wears more.

In hygiene, the smooth surface of zirconia holds less biofilm (bacterial plaque) and less odor than acrylic, which is porous. In space, the acrylic prosthesis needs more height between the gums and the opposing arch, because the bar and the resin have a minimum thickness; zirconia can be thinner when space is short. In repair, acrylic has the advantage: a chipped tooth can usually be fixed at the office, in the same visit, while a fracture in zirconia generally requires the lab or a new prosthesis.

In durability, both can last many years when the implants are healthy and check-ups are kept up. Resin teeth tend to need replacing or relining every few years; zirconia usually goes longer without intervention. In both cases, upkeep includes removing the prosthesis for professional cleaning, usually once or twice a year, replacing screws when indicated and reassessing the implants with X-rays. These are averages: habits, hygiene and bruxism change these timelines.

How do you choose between acrylic and zirconia, and what determines the cost?

The choice comes down to five points: space between the arches, bite force and bruxism, cosmetic expectations, ease of upkeep and the condition of the implants. With little space, zirconia is usually the option considered, because it can be thinner. With heavy bruxism, acrylic cushions the load on the implants but wears faster; zirconia holds up but calls for a night guard. Those who prioritize stable color and fewer interventions lean toward zirconia; those who prefer a light prosthesis that is easy to repair at the office usually stay with acrylic or the hybrid.

The cost of a full-arch prosthesis depends on several items, and the material is only one of them: the number of implants (4, 5 or 6), the need for a bone graft, the type of temporary prosthesis used during healing, the lab work (milled and layered zirconia involves more steps than conventional acrylic), the prosthetic components and follow-up. That is why the quote is only finalized after planning with a CT scan.

With both materials, the prosthesis is removed periodically for cleaning, checking the screws and assessing the implants. At home, hygiene uses a soft toothbrush, floss with a threader or a water flosser under the prosthesis, where food debris collects. Acrylic prostheses usually need the teeth replaced or a reline every few years; zirconia ones need less intervention, but a fracture requires the lab.

Inflamed gums around the implants, uncontrolled bruxism or too little bone are not definitive obstacles: they are earlier steps in the plan, resolved before the prosthesis is defined. At the office, the assessment starts with a clinical exam, photos and a conversation about what bothers you and what you expect; planning the rehabilitation with implants continues with a CT scan. The dentist who assesses you is the one who does the work, and the types of dental prosthesis are explained before any decision.

‹

Fixed, removable or full-arch implant denture: which to choose?

Fixed full-arch implant bridge or snap-on denture: which to choose when all teeth are missing

How much does a full-arch implant denture cost? Cost factors

How much does a dental implant cost? What goes into the price

›