All-on-4 implant rehabilitation of the maxilla without sinus lift with screw-retained prosthesis - a case report

In today’s modern world, patients are increasingly seeking advanced fixed dental solutions that provide a natural look and feel, while eliminating the discomfort and limitations associated with removable dentures. Over the years, medical and dental sciences have continuously evolved to find faster, simpler, and more efficient solutions for full mouth rehabilitation. Newer-generation dental implants and screw-retained dental prostheses have brought several advancements that significantly improve clinical outcomes, patient satisfaction, and long-term success. Bone resorption, remodeling, and atrophy following tooth extraction commonly result in insufficient jawbone volume.
Treatment options include complete upper and lower dentures, implant-supported overdentures, and fixed implant supported prostheses. Implant supported fixed prostheses offer superior comfort, stability, and patient satisfaction but require adequate bone support for successful implant placement. In the posterior maxilla, inadequate bone beneath the maxillary sinus often makes sinus lifting necessary for implant placement. That makes the process of dental implant placement more complicated and increases the total cost of the procedure. In the All-on-4 procedure, two implants are placed axially in the anterior region and two longer implants are placed tilted at approximately 30° in the posterior premolar region. This angulation allows longer implants to engage more bone, avoiding the maxillary sinus and eliminating the need for grafting. Using newer generation of implants with multi-unit abutments make this technique available. The All-on-4 treatment concept presents a minimally invasive and cost-effective alternative for full-arch rehabilitation in edentulous or atrophic jaws. This configuration provides favorable biomechanical support for a screw-retained, implant-supported fixed prosthesis used in full-arch rehabilitation.
Patients with a resorbed maxilla can often be successfully treated without the need for bone grafting or sinus lifting,
making this technique a simpler and more cost-effective alternative. The protocol enables cost-effective, fixed full arch rehabilitation with high success and satisfaction rates. Additionally, by simplifying surgical procedures, the
technique becomes accessible to a broader range of clinicians and patients. After completing treatment, patients are able to chew and eat comfortably, smile with confidence, and easily care for their new teeth. This report supports the clinical utility of the All-on-4 technique, particularly in resource-limited or anatomically constrained cases. This case report presents successful full-mouth rehabilitation of a 60-year-old male patient with severe periodontal disease and generalized tooth loss using and atrophied maxilla with the All-on-4 implant concept.