All-on-4 implants · lower arch

Starting situation

A patient over 60 with near-total loss of the lower teeth — a few unstable roots loosening from advanced periodontal disease. The patient had been wearing a removable denture for several years but was carrying a functional burden (difficulty chewing), a psychological one (fear of the denture coming loose), and a biological one (rapid bone atrophy under the denture).

Why All-on-4

The All-on-4 protocol (Maló, 1998) has been validated by long-term clinical studies as a durable solution for full-arch cases. Advantages over the alternatives:

• vs. a full denture: fixed teeth, not removable — the patient gets the security of having their own teeth back
• vs. 6–8 individual implants: less surgery, lower cost, less time
• Immediate loading: a temporary bridge on the same day, essentially eliminating any toothless period

Clinical phase

1. CBCT and digital planning — the position of the 4 implants (2 straight in the incisor region, 2 tilted in the second-molar region) is calculated in software (NobelGuide, R2 Gate or Co-Diagnostix).
2. Extraction of the remaining teeth and immediate socket preservation.
3. Implant placement using a 3D-printed surgical guide that ensures ±0.5 mm positioning accuracy.
4. Fixed temporary bridge on the same day — the patient leaves with functional teeth.
5. After 4 months of osseointegration: digital scan, fabrication of the final zirconia or hybrid bridge.

Maintenance

Interproximal hygiene around the implants is critical. The patient is trained on using a Waterpik, implant-specific brushes (Curaprox Implant Surgical), and 6-monthly check-ups with the dental hygienist.