Duration: 15 minutes, 35 seconds

Author: Dr. George Perri

AZ in Restorative Implant Dentistry Case 4: Maxillary Allon4 Hybrid


Welcome to this case analysis on a restorative implant dentistry treatment. In this article, we will be focusing specifically on the All on Four technique in the maxillary arch. Restorative implant dentistry is a field of dentistry that aims to rehabilitate and restore oral function and aesthetics using dental implants. The maxilla, or upper jaw, can present unique challenges when it comes to treatment due to aesthetic issues, phonetic problems, and lip support complications.

The Challenges of the Maxilla

When it comes to restorative implant dentistry, the maxilla is often seen as a more difficult area to treat compared to other parts of the mouth. Aesthetic issues can arise in the maxilla due to the visibility of the upper teeth when smiling. Phonetic problems can also occur as the maxilla plays a crucial role in speech production. Lip support complications can further complicate treatment, as the upper lip needs adequate support from the maxillary teeth for a balanced facial appearance.

The Patient’s Condition

In this particular case, the patient presented with a failing natural dentition in the maxillary arch. The patient had postponed treatment for a long time, resulting in extensive damage to their existing teeth. Other treatment options, such as individual implants or dentures, were considered but deemed unsuitable for various reasons.

Treatment Planning

Before proceeding with the All on Four technique, thorough treatment planning is essential. This includes evaluating the patient’s existing dentures, assessing the vertical dimension of their occlusion, and using a surgical guide for precise implant placement.

Evaluating Existing Dentures

The patient in this case had a six-unit anterior bridge held by two remaining canines. The condition of the bridge was assessed to determine its suitability for the restorative implant treatment. The bridge was found to be structurally compromised and not suitable for long-term use.

Assessing Vertical Dimension

The vertical dimension of occlusion refers to the distance between the upper and lower jaws when the teeth are in contact. It plays a crucial role in establishing a balanced and functional bite. In this case, the vertical dimension was carefully evaluated to ensure the correct placement of the implant-supported prosthesis.

Surgical Guide for Implant Placement

A surgical guide is a tool used during dental implant surgery to ensure precise and accurate placement of the implants. It provides a guide for the surgeon, indicating the optimal locations for implant placement. The use of a surgical guide increases the success rate of the implant procedure and reduces the risk of complications.

Immediate Treatment Despite Blood Thinners

In this case, the surgeon decided to proceed with immediate treatment despite the patient being on blood thinners. This decision was made based on a comprehensive assessment of the patient’s medical history and in consultation with the patient’s physician. While immediate treatment allows for faster restoration of oral function, it can also lead to bruising and swelling due to increased bleeding during the procedure.


The All on Four technique in restorative implant dentistry offers a viable solution for patients with failing dentition in the maxillary arch. Despite the inherent challenges that come with treating the maxilla, proper treatment planning and careful consideration of the patient’s specific needs can lead to successful outcomes. By addressing aesthetic issues, phonetic problems, and lip support complications, restorative implant dentistry can greatly improve the quality of life for patients.


1. Is the All on Four technique suitable for everyone?

No, the All on Four technique is not suitable for everyone. It requires a comprehensive evaluation of the patient’s oral health and specific needs to determine its suitability.

2. How long does the All on Four treatment process take?

The duration of the treatment process can vary depending on various factors, including the patient’s individual case and any necessary preparatory procedures. It is best to consult with your dentist or oral surgeon for a personalized estimate.

3. Are there any risks or complications associated with the All on Four technique?

As with any surgical procedure, there are risks and potential complications associated with the All on Four technique. These can include infection, implant failure, nerve damage, and sinus complications. However, with proper planning and execution, these risks can be minimized.

4. How long do All on Four implant-supported prostheses last?

The lifespan of an All on Four implant-supported prosthesis can vary depending on factors such as oral hygiene maintenance, regular dental check-ups, and individual habits. With proper care, they can last for many years.

5. Are there any alternative treatment options available for the maxilla?

Yes, there are alternative treatment options for the maxilla, including individual dental implants, removable dentures, and hybrid dentures. The most suitable option will depend on the patient’s specific case and needs.

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