“All-on-4” Immediate-Function Concept for Completely Edentulous Maxillae: A Clinical Report on the Medium (3 Years) and Long-Term (5 Years) Outcomes


Dr. Miguel de Araújo Nobre, Malo Clinic, Avenida dos Combatentes, 43, 8, Edificio Green Park, 1600-042 Lisboa, Portugal; e-mail: mnobre@maloclinics.com


Background: Immediate implant function has become an accepted treatment modality for fixed restorations in totally edentulous mandibles, whereas experience from immediate function in the edentulous maxilla is limited.

Purpose: The purpose of this study was to report on the medium- and long-term outcomes of a protocol for immediate function of four implants (All-on-4™, Nobel Biocare AB, Göteborg, Sweden) supporting a fixed prosthesis in the completely edentulous maxilla.

Materials and Methods: This retrospective clinical study included 242 patients with 968 immediately loaded implants (Brånemark System® TiUnite™, Nobelspeedy™, Nobel Biocare AB) supporting fixed complete-arch maxillary all-acrylic prostheses. A specially designed surgical guide was used to facilitate implant positioning and tilting of the posterior implants to achieve good bone anchorage and large interimplant distance for good prosthetic support. Follow-up examinations were performed at 6 months, 1 year, and thereafter every 6 months. Radiographic assessment of the marginal bone level was performed after 3 and 5 years in function. Survival was estimated at patient level and implant level using the Kaplan–Meier product limit estimation with 95% confidence intervals.

Results: Nineteen immediately loaded implants were lost in seventeen patients, giving a 5-year survival rate estimation of 93% and 98% at patient and implant level, respectively. The survival rate of the prosthesis was 100%. The marginal bone level was, on average, 1.52 mm (standard deviation [SD] 0.3 mm) and 1.95 mm (SD 0.4 mm) from the implant/abutment junction after 3 and 5 years, respectively.

Conclusion: The high survival rates at patient and implant level indicates that the immediate-function concept for completely edentulous maxillae using the present protocol is viable in the medium- and long-term outcomes.