Background: Full-arch immediate function protocols such as the All-on-4 concept need long-term validation.Purpose: To report the 5-13 year outcomes of the All-on-4 treatment concept for the rehabilitation of the edentulous maxilla. Materials and Methods: This retrospective case series study involved 1072 patients (4288 maxillary implants) rehabilitated through the All-on-4 treatment concept. Primary outcome measures were cumulative prosthetic and implant success (life table analysis). Secondary outcome measures consisted in marginal bone loss (MBL) at 5 and 10 years, biological and mechanical complications. The estimation of risk indicators was performed through multivariable analysis for the outcome variables implant failure (Cox regression to estimate hazard ratios and 95% confidence intervals [95% CI]), MBL > 2.8 mm at 5 years, MBL > 3.0 mm at 10 years, biological and mechanical complications (binary logistic regression to estimate odds ratios [OR] with 95% CI). Results: Eighteen patients deceased unrelated to the implant treatment (1.7%) and 219 patients (20.4%) were lost to follow-up. The prosthetic success rate was 99.2%; Implant cumulative survival and success rate was 94.7% and 93.9%, respectively, with up to 13 years of follow-up. Male gender (HR = 1.73), smoking (HR = 1.94), and mechanical complications (HR = 0.59) were significantly associated with implant failure.Average MBL at 5 and 10 years was 1.18 mm (95% CI: 1.16, 1.21) and 1.67 mm (95% CI: 1.58, 1.77) with age (OR = 0.97), male gender (OR = 0.58), smoking (OR = 1.73), and biological complications (OR = 2.1) associated with MBL > 2.8 mm at 5 years. The incidence of biological complications was 7.8% at implant level, with age (OR = 0.98) and smoking (OR = 1.53) significantly associated. The incidence of mechanical complications was 58.8% for the provisional prostheses and 7.3% for the definitive prostheses. Conclusions:The high success rates registered for both implants and prostheses together with the low MBL confirm the All-on-4 treatment concept is predictable and safe in the long term outcome.

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The use of new devices for the rehabilitation of the severely atrophic maxillae needs validation. We aimed to report the short-term outcome of severely atrophic jaws rehabilitated with zygomatic implants with no implant head angulation placed extramaxillary in conjunction with standard implants. Forty-four patients were consecutively included with 77 zygomatic implants (31 abutments of 45 degrees and 46 abutments of 60 degrees) and 115 standard implants. Outcome measures were prosthetic survival, implant/abutment success, complications, modified plaque index (mPLI), modified bleeding index (mBI), mucosal seal efficacy evaluation (MSEE) >4 mm, and Zygomatic implants classification level (ZICL). Two patients (4.5%) were lost to follow-up. No prosthesis was lost; one patient lost one zygomatic implant; two angulated abutments of 60 degrees needed to be replaced in one patient due to an aesthetic complaint; rendering a cumulative success rate at 2-years of 95.3% and 95.9% using patient and implant/abutment as unit of analysis, respectively. Mechanical and biological complications occurred in 13 and six patients, respectively; all resolved. The median mPLI and mBI was 1; MSEE > 4 mm occurred in 17% and 21% of patients at 1- and 2-years, respectively; ZICL1 was registered in 80% of patients. The current protocol enabled good short-term outcomes.

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