All-on-4 treatment of an edentulous patient after autogenous grafting

Abstract

All-on-4 concept is a treatment method for fixed prosthetic rehabilitation of edentulous jaws with a total of four dental implant, two anterior vertically placed and two posterior inclined implants, supported full arch hybrid prosthetic restorations. It has been reported that inclined implants placed to the posterior region can provide better biomechanical strength, reduced size of prosthetic cantilever extensions, without anatomic limitations and no need for further surgical procedures. Many studies have shown that after the loss of teeth, bone resorption in the jaws is seen more intensely in the posterior regions. All-on-4 treatment concept is usually preferred because of the anatomical limitations of the maxillary sinuses in the posterior maxilla and inferior alveolar nerve in the mandible. Thus, advanced surgical procedures such as bone augmentation in the posterior region are avoided. However, over time resorption in the posterior regions begins to accompany with horizontal resorption of the anterior region. In this case, surgical procedures to increase the bone volume are inevitable to maintain the existing vertical crest height and to be able to provide an implant-supported treatment to the region. In this case report, a 68-year-old female patient, who has edentulous maxilla and only canine teeth in mandible, was treated by grafting anterior maxilla with autogenous bone block grafts obtained from mandibular symphysis, and then the rehabilitation of both jaws prosthetically according to the All-on-4 concept was done. There was no complication in follow-up of the patient for 2 years and there was no bone loss in the periimplant bone except physiologically accepted levels. Thanks to this application, the aesthetic and functional expectations of the patient are met.