RESUMO
The goal of this clinical report was to present an alternative to traditional flat bone reduction guides, using a custom-designed 3-dimensional (3D)-printed guide according to the future gingival margin of the planned dentition. A 61-year-old woman with concerns regarding her smile appearance was presented. The initial examination revealed excessive gingival show accompanied by excessive overjet. The dentition was in a failing situation. The proposed treatment plan, relying on the sufficient amount of bone and keratinized tissue, consisted of recontouring of the alveolar ridge and gingiva and placement of 6 implants and an FP-1 prosthesis after extraction of all remaining maxillary teeth. Digital smile design was completed, and a fully digitally guided surgery was planned. This consisted of using 3 surgical guides, starting with the fixation pin guide, continuing with the scalloped hard- and soft-tissue reduction guide, and finally the implant placement template. Following the surgery, the patient received a temporary restoration, and on the 4-month follow-up, a new polymethyl meta-acrylate temporary prosthesis was delivered. The patient's 7-month follow-up is presented in the article. The report of this triple-template guided surgery indicated that digital 3D planning is a considerably predictable tool to properly establish and evaluate future occlusal plane, smile line, and lip support. Scalloped guides seem to be an excellent alternative to conventional bone reduction guides since they require less bone removal and improve patient comfort during surgery.
Assuntos
Implantação Dentária Endóssea , Implantes Dentários , Humanos , Feminino , Pessoa de Meia-Idade , Implantação Dentária Endóssea/métodos , Processo Alveolar , Gengiva/cirurgia , Implantação de Prótese , Prótese Dentária Fixada por ImplanteRESUMO
The aim of this study was to evaluate intraoral scanners accuracy in full-arches, comparing them with conventional impressions. A scientific research performed in MEDLINE, EBSCOhost, and SciELO databases was conducted to analyze articles published between 2015 and 2020. Clinical and in vitro studies that evaluated accuracy (precision and trueness) from intraoral scanners and conventional impressions in full-arches were included. Two tests were applied to evaluate the methodological bias from the studies. Out of the 191 articles found, seven of them were selected for a qualitative analysis. In clinical studies,intraoral scanners CEREC Omnicam and 3Shape TRIOS Colorhad the highest precision compared to conventional irreversible hydrocolloid impressions. In in vitro studies, conventional polyvinyl siloxane impressions showed the highest accuracy, followed by intraoral scanners Cadent iTero and CEREC Omnicam, while irreversible hydrocolloid impressions showed the lowest accuracy. Digital intraoral impression systems do not show superior accuracycompared to highly accurate conventional impression techniques. However, they provide excellent clinical results and both methods are clinically accepted.
El objetivo de este estudio fue evaluar la exactitud de escáneres intraorales en impresiones digitales de arco completo en comparación con las impresiones convencionales. Se realizó una revisión sistemática en las bases de datos MEDLINE, EBSCOhost y SciELO para analizar artículos publicados entre los años 2015 y 2020. Se incluyeron estudios clínicos e in vitro que evaluaran exactitud (precisión y/o veracidad) de escáneres intraorales impresiones convencionales en arcos completos. Dos pautas se aplicaron para evaluar el riesgo de sesgo de los estudios. De 191 artículos encontrados, 7 fueron seleccionados para un análisis cualitativo. En los estudios clínicos, los escáneres intraorales CEREC Omnicam y 3Shape TRIOS Color presentaron la mayor precisiónen comparación con las impresiones convencionales de hidrocoloide irreversible. En los estudios in vitro, las impresiones de polivinil siloxano presentaron la mayor exactitud seguido por los escáneres intraorales CadentiTero y CEREC Omnicam, mientras quelas impresiones de hidrocoloide irreversible presentaron la menor exactitud. Los sistemas de impresión digital intraoral no mostraron tener una exactitud superior comparados con las técnicas de impresión convencional de gran exactitud. Sin embargo, proveen excelentes resultados clínicos y ambos métodos son clínicamente aceptables.
Assuntos
Humanos , Arco Dental/diagnóstico por imagem , Técnicas In Vitro , Técnica de Moldagem Odontológica , Desenho Assistido por Computador , Seleção de Pacientes , Imageamento Tridimensional , Materiais para Moldagem OdontológicaRESUMO
BACKGROUND: The main objective of this systematic review was to present the outcomes of the treatment with zygomatic implants (ZIs) in the rehabilitations of atrophic upper jaw. FINDINGS: An electronic database search in PubMed, along with a manual search, taking into account language and study period, was performed by two observers; any type of clinical trial and series that included the use of ZIs was used. In the search strategy, the following search terms were used: zygom* AND dental (Implant OR implants) AND edentulous NOT (biomechanic* OR finite element) NOT cadaver. The search was limited to English language, full text, and humans. Literature reviews and clinical case reports were not considered. Forty-two articles published between March 2003 and April 2019 were included in this analysis. The cases of 1247 patients were recovered; these patients received 2919 ZIs. Fifty-two ZIs were removed during the follow-up time. The survival rate of these implants was 98.22%, with a minimum follow-up of 1 month and a maximum of 228 months. Different surgical techniques were used to place ZIs; however, the intrasinusal technique was the most used (23 studies). Post-surgical sinusitis was the most common complication reported in the studies (39 cases). CONCLUSIONS: Based on this review, ZIs were commonly used for rehabilitation of patients with atrophic upper jaw. The survival rates presented were high, and the surgical technique is dependent on the professional experience and the local anatomy. However, it needed additional clinical evidence on bone resorption, esthetic outcomes, and physiological characteristics.
Assuntos
Arcada Edêntula , Zigoma , Seguimentos , Humanos , Maxila/cirurgia , Resultado do Tratamento , Zigoma/cirurgiaRESUMO
PURPOSE: To evaluate implant and prosthetic survival rates of full-arch rehabilitations retained by three implants in patients with edentulous mandibles. MATERIALS AND METHODS: This systematic review was developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The focused question was: Are fixed mandibular 3-implant retained prostheses safe and predicable for full-arch mandibular prostheses? The Medline/PubMed and Cochrane Library databases were used to conduct the systematic search for clinical trials on fixed mandibular 3-implant retained prostheses published between 1999 and 2020. Only English-language studies that presented information on implant and prosthetic survival were included. RESULTS: A total of 302 studies were identified, of which 13 addressed the inclusion criteria. Additionally, 574 participants were included in these studies. As reported, 73 (4.57%) of 1596 implants failed, with a survival rate of 95.43%. In addition, the mean survival rate of the presented prostheses was 89.66%. The mean marginal bone loss was 1.09 mm. CONCLUSION: Within the limitations of the present review, implant and prosthetic survival rates of fixed mandibular 3-implant retained prostheses were similar to those of full-arch mandibular prostheses retained by four or more implants. Further research exploring the topic is necessary.
Assuntos
Implantes Dentários , Prótese Mandibular , Prótese Dentária Fixada por Implante , Falha de Restauração Dentária , Seguimentos , Humanos , Mandíbula/cirurgiaRESUMO
The current study aimed to evaluate the mechanical behavior of two different maxillary prosthetic rehabilitations according to the framework design using the Finite Element Analysis. An implant-supported full-arch fixed dental prosthesis was developed using a modeling software. Two conditions were modeled: a conventional casted framework and an experimental prosthesis with customized milled framework. The geometries of bone, prostheses, implants and abutments were modeled. The mechanical properties and friction coefficient for each isotropic and homogeneous material were simulated. A load of 100 N load was applied on the external surface of the prosthesis at 30° and the results were analyzed in terms of von Mises stress, microstrains and displacements. In the experimental design, a decrease of prosthesis displacement, bone strain and stresses in the metallic structures was observed, except for the abutment screw that showed a stress increase of 19.01%. The conventional design exhibited the highest stress values located on the prosthesis framework (29.65 MPa) between the anterior implants, in comparison with the experimental design (13.27 MPa in the same region). An alternative design of a stronger framework with lower stress concentration was reported. The current study represents an important step in the design and analysis of implant-supported full-arch fixed dental prosthesis with limited occlusal vertical dimension.
Assuntos
Prótese Dentária , Fenômenos Biomecânicos , Simulação por Computador , Análise de Elementos Finitos , Estresse MecânicoRESUMO
RESUMEN: Los protocolos odontológicos de controles son guías que tienen por objetivo optimizar la calidad de atención y estandarizar ciertos procedimientos para poder establecer mejores pronósticos. Varias complicaciones se pueden presentar posterior a la instalación de una prótesis fija total con carga inmediata (PFTC), desde el daño de la estructura protésica provisoria hasta la pérdida de la oseointegración de los implantes dentales. La escasa evidencia sobre el comportamiento clínico que se debe tener posterior a este tipo de tratamiento indica la necesidad de confección de un protocolo para poder mejorar las tasas de éxito. Para confeccionar el protocolo clínico se realizó una revisión sistemática de la literatura en la base de datos PubMed. Los filtros de búsqueda fueron ajustados de la siguiente manera. Se utilizaron los términos de búsqueda "immediate loading" AND "full arch" AND "Resonance frequency analysis". Los que fueron sometidos a los criterios de inclusión y exclusión, dando como resultado un total de 15 estudios. Todos los estudios seleccionados son ensayos clínicos controlados donde se encontraron complicaciones como fracturas, desalojos y desgaste de la estructura protésica, entre otros. En los resultados encontrados no existe evidencia sobre el número y rango de sesiones necesarias para el control clínico de una PFTCI. El momento más indicado para la extracción de la prótesis provisoria e instalación de la prótesis definitiva es durante el 3° y 4° mes posterior a la carga inmediata. Existe escasa evidencia sobre el número, momento y tipo de examen imageneológico a solicitar. Por lo que este protocolo clínico será una guía para los controles que se realicen posterior a una instalación de una PFTCI.
ABSTRACT: Dental protocols are guidelines used to optimize service quality and to standardize procedures to establish a better prognosis. There are many complications that can occur after installation of a an immediately loaded implant-supported prosthesis for rehabilitation. These may generate damage to the provisional structure and even loss of osseointegration from the dental implants. Limited evidence on the clinical approach required to monitor these procedures, makes it necessary to establish clinical protocols for treatment control, and increases the success rate. In order to develop such protocols a systematic research was carried out in the Pubmed database. The filters used were "immediate loading", "full arch" and "Resonance frequency analysis". The results were subject to the inclusion and exclusion criteria. A total of 15 studies were selected. All of the studies were randomized clinical trials. An important number of complications were recorded, such as fractures, dislodgment and wear of the prosthesis structure. There is no evidence about the number and range of sessions needed to assess the clinical control of an immediate loading fixed rehabilitation. The best time to remove the provisional prosthesis and install the restorative rehabilitation is during the third and fourth month following immediate loading. Limited evidence was found regarding the number, time and type of radiological images requested for clinical support. Therefore, the clinical protocol developed by the authors will be a guide for future controls related to an immediately loaded implant-supported prosthesis.
Assuntos
Humanos , Implantes Dentários , Arcada Edêntula , Revestimento de Dentadura , Retenção de Dentadura , Prótese Dentária Fixada por Implante , Arco Dental , Implantação Dentária Endóssea/métodos , MandíbulaRESUMO
RESUMEN: Son varias las complicaciones que se pueden presentar posterior a la instalación de una prótesis fija total con carga inmediata (PFTCI), estas pudiesen generar desde el daño de la estructura protésica provisoria hasta la pérdida de la oseointegración de los implantes dentales. La escasa evidencia sobre el comportamiento clínico que se debe tener posterior a este tipo de tratamiento indica la necesidad de controlar mejor estas complicaciones. En esta revisión narrativa, el 3 de marzo de 2016 se realizó una búsqueda electrónica en la base de datos PubMed. Para poder efectuar una investigación acabada los filtros de búsqueda fueron ajustados de la siguiente manera. Se utilizaron los términos de búsqueda "immediate loading" AND "full arch" AND "Resonance frequency analysis". Los que fueron sometidos a los criterios de inclusión y exclusión, dando como resultado un total de 15 estudios. Todos los estudios eran ensayos clínicos controlados, donde se encontraron complicaciones como fracturas, desalojos y desgaste de la estructura protésica, entre otros. Se pudo observar que desde el día de la carga hasta un mes después el valor ISQ (cociente de estabilidad del implante) disminuye, para luego aumentar paulatina y progresivamente. En conclusión, no existe evidencia sobre el número y rango de sesiones necesarias para el control clínico de una PFTCI. El momento más indicado para la extracción de la prótesis provisoria e instalación de la prótesis definitiva es durante el 3° y 4° mes posterior a la carga inmediata. Existe escasa evidencia sobre el número, momento y tipo de examen imageneológico a solicitar. La presencia de complicaciones protésicas posterior a una PFTCI hace necesaria la confección de un protocolo de control clínico para este tipo de tratamiento.
ABSTRACT: There are many complications that can occur following placement with an immediately loaded implant-supported prosthesis in rehabilitation, these may generate damage to the provisional structure and even loss of the osseointegration from the dental implants. Limited evidence about clinical behavior post-installation, creates the need to better assess possible future complications that may arise. In this review, a systematic research was made in the PubMed database. The filters used were "immediate loading", "full arch" and "Resonance frequency analysis". The results were subject to the inclusion and exclusion criteria. A total of 15 studies were selected. All of the studies were randomized clinical trials, many complications were recorded, such as fractures, dislodgement and wear of the prosthesis structure. It was observed that from the first day of immediate loading until the first month, Implant Stability Quotient value decreases, subsequently, progressively increasing. There is no evidence about the number and range of sessions needed to assess the clinical control of a immediate loading fixed rehabilitation. The ideal time for removal of the provisional prosthesis and installation of the restorative rehabilitation, is during the third and fourth month after the immediate loading. Limited evidence was found regarding the number, the time and type of radiological images for clinical support. The possibility of several complications after an installation of a immediately loaded implant-supported prosthesis are very real, therefore is necessary to establish a clinical protocol for controls regarding this treatment.
Assuntos
Humanos , Implantes Dentários , Arcada Edêntula , Revestimento de Dentadura , Retenção de Dentadura , Prótese Dentária Fixada por Implante , Carga Imediata em Implante Dentário/métodos , Análise de Frequência de Ressonância , MandíbulaRESUMO
El propósito de esteestudio fue evaluar elnivel óseo y el éxito y fracaso de implantes con carga inmediata posicionados inmediatamentedespués de la extracciónpara rehabilitaciones de arco completo ycompararlos con los resultados obtenidos con implantes situados en alvéolos cicatrizados, en un periodo de 12 meses, para determinar la mejor alternativa de uso. Se efectúo una revisión sistemática en base aensayos clínicos aleatorios prospectivos y los ensayos clínicos aleatorizado o no aleatorizados, controlados o no controlados que evaluaron el fracaso yreabsorción ósea de implantes con carga inmediata posicionados en alveolos post-extracción y en alvéolos cicatrizados en pacientes adultos para rehabilitaciones de arco completo. Los datos de los ensayos clínicos fueron ingresados al software Review Manager®. Se realizaron dos metaanálisis para las distintas variables a analizar y posteriormente un análisis de sensibilidad para eliminar los estudios que causaban sesgo. De un total de 431 implantes analizados, 16 de ellos fracasaron, 11 de los cuales habían sido posicionados inmediatamente luego de la exodoncia. Tres de losautores considerados en la revisión, concuerdan en que hay un mayor éxito y menor pérdida ósea en aquellos implantes posicionados de manera tardía. Para rehabilitaciones implanto-soportadasde arco completo fijas o removibles, el protocolo de posicionamiento tardío, demostró ser una mejor alternativa puesto que manifestó una menor tasa de fracaso y una menor pérdida ósea.
The purpose of this study was to evaluate the bone level and the success and failure of loaded implants positioned immediately after extraction for full-arch restorations and compare the results obtained with implants placed in healed alveoli, in a period of 12 months, to determine the best alternative. A systematic review based on prospective randomized clinical trials, and randomized or nonrandomized controlled and uncontrolled trials evaluating failure and bone resorption of immediate loaded implants, positioned in post extraction and healed sockets in adult patients for full arch rehabilitations. Data from clinical trials were entered into Review Manager® software. Two meta-analyzes for different variables to analyze and subsequently a sensitivity analysis to eliminate bias caused studies were performed. From a total of 431 implants studied, 16 of them failed, 11 of which had been positioned immediately after the extraction. Three of the authors of the review considered agree that there are more successful and less bone loss in implants positioned so late. To implant-supported full-arch restorations fixed or removable, late positioning protocol proved to be a better alternative since it showed a lower failure rate and less bone loss.
Assuntos
Humanos , Perda do Osso Alveolar , Implantes Dentários , Carga Imediata em Implante Dentário , TitânioRESUMO
O presente trabalho apresentou um caso de cirurgia guiada onde o guia cirúrgico foi modificado para facilitar a posterior confecção da prótese fixa sobre implantes, minimizando o risco de falhas na adaptação e na relação interoclusal. Foi descrito o passo a passo das fases cirúrgica e protética de uma cirurgia guiada de paciente desdentado total, atentando para as vantagens de tal técnica, como a alta taxa de sobrevivência dos implantes, a elevada satisfação do paciente e a baixa perda óssea marginal ao redor dos implantes.
The present study presents a guided surgery case, where the surgical stent has been modified to facilitate the confection of an implant-supported prosthesis, reducing the risk of failures during fit and interocclusal registration. The step-by-step surgical and prosthetic approach is described, highlightening the advantages of this technique such as high implant survival rates, patient satisfaction, and low peri-implant bone loss.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Implantes Dentários , Prótese Dentária Fixada por Implante , Prótese Total , Cirurgia Assistida por ComputadorRESUMO
A intercorrência de fratura em próteses do tipo protocolo provisório na região de cantiléver tem sido relatada na literatura. Para conferir resistência, impedindo uma possível fratura em toda a sua extensão, o seguinte caso clínico relata a utilização de barras pré-fabricadas idealizadas por Freitas e Viana, em uma prótese provisória do tipo protocolo com carga imediata na mandíbula. A finalidade da utilização das barras, além de conferir resistência, foi apresentar uma alternativa mais econômica em relação às barras distais para reforço do cantiléver, existentes no mercado (Neodent®) e eliminar a etapa laboratorial, proporcionando um tratamento mais rápido e de custo inferior. No caso clínico descrito, após constatação de intensa perda óssea e de mobilidade nos dentes presentes, foi realizada moldagem, confecção de prótese total superior e inferior, exodontias e instalação de cinco implantes Cone Morse (SIN Sistema de Implantes) na mandíbula, minipilares e sutura. A prótese total inferior foi capturada sobre os cilindros de titânio unidos com barras pré-fabricadas Freitas e Viana colocadas na região de cantiléver, entre os cilindros na região anterior e presas com fio 012. A prótese foi desgastada por lingual até ficar na posição correta, observando a oclusão e capturada. A prótese permaneceu sem fraturas até a confecção do protocolo final. A utilização das barras pré-fabricadas Freitas e Viana permitiu rigidez à prótese, reforçando a região de cantiléver e também anterior, proporcionando custo mais baixo, além de agilidade no tratamento (AU).
The intercurrence of fracture in provisional protocol type prosthesis in the cantilever region has been reported in the literature. To confer resistance, preventing a possible fracture in its entire length, the following clinical case reports the use of prefabricated bars designed by Freitas and Viana in a provisional protocol type prosthesis with immediate loading in the jaw. The purpose of the bars use, besides conferring resistance, was to present a cost-effective alternative to the distal bars for cantilever reinforcement existing in the market (Neodent®) and to eliminate the laboratory stage, providing a faster and lower cost treatment. In the clinical case described, after finding severe bone loss and mobility loss in the teeth present, molding was carried out, making full upper and lower prosthesis, tooth extraction, installation of five Cone Morse (SIN Implant System) in the jaw, mini pillars and suturing. The total lower denture was captured on titanium cylinders attached with Freitas' and Viana's prefabricated bars put in the cantilever region between the cylinders in the anterior region and joined with wire 012. The prosthesis was worn out by lingual until the correct position, observing the occlusion and capture. The prosthesis remained without fractures until manufacturing of the final protocol. The use of Freitas' and Viana's prefabricated bars allowed rigidity to the prosthesis, enhancing the cantilever region and also the anterior region, providing lower cost and a prompt treatment (AU).
Assuntos
Humanos , Prótese Dentária Fixada por Implante , Carga Imediata em Implante Dentário/métodos , Mandíbula , Brasil , Radiografia Panorâmica/instrumentaçãoRESUMO
The present retrospective case series is aimed at evaluating a staged approach using a removable partial denture (RPD) as an interim prosthesis in treatment to correct a failing dentition until such time as a full-arch fixed implant-supported prosthesis may be inserted. Eight patients, who had undergone maxillary full-arch rehabilitation with dental implants due to poor prognosis of their dentitions, were analyzed. All treatment included initial periodontal therapy and a strategic order of extraction of hopeless teeth. An RPD supported by selected teeth rehabilitated the compromised arch during implant osseointegration. These remaining teeth were extracted prior to definitive prosthesis delivery. Advantages and drawbacks of this technique were also recorded for the cases presented. Among the advantages provided by the staged approach are simplicity of fabrication, low cost, and ease of insertion. Additionally, RPD tooth support prevented contact between the interim prosthesis and healing abutments, promoting implant osseointegration. The main drawbacks were interference with speech and limited esthetic results. Implant survival rate was 100% within a follow-up of at least 1 year. The use of RPDs as interim prostheses allowed for the accomplishment of the analyzed rehabilitation treatments. It is a simple treatment alternative for patients with a low smile line.
Assuntos
Prótese Dentária Fixada por Implante , Prótese Parcial Fixa , Prótese Parcial Temporária , Reabilitação Bucal/métodos , Idoso , Dente Suporte , Implantação Dentária Endóssea/métodos , Implantes Dentários , Prótese Parcial Imediata , Prótese Parcial Removível , Estética Dentária , Feminino , Seguimentos , Humanos , Masculino , Maxila/cirurgia , Pessoa de Meia-Idade , Osseointegração/fisiologia , Planejamento de Assistência ao Paciente , Estudos Retrospectivos , Fala/fisiologia , Cirurgia Assistida por Computador/métodos , Extração Dentária/métodos , Interface Usuário-ComputadorRESUMO
Os implantes osseointegrados promoveram importantes mudanças nas formas de reabilitação de pacientes parcial ou totalmente desdentados. Os pacientes totalmente desdentados apresentam clara predileção pelas próteses fixas implantossuportas, sobretudo porque proporcionam maior eficiência mastigatória e conforto, menos reparo e manutenção, além de favorecer o aspecto psicológico, uma vez que elimina o caráter removível das overdentures. Dentre os possíveis desenhos de próteses fixas as do tipo protocolo são as que apresentam maior aplicação clínica, e se caracterizam na mandíbula pela colocação de 4 a 6 implantes na região anterior, entre os forames mentuais, e cantilever distal bilateral para substituir os dentes posteriores. Na maxila recomenda-se a colocação de 6 a 8 implantes. Neste tipo de prótese utiliza-se uma infraestrutura metálica e uma base de resina para uni-la aos dentes de resina acrílica. O objetivo deste trabalho foi relatar um caso clínico de próteses totais fixas tipo protocolo bimaxilares, em que foram adotados critérios bem definidos de diagnóstico e planejamento, e empregadas técnicas cirúrgicas e protéticas com fundamentação científica.
The dental implants promoted important changes in the forms of rehabilitation of partially or fully edentulous patients. Edentulous patients show clear preference for implant-supported fixed prosthesis, mainly because they provide greater chewing efficiency and comfort, less repair and maintenance, in addition to promoting the psychological aspect, considering that eliminates the character removable of overdentures. Among the possible designs of the fixed prosthesis, the type protocols are the which have greater clinical application, and characterized by placing the jaw 4-6 implant in the anterior region between the foramina mentuals, and bilateral distal cantilevers to replace the posterior teeth. In the maxilla is recommended to put 6-8 implants. In this type of prosthesis is used a metal infrastructure and a resin base to attach it to the teeth of acrylic resin. The objective of this study was to report a case of protocol type full-arch fixed prosthesis bimaxillaries with employment of well-defined criteria for diagnosis and planning, and surgical and prosthetic techniques scientific evidence-based.
RESUMO
La Técnica TODO SOBRE -4 (All-on-4) desarrollada por el Dr. Paulo Maló, está basada en la rehabilitación completa de los maxilares con una prótesis fija de carga inmediata sobre 4 implantes adecuadamente distribuidos; 2 implantes angulados posteriores y 2 implantes axiales anteriores, sin la utilización de injertos óseos. En este trabajo presentamos un caso clínico de rehabilitación completa del maxilar superior con la técnica Todo Sobre -4
The All-on-4 technique developed by Dr. Paulo Maló, is based on the full arch rehabilitation of the jaws with a fixed prostheses on four implants immediately loaded and adequately distributed; 2 tilted posterior implants and 2 axial anterior implants without the need of bone grafts. In this work we present a clinical case of full arch rehabilitation of the maxilla with the All-on-4 technique