GUIDED ALL-ON-FOUR PALATINE APPROACH WITH PREDICTABILITY FOR IMMEDIATE LOADING: CASE REPORT

Abstract

Implant-supported rehabilitation of atrophic maxillae has advanced with new techniques, reducing the need for multiple interventions and increasing predictability in immediate loading. In this case, a patient who is aesthetically and functionally dissatisfied with her smile is observed, uses a maxillary total denture with masticatory instability and atrophy in the anterior region of the maxilla. Although the conventional plan included bone reconstruction before implants, the All-on-Four technique with a palatal approach was chosen, taking into account their clinical conditions and main complaints. This technique avoids multiple surgical stages, taking advantage of the maxilla's anatomy with the presence of keratinized palatine tissue to cover the exposed turns of the implants. A surgical guide was prepared and the mini abutments were scanned, allowing the digitization of the preoperative condition, digital design of the prosthesis and milling in PMMA, being delivered eight hours after surgery. DISCUSSION: The All-on-four technique has transformed the rehabilitation of total edentulous patients, offering less complex alternatives to bone grafts. Using four strategically placed implants, the technique allows for a reduced cantilever of long-term prosthetic complications and treatment time, avoiding multiple surgical steps. It allows immediate loading with approaches such as the palate, zygomatic, and pterygoid approaches. Guided surgery increases the precision in implant placement, reducing complications and surgical time, in addition to assisting in diagnosis and planning. FINAL CONSIDERATIONS: The All-on-four technique in palatine with guided surgery is crucial to rehabilitate complex cases, the patient has reestablished aesthetics and masticatory function, demonstrating the success of the treatment and the efficacy of the chosen approach.