Case Study: Guided Maxillary All-on-4, Four Remaining Teeth to Fixed Teeth

Yaan Reznik

Sep 15

2 min read

Four remaining maxillary teeth were not restorable. All four were extracted and the arch was restored on four implants in the same surgical visit, opposed by natural mandibular teeth. TrueGuide Dental planned the case from the CBCT and the intraoral scan and printed the TrueGuide Stackable guide system.

Case at a Glance

Arch: maxilla, opposed by natural mandibular teeth
Presentation: four non-restorable teeth
Extracted: four teeth, with alveolar reduction through the guide
Placed: four implants, with the posterior pair tilted to clear the maxillary sinuses
Guide: TrueGuide Stackable system, with the base template indexed on the remaining teeth and pinned before extraction
Abutments: angled multi-unit abutments posteriorly and straight abutments anteriorly
Loading: immediate, with a screw-retained interim prosthesis
Surgical visits: one

Surgical Sequence

Reference capture: the base template was indexed on the remaining maxillary teeth and pinned to bone before any extraction, so the planned vertical and the midline were fixed while the dentition was still present to register them.
Extraction and alveolar reduction: the four remaining teeth were removed and the ridge was reduced through the guide to create the restorative space the prosthesis required, with the sockets debrided.
Guided placement: four implants were placed through the stacked osteotomy template, the posterior pair tilted to clear the maxillary sinuses and to widen the anterior-posterior spread available to the prosthesis.
Abutment-level conversion: angled multi-unit abutments were seated on the tilted implants and straight abutments anteriorly, correcting the divergence into one common path of insertion.
Immediate provisional: a screw-retained interim prosthesis was picked up intraorally on temporary cylinders and delivered the same day.

Outcome

The arch went from terminal dentition to a fixed screw-retained provisional in one appointment, and the definitive prosthesis is designed from the same digital plan that produced the guides.

What the Literature Reports

Four implants with the posterior pair tilted is a documented approach rather than a shortcut. A systematic review of 4,804 implants in 1,201 patients reports 99.0 percent implant survival and 99.9 percent prosthesis survival at 36 months, with no significant difference between axial and tilted implants or between arches. Cantilever length is then set case by case, since published anterior-posterior spread ratios are convention rather than validated rules.

Planning and guides by TrueGuide Dental. Surgery performed by the treating clinician.

Plan a Similar Case

Upload the CBCT, intraoral scan and Rx on the Submit a Case page or call (201) 255-4233. Guide packages are on the TrueGuide Pro page, and the other four cases are on the Case Studies page. How a stackable guide keeps one reference through the extractions is covered in Stackable Guides for Full-Arch.