All-On-Four Protocol With Immediate Load on Short Implants in an Atrophic Mandible: A Case Report with a 4-Year Follow-Up

Enéias Carpejani Rosa1, Tuanny Carvalho de Lima Do Nascimento1, Aline Monise Sebastiani1, Rafaela Scariot1, Tatiana Miranda Deliberador2, João Cezar Zielak2, Fernando Luis Esteban Florez2, Carmen Lucia Mueller Storrer1, *
1 School of Health Science, Universidade Positivo, Curitiba, Brazil
2 Department of Restorative Sciences, Division of Dental Biomaterials, University of Oklahoma Health Sciences Center, College of Dentistry, Oklahoma, Oklahoma, USA

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© 2018 Rosa et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address Correspondence to this author at the School of Health Science, Universidade Positivo, Pedro Viriato Parigot de Souza, 5300 - Cidade Industrial, Curitiba - PR, 81280-330, Brazil, Tel: +55 41 3317345; E-mail:



Edentulism has been demonstrated to have negative social and psychological effects on individuals that include adverse impacts on facial and oral esthetics, masticatory function and speech abilities, that when combined, are translated into significant reductions in patients’ quality of lives. It is well-known that immediate placement of implants is a challenging surgical procedure that requires proper treatment planning and surgical techniques. Therefore, the present study describes a 4-year follow-up case report where short implants were placed in an atrophic mandibule and were loaded with the utilization of an all-on-four prosthetic protocol.

Case report:

A 54 year-old woman dissatisfied with her oral and facial esthetics, masticatory function and speech ability came to the implantology clinic of the Positivo University seeking for oral rehabilitation treatment. After detailed physical and clinical examination, a Computer Tomography scan (CT-scan) was performed to determine the patient’s bone ridge density, dimensions and eligibility for the placement of dental implants. The CT-scan results have indicated the presence of an extremely atrophic mandibular bone ridge. The CT-scan was also used as an aid during the final restoration treatment planning in terms of vertical dimension of occlusion, masticatory function, and stabilization of the lower denture. An all-on-four protocol supported by short implants was then treatment-planned to reduce time, costs and morbidity, and also to achieve superior immediate esthetic results and masticatory function. To reconstruct the patient’s atrophic edentulous mandibule, 4 short implants, including 2 distally tilted, were placed with a final torque of 45 Ncm.


Following the development and implementation of a complex treatment plan, the patient displayed stable soft and hard tissues at 4-year postoperative follow-up assessment, demonstrating the effectiveness of the all-on-four technique supported by short implants.


Within the limits of this study, the present case report demonstrated that the all-on-four prosthetic protocol with immediate loading on short implant was effective in an atrophic mandible over a 4-year follow-up.

Keywords: All-on-four, Dental implants, Immediate loading, Short implants, Atrophic mandible, Computer tomography scan.