Augma Biomaterials

Full Arch Rehabilitation of the Maxilla with an Immediate All-on-4

The patient is a healthy, 61-year-old woman who attended the consultation complaining about the lack of aesthetics of her smile and difficulties in chewing properly.

The patient had only 6 maxillary front teeth remaining, and she was incapable of using an old removable prosthesis that she had been using.

She wanted a fixed prosthesis and to be able to feel good with her appearance again.


  1. Hello,
    Did you level the bone before the implant placement? What sutures are used?
    Thank you

    1. The following reply is from Dr. José Camelo Ferreira:

      In this case the bone was leveled very slightly. The smile line was low and the start of the future prosthesis was out of sight. 

      I normally use two things: The Goiva tweezers for small leveling, like in this case, and the Handpiece for large leveling as you can see in the photo above.
      The suture is B/Braun Supramid 4-0 (pseudo-monofilament polyamide). For me, it’s a great suture, comfortable for the patients and resistant during and after surgery.

  2. Doctor,
    Thank you for your kind response.
    One more question.
    The lendable of a final prosthesis/ hybrid.
    The intaglio of the hybrid appears to be concave, food will adhere there. What is the hygiene recommendations to pt. and what is the solution for the convex intaglio?
    Thank you.

  3. The following reply is from Dr. José Camelo Ferreira:

    This is a very good question. The hybrid is not concave. It has a ramp from buccal to palatal but it’s not concave. The hygiene recommendations are the normal recommendations for natural teeth, plus the use of a water jet every day (at least once a day). Periodic consultations are done every 4 months, or every 6 months for patients with good hygiene. This is to disassemble and clean the hybrid prosthesis. Sometimes the shape of the soft tissue (different heights between buccal and palatal) and the volume needed to support the lip, doesn’t allow a completely convex base of the prosthesis. Nevertheless, a ramp shaped base will enable the patient to clean the prosthesis in a very satisfactory way as the water jet will push all food debris to the palate exit. A concave base is done by some to hide badly placed implants, or badly planned smile lines. In my opinion there is no way of doing a proper hygiene on them. Thank very much you for your question.

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