Full-Mouth Same-Day Dental Implants (All-on-4 Protocol) : Advanced Immediate Loading Case Study

Full-Mouth Same-Day Dental Implants (All-on-4 Protocol) — Advanced Immediate Loading Case Study

• Patient Profile: 53-year-old male, presenting with a severely compromised dentition (near-edentulous condition).
• Lead Specialist: Prof. Wu Dayi (吴大怡教授)
• Implant System Used: CDIC Dental Implant System
• Treatment Approach: Full-Mouth Immediate Loading Protocol (4 Implants per Arch / All-on-4)

This case report details the clinical workflow and immediate-loading outcomes in a 53-year-old male patient. Despite severe posterior maxillary bone resorption, our surgical team provided the patient with fixed provisional teeth (teeth 5 to 5, i.e., second premolars) and immediate improvement in essential masticatory function and facial aesthetics within approximately 8 hours, followed by a permanent all-ceramic restoration after a 12-month healing period and satisfactory osseointegration.

To minimize surgical trauma and optimize postoperative recovery, Prof. Wu Dayi executed a phased extraction and implantation protocol rather than removing all unsalvageable teeth simultaneously.

• Minimally Invasive Phased Extraction: The teeth were removed in planned stages to make the surgery more controlled and to allow immediate implant placement at selected sites. This approach enabled the surgical team to manage the soft tissues and extraction sites with greater precision compared with all-at-once extractions.
• Maxillary Bone Deficit & Site Selection: Due to extreme bone resorption in the posterior maxilla (maxillary tuberosity area), immediate bone grafting was deferred to the second-stage procedure. In the maxilla, four implants were strategically placed in the anterior and premolar regions. This layout was selected specifically to bypass localized bone defects while ensuring optimal AP spread (anterior-posterior).
• Mandibular Stabilization: Mandibular bone density was adequate for implant stabilization. Four implants were placed in matching positions in the lower jaw to establish a stable four-point support in the anterior-premolar region for immediate full-mouth reconstruction.

Same-Day Provisional Teeth Delivery (8-Hour Protocol)
Same-day provisional teeth refer to a fixed provisional bridge delivered on the same day as implant surgery. Within approximately 8 hours, all implants across both arches were placed and fitted with provisional long-span acrylic resin bridges for both upper and lower arches.

Occlusal Alignment & Cantilever Risk Management
Upper arch and lower arch bridge designs were carefully coordinated to balance function and implant protection:

Upper Arch
Supported by four strategically placed implants, the provisional bridge extended to teeth 5 to 5. To mitigate biomechanical risk from distal cantilevers, cantilever segments were intentionally placed in infraocclusion (cleared of centric occlusal contact) to minimize direct biting forces on the implants during the early healing period.

Lower Arch
Although mandibular bone density could support extension to the first molar (tooth 6), the lower bridge was intentionally restricted to teeth 5 to 5 primarily to achieve a symmetrical occlusal match with the upper arch. As a secondary biomechanical benefit, this restricted span helped minimize potentially damaging non-axial forces on the newly placed implants during the critical initial integration phase. Lower molar restoration may be re-evaluated in the second phase based on the patient's long-term functional demand.

Patient Consent
With patient consent, posterior molar restoration was deferred to the second phase to prioritize safe osseointegration during the immediate loading period.

Final Ceramic Restoration
After a 12-month healing period with satisfactory osseointegration and routine follow-up checks (at 3, 6, and 12 months), the provisional resin bridges were successfully replaced with high-strength, wear-resistant all-ceramic restorations.