Complex All-on-4 Case: Full Arch Restoration with Bone Atrophy

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All on 4 complex case dentists

A complex All-on-4 case treated at Asensio Advanced Dentistry in Valencia — a complete upper jaw restoration in a patient with severe edentulism and maxillary bone atrophy, previously rejected by other clinics as unsuitable for standard implant treatment. Dr. Lucía Asensio Romero, specialist in implantology and oral surgery, resolved the case using biomaterials without the need for aggressive bone grafting procedures. The patient left the clinic the same day with fixed teeth and the ability to eat immediately.

complex case All on 4

Cases of this complexity — severe bone atrophy, previous failed treatment attempts, multiple rejected consultations — are precisely the type of situation that Asensio specialises in. Over 30 years of experience and more than 5,000 implants placed means our team has encountered and resolved the full spectrum of implant complexity, including cases that other clinics decline.

If you have been told you are not a candidate for dental implants due to bone loss or jaw atrophy, contact us for a free second opinion — call 0800 048 8058 or email office@dentalasensio.co.uk.

About this case

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Complex All-on-4 case — preparing material

The patient presented with complete edentulism of the upper arch combined with significant maxillary bone atrophy — a condition that reduces or eliminates the bone volume available for conventional implant placement. Standard implant protocols were not viable without extensive bone grafting, which other clinics had either declined to perform or quoted at prohibitive cost and recovery time.

At Asensio, the case was resolved using the All-on-4 technique with biomaterials — four specially angled implants that maximise contact with the available bone, eliminating the need for bone grafting. The fixed provisional prosthesis was placed the same day as surgery, allowing the patient to leave the clinic with functioning teeth.

Why All-on-4 works for complex bone loss cases

All-on-4 implant surgery

The All-on-4 technique was specifically developed to address the challenge of reduced bone volume in edentulous patients. By angling the posterior implants at up to 45 degrees, the procedure maximises contact with existing bone — avoiding the anatomical areas most affected by atrophy. This approach means that many patients who have been told they need extensive bone grafting before implants can instead be treated directly with All-on-4.

For patients with extreme bone loss where even All-on-4 is not viable, zygomatic implants — which anchor in the cheekbone rather than the jaw — offer a further alternative. See our guide to dental implants with bone loss for a full overview of options.

What the All-on-4 procedure involves

All-on-4 final result

Stage What happens
3D CT planning Planmeca Promax 3D scan maps available bone volume and nerve positions — implant positions planned digitally before surgery
Extractions Any remaining failing teeth removed in the same surgical session
Implant placement Four implants placed — two straight, two angled posteriorly to maximise bone contact with available jaw structure
Same-day prosthesis Fixed provisional teeth attached to the implants the same day — patient leaves with functioning teeth
Final prosthesis Permanent fixed teeth fitted after osseointegration — typically 3 to 6 months later

Related guides

Zygomatic implants

Zygomatic Implants: Fixed Teeth When Conventional Implants Are Not Possible

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Zygomatic implants are a specialist surgical solution for patients with severe bone loss in the upper jaw who cannot receive conventional dental implants or All-on-4. Instead of anchoring in the jawbone — which has resorbed to the point where it cannot support standard implants — zygomatic implants are fixed in the cheekbone (zygoma), which retains its density and volume even after years of tooth loss.

For patients who have been told that implants are impossible because of insufficient bone, zygomatic implants often represent the only pathway to fixed teeth without extensive bone grafting. The technique was developed in Sweden by Professor Per-Ingvar Brånemark and has been refined over three decades into a predictable, well-documented procedure with high long-term success rates.

At Asensio Advanced Dentistry in Valencia, zygomatic implants are performed by Dr. Lucía Asensio Romero, a specialist in implantology and oral surgery with over 30 years of experience in complex implant cases. If you have been told you cannot have implants, contact us with your existing scans for a preliminary assessment before travelling. Call us on 0800 048 8058 or email office@dentalasensio.co.uk.

Who are zygomatic implants for?

Zygomatic implants are indicated for a specific group of patients: those with severe maxillary bone atrophy — significant resorption of the upper jawbone — who are not suitable for conventional implants or All-on-4 with standard biomaterial augmentation. This situation typically arises after:

Cause of bone atrophy Why it creates problems for standard implants
Long-term complete edentulism Bone resorbs progressively without tooth roots to stimulate it
Long-term denture use Denture pressure accelerates resorption of the underlying bone
Failed previous implants Bone loss at the failed implant site reduces available volume
Severe periodontal disease Chronic infection destroys supporting bone around teeth
Trauma or oncological surgery Direct bone loss from injury or surgical removal

Not all patients with bone loss require zygomatic implants. Many cases of moderate atrophy can be resolved with All-on-4 angled implants and biomaterial augmentation — as described in our complex All-on-4 case study. Zygomatic implants are reserved for cases where the bone volume is genuinely insufficient for any standard implant approach.

How zygomatic implants work

A zygomatic implant is significantly longer than a conventional implant — typically 30–52mm compared to 8–16mm for a standard implant. It passes through the remaining maxillary bone and the maxillary sinus, anchoring its apex in the dense cortical bone of the zygoma. This provides stable, immediate fixation that does not depend on the quality or volume of the jawbone.

In most cases, two zygomatic implants are used in combination with two or four standard implants placed in the anterior maxilla where bone is more preserved. This hybrid approach — known as the “quad zygoma” or standard zygoma protocol depending on the case — supports a complete fixed upper arch prosthesis fitted on the same day as surgery.

Stage What happens
Pre-surgical assessment 3D CBCT scan, surgical planning, prosthetic design
Surgery Placement of zygomatic implants under local anaesthesia with sedation if required
Same-day prosthesis Fixed provisional teeth fitted on the day of surgery
Osseointegration 3–6 months at home in the UK with functional provisional teeth
Definitive prosthesis Final restoration fitted at second visit to Valencia

Advantages vs bone grafting

The traditional solution for severe maxillary atrophy has been bone grafting — harvesting bone from another part of the body (typically the hip or skull) and transplanting it to the jaw, followed by a healing period of 6–12 months before implants can be placed. Zygomatic implants offer a fundamentally different approach:

Factor Bone graft approach Zygomatic implants
Treatment timeline 12–18 months total Fixed teeth same day
Number of surgeries 2–3 (graft + implants + prosthesis) 1 surgical session
Donor site surgery Yes — hip, skull or chin No
Graft failure risk 10–30% depending on case Not applicable
Cost Significantly higher Lower total cost — fewer procedures

For a real example of a complex bone atrophy case resolved at Asensio, see our complex All-on-4 clinical case — full arch restoration in a patient previously rejected by other clinics.

Related guides

Frequently asked questions

Am I a candidate for zygomatic implants?

Zygomatic implants are indicated for patients with severe maxillary bone atrophy who are not suitable for conventional implants. The definitive assessment requires a 3D CBCT scan to evaluate bone volume, sinus anatomy and surgical access. If you have been told you cannot have implants due to bone loss, send us your existing scans for a preliminary remote assessment — contact us at office@dentalasensio.co.uk.

Is the surgery painful?

Zygomatic implant surgery is performed under local anaesthesia. Conscious sedation is available for patients who prefer it. Post-operative discomfort is typically managed with standard pain relief and most patients describe the experience as less uncomfortable than anticipated. Mild swelling for 3–5 days is normal.

How long do zygomatic implants last?

Long-term clinical studies show zygomatic implants have success rates above 95% at 12 years. The zygoma — unlike the maxillary bone — does not resorb, providing a stable foundation for the implant throughout the patient’s lifetime.

Can I have zygomatic implants if I have already had failed conventional implants?

In most cases yes. Failed implants are removed, the sites are treated, and zygomatic implants bypass the compromised area entirely by anchoring in the cheekbone. Each case is assessed individually with a 3D CBCT scan before any treatment is planned.

How many trips to Valencia are required?

Most patients require two trips: the first for the surgical assessment and implant placement (typically 4–5 days including pre-surgical consultation), and the second for the definitive prosthesis fitting 3–6 months later. Fixed provisional teeth are worn between visits. For more information visit our how it works page or our dental implants abroad page.