Challenges and Solutions in Geriatric Dentistry: All-on-Four Rehabilitation of Atrophic Maxilla in an 88-Year-Old Patient – A Case Report

Résumé

The progressive aging of the population has increased the demand for predictable and minimally invasive oral rehabilitation strategies capable of restoring masticatory function, esthetics, and quality of life in elderly patients. Edentulism and maxillary atrophy pose anatomical and functional challenges that often limit conventional implant placement. The All-on-Four protocol has emerged as an alternative treatment that optimizes the use of available bone, reduces surgical morbidity, and shortens rehabilitation time. An 88-year-old male patient, classified as ASA I and systemically healthy, presented with an atrophic maxilla and poor adaptation of a provisional removable partial denture. Full-arch maxillary rehabilitation was performed using the All-on-Four protocol. Two anterior axial and two posterior tilted implants were placed (Conexão, Brazil), achieving primary stability of 45 Ncm. A provisional complete denture was adapted and, after osseointegration, definitive fixed prostheses were fabricated. Postoperative follow-up included clinical and radiographic evaluations at 12 months. At one-year follow-up, the patient presented satisfactory peri-implant health, absence of bone exposure, and excellent functional and esthetic adaptation. He reported significant improvement in masticatory efficiency, facial harmony, self-confidence, and overall quality of life. The All-on-Four approach proved to be a predictable and efficient solution for the rehabilitation of an atrophic maxilla in an elderly patient, minimizing surgical complexity while ensuring biomechanical stability and favorable esthetic outcomes. This case reinforces the technique as a valuable option in geriatric dentistry, combining functionality, comfort, and long-term success even in advanced age.