All-on-Four protocol in the rehabilitation of atrophic maxillae: an integrative review of efficacy, safety, and impact on quality of life

Abstract

Tooth loss compromises chewing, aesthetic, and psychosocial functions, directly impacting quality of life. Conventional techniques, such as bone grafts or protocols requiring more implants, often involve surgical complexity and elevated risks, underscoring the need for effective and accessible methods. The All-on-Four protocol has emerged as an innovative approach for rehabilitating atrophic and edentulous maxillae, particularly in patients requiring less invasive solutions. This study aimed to analyze, through an integrative review, the efficacy, safety, and impact on quality of life of the All-on-Four protocol in rehabilitating atrophic maxillae. PubMed, SciELO, and BVS databases were consulted. Articles published in Portuguese and English (2005–2025), focusing on original studies, systematic reviews, and longitudinal research, were included. Out of 68 identified studies, 31 were selected after screening for relevance and methodological quality. The protocol demonstrated an implant survival rate exceeding 95% over 10 years, with a mean marginal bone loss of 1.2 mm and minimal complications such as screw fractures and peri-implantitis. Compared to techniques like All-on-Six, it exhibited reduced invasiveness, avoiding bone grafts and shortening recovery time. Studies also highlighted significant improvements in quality of life, with patient satisfaction regarding masticatory function and aesthetics. The All-on-Four protocol proved effective, safe, and predictable, offering biomechanical and psychosocial advantages over traditional methods. Its application promotes comprehensive rehabilitation, aligning oral health, physical well-being, and social reintegration, reinforcing its role as a priority strategy for cases of maxillary atrophy.