Research Article

Selective use of dynamic navigation for anatomically challenging immediate loading of All-on-4 implants: a retrospective cohort study

Volume: 60 Number: 1 September 9, 2026

Selective use of dynamic navigation for anatomically challenging immediate loading of All-on-4 implants: a retrospective cohort study

Abstract

Purpose

Edentulism compromises oral function and quality of life. The All-on-4 concept offers a fixed alternative to conventional dentures under immediate loading. However, evidence on outcomes in anatomically challenging arches, particularly with dynamic navigation, remains limited. This study reports early clinical and radiographic outcomes, and the feasibility, of immediate-loading All-on-4 in a real-world setting using an anatomy-driven allocation strategy with freehand and navigation workflows.

Materials and Methods

This retrospective cohort included consecutive patients treated between November 2023 and February 2025. Dynamic navigation was selectively applied in unfavorable arches; freehand surgery was used otherwise. Four implants per arch supported screw-retained provisional prostheses delivered within 24-36 hours. Primary outcomes were implant and arch-level survival and marginal bone level (MBL) change. Secondary outcomes included complications and provisional prosthesis survival.

Results

Twenty-two patients (23 arches; 92 implants) were analyzed: 13 arches freehand and 10 navigation. Median follow-up was 5.11 months. Five implants failed (5.43%), all in the maxilla, affecting four arches (one navigation, three freehand). Implant survival was 94.23% (freehand) and 95.00% (navigation). MBL change was negligible, consistent with early re-modeling and measurement variability. Biological complications occurred in 8 implants (8.70%), and two provisional fractures were repaired; 22 of 23 prostheses remained functional (95.65%).

Conclusion

Immediate-loading All-on-4 with selective navigation achieved high short-term implant and prosthesis survival and minimal MBL variation. These findings support the feasibility of navigation in demanding arches in routine practice, warranting confirmation in prospective studies with longer follow-up.

Keywords

Supporting Institution

This work received no financial support

Ethical Statement

The study complied with the Declaration of Helsinki; ethical approval was waived due to its retrospective design (EC AZ Sint-Lucas, project AZSTL2025-014).

References

  1. Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NH. Tooth loss and oral health-related quality of life: a systematic review and meta-analysis. Health Qual Life Outcomes. 2010; 8(1): 126 google scholar
  2. Emami E, de Souza RF, Kabawat M, Feine JS. The impact of edentulism on oral and general health. Int J Dent. 2013; 2013: 498305 google scholar
  3. Feine JS, Carlsson GE, Awad MA, Chehade A, Duncan WJ, Gizani S, Head T, Lund JP, MacEntee M, Mericske-Stern R, Mojon P, Morais J, Naert I, Payne AG, Penrod J, Stoker GT, Tawse-Smith A, Taylor TD, Thomason JM, Thomson WM, Wismeijer D. The McGill consensus statement on over-dentures. Mandibular two-implant overdentures as first choice standard of care for edentulous patients. Montreal, Quebec, May 24-25, 2002. Int J Oral Maxillofac Implants. 2002; 17(4): 601-602 google scholar
  4. Şirin Sarıbal G, Ersu N, Canger EM. Effects of conventional complete dentures and implant-supported overdentures on alveolar ridge height and mandibular bone structure: 2-year and 6-year follow-up study. Clin Oral Investig. 2022; 26(9): 5643-5652 google scholar
  5. Schimmel M, Araujo M, Abou-Ayash S, Buser R, Ebenezer S, Fonseca M, Heitz-Mayfield LJ, Holtzman LP, Kamnoedboon P, Levine R, McKenna G, Maniewicz S, Matarazzo F, Mattheos N, Papaspyridakos P, De Souza AB, Srinivasan M, Stilwell C, Weber HP. Group 4 ITI Consensus Report: Patient benefits following implant treatment in partially and fully edentulous patients. Clin Oral Implants Res. 2023; 34(S26): 257-265 google scholar
  6. Maló P, Rangert B, Nobre M. ”All-on-Four” immediate-function concept with Brånemark System implants for completely edentulous mandibles: a retrospective clinical study. Clin Implant Dent Relat Res. 2003; 5(s1): 2-9 google scholar
  7. Peñarrocha-Diago M, Peñarrocha-Diago M, Zaragozí-Alonso R, Soto-Peñaloza D. (on behalf of the Ticare Consensus). Consensus statements and clinical recommendations on treatment indications, surgical procedures, prosthetic protocols and complications following All-on-4 standard treatment. 9th Mozo-Grau Ticare Conference in Quintanilla, Spain. J Clin Exp Dent. 2017; 9:e712-5. google scholar
  8. Chen CS, Hsu H, Kuo YW, Kuo HY, Wang CW. Digital Workflow and Guided Surgery in Implant Therapy-Literature Review and Practical Tips to Optimize Precision. Clin Implant Dent Relat Res. 2025; 27(3): e70038 google scholar

Details

Primary Language

English

Subjects

Oral and Maxillofacial Surgery, Oral Implantology, Restorative Dentistry

Journal Section

Research Article

Publication Date

September 9, 2026

Submission Date

January 19, 2026

Acceptance Date

June 12, 2026

Published in Issue

Year 2026 Volume: 60 Number: 1

APA
Supply, K., Corthals, S., & Diez-Fraile, A. (2026). Selective use of dynamic navigation for anatomically challenging immediate loading of All-on-4 implants: a retrospective cohort study. European Oral Research, 60(1), 329-337. https://doi.org/10.26650/eor.20261864559
AMA
1.Supply K, Corthals S, Diez-Fraile A. Selective use of dynamic navigation for anatomically challenging immediate loading of All-on-4 implants: a retrospective cohort study. EOR. 2026;60(1):329-337. doi:10.26650/eor.20261864559
Chicago
Supply, Karen, Simon Corthals, and Araceli Diez-Fraile. 2026. “Selective Use of Dynamic Navigation for Anatomically Challenging Immediate Loading of All-on-4 Implants: A Retrospective Cohort Study”. European Oral Research 60 (1): 329-37. https://doi.org/10.26650/eor.20261864559.
EndNote
Supply K, Corthals S, Diez-Fraile A (September 1, 2026) Selective use of dynamic navigation for anatomically challenging immediate loading of All-on-4 implants: a retrospective cohort study. European Oral Research 60 1 329–337.
IEEE
[1]K. Supply, S. Corthals, and A. Diez-Fraile, “Selective use of dynamic navigation for anatomically challenging immediate loading of All-on-4 implants: a retrospective cohort study”, EOR, vol. 60, no. 1, pp. 329–337, Sept. 2026, doi: 10.26650/eor.20261864559.
ISNAD
Supply, Karen - Corthals, Simon - Diez-Fraile, Araceli. “Selective Use of Dynamic Navigation for Anatomically Challenging Immediate Loading of All-on-4 Implants: A Retrospective Cohort Study”. European Oral Research 60/1 (September 1, 2026): 329-337. https://doi.org/10.26650/eor.20261864559.
JAMA
1.Supply K, Corthals S, Diez-Fraile A. Selective use of dynamic navigation for anatomically challenging immediate loading of All-on-4 implants: a retrospective cohort study. EOR. 2026;60:329–337.
MLA
Supply, Karen, et al. “Selective Use of Dynamic Navigation for Anatomically Challenging Immediate Loading of All-on-4 Implants: A Retrospective Cohort Study”. European Oral Research, vol. 60, no. 1, Sept. 2026, pp. 329-37, doi:10.26650/eor.20261864559.
Vancouver
1.Karen Supply, Simon Corthals, Araceli Diez-Fraile. Selective use of dynamic navigation for anatomically challenging immediate loading of All-on-4 implants: a retrospective cohort study. EOR. 2026 Sep. 1;60(1):329-37. doi:10.26650/eor.20261864559