Dr. Marques and Dr. Davó

“The patient was told bone harvest and grafting was the only option.”

Clinical situation

Francisca began losing her teeth at the young age of nine. She grew up in Angola, where access to dental care was very limited at the time. Her dental problems persisted, leading her to extract more of her maxillary teeth over time. At the age of 19, she was advised by the local dentist that if she extracts all the maxillary teeth, including the anterior ones that were still functional, she could have a removable denture with white and aligned teeth, which she did.

Periodontal examination and face analysis prior to surgery.

Periodontal examination and face analysis prior to surgery.

“It was the biggest mistake of my life,” she says.

The removable denture did not work due to the progressive atrophy in her maxilla. Even after five adjustments and changing the denture, the retention was never adequate, robbing her of her confidence to smile.

When Francisca relocated to Portugal, she consulted with several dentists who recommended extensive and invasive surgeries, bone harvesting, and grafting. She continued to live without a maxillary denture for an entire year until she visited MD Clínica. Upon hearing the suggestion that she could have a fixed denture in just 24 hours, her immediate response was an enthusiastic “Façamos isso!” - which translates to “let’s do this!”

Surgical solution

Dr. Rubén Davó and I collaborated on Francisca’s surgery. Our clinical and X-ray image analyses showed alveolar bone atrophy, with severe thickness loss, in addition to a high-level pneumatization of the maxillary sinus, bilaterally, and history of implant loss. We are dedicated to providing our patients with the best possible outcome, which is why we have carefully selected the most effective and reliable implants and prostheses for Francisca’s surgery. We chose the hybrid All-on-4® treatment concept.1

For the posterior implant, we used NobelZygoma 45°. This implant has a unique design, featuring a tapered tip that makes insertion easier and facilitates primary stability for Immediate Function. Moreover, the implant body is partially unthreaded at the coronal part, which interfaces with the soft tissue and does not necessarily engage with the bone.

Preparation for impression coping after implant insertion

Preparation for impression coping after implant insertion.

Orthopantomogram after placing the straight and angulated Multi-unit Abutments.

Orthopantomogram after placing the straight and angulated Multi-unit Abutments.

Healthy soft tissue after healing

Healthy soft tissue after healing.

Studies have shown that the NobelZygoma implant offers a high survival rate and low rate of complications, making it a viable option for graftless restoration of the maxilla, including immediate loading protocols.2 We also used NobelActive® in the anterior, and NobelProcera® implant-supported prosthesis with immediate loading.

Patient outcomes


Before the treatment, Francisca faced a range of physical, social, and emotional challenges due to her condition. But she was able to return to her normal activities and felt more confident in social situations after the treatment. One month after her surgery, Francisca attended her daughter’s wedding and sent us a photo with the caption, ‘Now I can truly smile.’


1. Lopes A, de Araújo Nobre M, Ferro A, et al. Zygomatic Implants Placed in Immediate Function through Extra-Maxillary Surgical Technique and 45 to 60 Degrees Angulated Abutments for Full-Arch Rehabilitation of Extremely Atrophic Maxillae: Short-Term Outcome of a Retrospective Cohort. J Clin Med. 2021 16;10(16):3600.
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2. Davó R, Bankauskas S, Laurincikas R, et al. Clinical Performance of Zygomatic Implants-Retrospective Multicenter Study. J Clin Med. 2020 9;9(2):480.
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