Instant loading of a prefabricated definitive zirconia prosthesis in an all-on-four rehabilitation with pterygoid implants using the full-arch surgery technique protocol.

Introduction: Immediate rehabilitation of severely atrophic maxillae is often complicated by the need for extensive surgical procedures, such as zygomatic or subperiosteal implants, when conventional techniques are no longer feasible. Incorporating pterygoid implants into the All-on-Four concept offers an attractive alternative by leveraging the dense cortical bone of the pterygomaxillary complex while eliminating posterior cantilevers.

Technical note: Building upon the Full-Arch Surgery Technique (FAST) approach, we present an innovating protocol that combines guided implant placement with instant loading of a prefabricated zirconia definitive prosthesis in a single surgical session. Rigorous digital planning, the use of rigid metal surgical guides, and low-speed drilling techniques contribute to surgical accuracy and predictable prosthetic outcomes. In our initial experience with 11 patients, all pterygoid implants remained functional at 15 months. One prosthetic fracture occurred and was successfully managed.

Conclusion: This protocol reduces morbidity, avoids complex and multiple surgeries (grafts, zygomatic implants, or delayed steps) and offers a reliable, efficient solution for fixed rehabilitation of atrophic maxillae.