Why 4–6 Implants Only in the Premaxilla Are an Obsolete, Unstable and No Longer Acceptable Solution for Any Patient
- 1 Clinical introduction
- 2 History: why this technique was born
- 3 Anatomy of the premaxilla: why it cannot support an arch
- 4 Biomechanical limits of the 4–6 anterior implants
- 5 Why this technique is inadequate for ALL patients
- 6 Comparison between anterior and modern techniques
- 7 Golden Rule
- 8 Recommended modern solutions
- 9 Clinical summary
- 10 Ethical note
- ⭐ Final memorandum for the patient
1. Clinical introduction
The rehabilitation with 4 or 6 implants placed exclusively in the premaxilla (area 13–23) is a technique born for elderly, atrophic patients with poor masticatory function.
Today, with the modern biomechanical knowledge and the advanced vertical techniques, this configuration is considered inadequate, unstable and unethical for any patient, young or adult.
The premaxilla is a soft, spongy area, not designed to support posterior masticatory loads.
Using it as the only implant pillar means building a bridge without posterior columns.
2. History: why this technique was born
2.1 Origins (1980s–2000s)
The first full-arch rehabilitations with anterior implants were born in a completely different clinical context:
- elderly patients
- atrophic bone
- poor masticatory force
- limited functional expectation
- light prostheses
- short prosthetic life
In that period:
- modern pterygoid implants did not exist
- vertical basal implants did not exist
- the deep cortex was not used
- the posterior pillars were not rebuilt
The only "easy" area to treat was the premaxilla.
From here the philosophy is born: few implants in front + cantilever behind.
2.2 Commercial spread (2000–2020)
With the arrival of the simplified protocols (All-on-4, All-on-6):
- the premaxilla was standardised as a "safe area"
- the cantilever was accepted as an "inevitable compromise"
- the fake gum was introduced as a quick aesthetic solution
- the arch was reduced to 10–12 teeth
These solutions were designed for elderly patients, not for people with:
- powerful masseter
- bruxism
- long life
- complete functional needs
2.3 Modern overcoming (2020–today)
With the arrival of the vertical techniques:
it was demonstrated that:
- the posterior pillars can always be rebuilt
- the basal cortex is always available
- the cantilevers are no longer necessary
- the arch can always be complete (14 teeth)
- the premaxilla must no longer be overloaded
The "anterior implants only" technique has become obsolete.
3. Anatomy of the premaxilla: why it cannot support an arch
The premaxilla is designed for:
- incisors
- canines
- incisal guidance
- aesthetics
It is not designed for:
- molars
- premolars
- high vertical loads
- torsions
- bruxism
- distal levers
Its structure is:
- spongy
- soft
- thin
- not cortical
It is a non-load-bearing area.
Building a complete arch on this area is biomechanically wrong.
4. Biomechanical limits of the 4–6 anterior implants
4.1 Total absence of the posterior pillars
With only anterior implants:
- there are no emergences in the molar area
- there is no distal support
- an inevitable cantilever is generated
- the prosthesis becomes an unstable lever
- the anterior implants are overloaded
4.2 Overload of the masseter
The masseter is the most powerful muscle of the human body.
Its force discharges posteriorly, not anteriorly.
With implants only in front:
- the force is deviated forward
- unnatural frontal chewing is created
- the anterior implants are compressed and twisted
- the risk of implant loss increases
4.3 Pathological frontal chewing
Natural chewing is:
- vertical
- bilateral
- posterior
With only anterior implants it becomes:
- frontal
- horizontal
- unilateral
- unstable
This leads to:
- prosthetic fractures
- implant overload
- progressive bone loss
- implant failures
5. Why this technique is inadequate for ALL patients
Rehabilitation with anterior implants only is inadequate for everyone: young patients for duration and function, elderly for the fragility of the bone, bruxists for the overload, women for the lower bone density and patients with parafunctions for the structural instability.
The rehabilitation with only anterior implants is inadequate for all: young patients for the duration and function, elderly for the fragility of the bone, bruxists for the overload, women for the lower bone density and patients with parafunctions for the structural instability.
6. Comparison between anterior and modern techniques
| Characteristic | 4-6 anterior implants | All-on-Full® / BSS |
|---|---|---|
| Posterior pillars | Absent | Always present |
| Molars | Missing | All 14 teeth |
| Cantilever | Mandatory | Zero |
| Fake gum | Present | Zero |
| Chewing | Frontal, pathological | 100% physiological |
| Duration | Reduced | Decades |
7. Golden Rule
The golden rule of modern implantology: never rehabilitate a complete arch with anterior implants only. The posterior pillars (18/28) and the retrocanine fossae (15/25) must always be rebuilt when clinically possible.
The golden rule of modern implantology: never rehabilitate a complete arch with only anterior implants. The posterior pillars (18/28) and the retrocanine fossae (15/25) must always be rebuilt when clinically possible.
8. Recommended modern solutions
- All-on-Full®: complete protocol with posterior pillars
- Bilateral Sinus Solution™ (BSS™): pterygoid implants and sinus bypass
- Circolare d'Autore®: definitive prosthesis with 14 teeth without fake gum
9. Clinical summary
Rehabilitation with 4-6 implants only in the premaxilla is obsolete: it builds a bridge without posterior columns, with mandatory cantilever, pathological frontal chewing, fake gum and high risk of failure. The modern techniques always rebuild the posterior pillars: 14 teeth, zero cantilever, zero fake gum.
The rehabilitation with 4-6 implants only in the premaxilla is obsolete: it builds a bridge without posterior columns, with mandatory cantilever, pathological frontal chewing, fake gum and high risk of failure. The modern techniques always rebuild the posterior pillars: 14 teeth, zero cantilever, zero fake gum.
10. Ethical note
Offering a rehabilitation with anterior implants only to a patient with sufficient bone reserves for posterior pillars is a choice that limits function and duration. The patient has the right to know all the available options before accepting a reductive solution.
Offering a rehabilitation with only anterior implants to a patient with sufficient bone reserves for posterior pillars is a choice that limits function and duration. The patient has the right to know all the available options before accepting a reductive solution.
⭐ Final memorandum for the patient
If they proposed 4-6 implants only at the front: ask why the posterior pillars cannot be rebuilt, ask whether the arch will be complete with molars, ask whether there will be fake gum and ask what alternatives exist. The answers to these questions will tell you whether you are in expert hands.
If they proposed 4-6 implants only in front: ask why the posterior pillars cannot be rebuilt, ask if the arch will be complete with molars, ask if there will be fake gum and ask what alternatives exist. The answers to these questions will tell you if you are in expert hands.
The Circolare d'Autore® prosthesis
- 14 teeth per arch, including all posterior molars
- Zero fake gum: the teeth emerge from the natural gum
- Zirconia + layered ceramic, with registered trademark ®
- Custom-made: every prosthesis is a unique piece designed for the patient
Discover all the details on the dedicated page: Circolare d'Autore® — the definitive prosthesis without fake gum.