Treatment Protocol for the Fully Edentulous Mandible with Implant-Supported Hybrid Prosthesis on Four Implants: “Full on Shorts®” Concept, Case Series

Introduction: Rehabilitation of the edentulous mandible with severe atrophy remains a major clinical challenge in implant dentistry. Conventional regenerative procedures, while effective, involve high morbidity, long treatment times, and increased costs. To overcome these limitations, the “Full on Shorts®” protocol was developed, based on the placement of short and extra-short implants in posterior mandibular positions, distributed vertically and parallel to minimize cantilevers and optimize biomechanical stability without the need for regenerative surgery or tilted implants. Materials and Methods: This retrospective study included patients treated with the “Full on Shorts®” protocol and followed for a minimum of two years after implant loading. Four implants were placed in each edentulous mandible using a biological drilling protocol. All cases received immediate loading with provisional prostheses, followed by definitive prostheses after 3–4 months. Clinical and radiographic follow-up was conducted every six months, with marginal bone loss evaluated using standardized periapical radiographs. Primary outcomes were implant and prosthesis survival, insertion torque, and marginal bone changes. Results: A total of 36 implants were placed in 9 patients (mean age 64.9 ± 7.3 years). Mean alveolar crest height at implant sites was 6.57 ± 0.63 mm. The average insertion torque was 47.2 ± 13.2 Ncm, with higher values in type I bone (50.3 Ncm) compared to type III bone (37.5 Ncm). All implants were immediately loaded. After a mean follow-up of 39.1 ± 13.3 months (range 20–67), the survival rate of both implants and prostheses was 100%. Mean marginal bone loss was minimal, with 0.21 ± 0.49 mm mesially and 0.13 ± 0.48 mm distally. Only two minor prosthetic complications (screw loosening) were recorded. Conclusions: The “Full on Shorts®” protocol represents a reliable and minimally invasive approach for the rehabilitation of atrophic mandibles. The excellent implant and prosthesis survival, combined with negligible marginal bone loss and the feasibility of immediate loading, support this technique as a predictable alternative to conventional regenerative or tilted implant protocols.