Dr. Sönke Harder uses the All-On-4-Concept to create an immediate, temporary rehabilitation for a patient with periodontal desease. Using digital volume tomography made preoperational planning possible. Thus a surgical guide could also be fabricated preoperatively. Initially, a marginal incision next to the residual upper teeth is followed by a crestal one expanding into the molar region of both sides. Dr. Harder then starts the preparation of a mucoperiostal flap and carefully extracts the highly loosened residual teeth oft he front an canine region. He also excises granulation tissue und planes sharp bone fragments to guarantee improved wound healing capacities. Four implants are inserted to substitute the lateral front teeth and second premolars using a surgical guide. The implants in the back are angled to 30° in order to improve their primary stability, which is predominantly obtained by attaching the implant body with a physical force of 45 Ncm. After the connective elements are inserted, healing caps are put on top oft he implant bodies. Bone substitute material is applied to fill residual intra-bony defects. Membranes are used to protect the bone from an accelarated epithelial growth. They are prevented from lateral slipping through fixation sutures. To create a tensionless wound closure interrupted sutures are placed. Finally, the preoperatively fabricated temporary prosthesis is used to secure an impression of the exact implant position and is then finalised by the dental technicial.