###### Abstract  
The aim of this retrospective single-cohort study was to evaluate the clinical outcome of four-to-five implants immediately restored with metal-resin screw-retained cross-arch fixed prostheses in edentulous jaws 10 years after loading. One-hundred-and-four consecutive patients received four to five implants placed with a torque superior 35 Ncm. One-hundred-and-twenty-seven metal-resin screw-retained fixed prostheses (59 mandibular and 68 maxillary) were to be delivered within 3 days. Outcome measures, evaluated by the treating clinician, were: prosthesis and implant failures, prosthetic modifications, peri-implant mucositis, and biological and prosthetic complications. A total of 549 implants were placed. Twenty-one implants failed in 14 patients and 102 prostheses were remade, at least once, in 81 patients: 2 due to implant failures and 33 because of fractures of the prostheses. In particular, 25 original metal-resin prostheses had to be remade because of fractures versus only eight of the replacement monolithic metal-resin prostheses. All patients were wearing fixed prostheses at the end of the follow-up. Thirty-six biological complications occurred in 22 patients. Eight-six prosthetic complications occurred in 42 patients. In conclusion, immediately loaded cross-arch prostheses supported by four-to-five immediately placed implants are a viable therapeutic option if robust prostheses are made.  
d 20221202202202212212221222122122212221222122221  
implant inclination, concluding that a reduction in force relief on the involved structures and stress on the peri-implant bone can be obtained by reducing cantilever length by tilting the posterior implant [11].  
The more implants inserted, the higher the costs for the patient. In addition, a greater number of implants also means more precision in the fabrication of the prosthetic structure that will be passively fitted to finalize the work. [PERSON] et al. conducted a comparative study between all-on-four and all-on-six treatment concepts [12]. After a distribution of the sample by the material used and the treatment performed, they concluded that all-on-six approach, when it is possible to execute, and stiffer framework materials had the most favorable biomechanical behavior.  
In addition, implants can be loaded immediately after their placement without significantly increasing the risk for failures [13], especially in fully edentulous mandibles [14; 15; 16], but also in fully edentulous maxillae [17; 18].  
Edetentulous patients would like to have a functional fixed prosthesis without delay, after a minimal surgical intervention and at a reduced biological and financial cost, providing that failure risks are not excessively increased [19]. Therefore, it would be interesting to know whether it could be possible to rehabilitate fully edentulous patients with fixed cross-arch prostheses supported by four-to-five immediately loaded implants. A previous publication of the same patient material presented the 1-year data [18].  
The aim of the present retrospective single cohort study was to evaluate the clinical outcomes of immediately loaded maxillary and/or mandibular cross-arch metal-resin screw-retained fixed prostheses on four-to-five immediately placed dental implants without bone augmentation in totally edentulous maxillary and/or mandibular jaws with a 7-year follow-up.