الفهرس 
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Abstract
Purpose: To evaluate the clinical peri-implant soft tissue changes and the ridge base relation for mandibular CAD-CAM manufactured screw-retained implant-supported hybrid prosthesis of polyetheretherketone (PEEK) framework with All-on-4 treatment concept. Material and methods: Six completely edentulous patients were rehabilitated by 4 implants following the “All on four” protocol. After 3 months, the definitive prosthesis was constructed to be screw retained CAD-CAM milled framework from the modified PEEK (BioHPP), bonded to PMMA teeth and a pink shaded indirect lightpolymerized nanofilled composite resin imitating the soft tissues. Peri-implant soft tissue changes regarding plaque, bleeding, gingival scores and probing depth were evaluated at prosthesis insertion (T0), six months (T1) and 12 months (T2) after insertion. Also, monitoring of the ridge base relation was performed using CBCT at prosthesis insertion (T0), one year (T1) and two years (T2) after mandibular fixed detachable All-on-4 framework insertion. Results: There was statistically significant difference regarding plaque, gingival, and bleeding scores for all implants with advance of time. However, there was statistically insignificant difference regarding probing depth in the posterior implants (p=.581). Regarding ridge base relation, there was a significant difference between observation times only in the anterior ridge area in between the two anterior implants (p= .011). Conclusion: Within limitations of the study, the full arch PEEK framework of fixeddetachable; hybrid; prosthesis used with All-on-4 concept for rehabilitation of mandibular edentulous arches is an acceptable treatment approach; based on the stable ridge base relation posteriorly found in this study. Special considerations for frequent soft tissue follow up and regular maintenance of oral hygiene measures are recommended.