Full arch implant prosthesis can be a quite demanding procedure. In this case the patient had severe periodontitis and multiple decays. No tooth could be saved, She also had two malposed implants and an impacted cuspid. After an accurate evaluation, the extraction of all the remaining maxillary teeth was planned, together with the removal of the two malposed implants, of the impacted cuspid and the immediate insertion of four implants and four angulated abutments. After the healing period, a digital impression with an intraoral scanner was performed and a full arch metal and composite prosthesis was delivered. The precise positioning of the implants allowed a good aesthetic result, resulting in an improved aesthetic and function.