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A new approach for immediately loaded pterygoid implants: piezoelectric implant site preparation

Poster · January 2016

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4 authors:

Alessandro Cucchi Riccardo Caricasulo

University of Bologna Private Practice
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Luciano Malchiodi Giuseppe Corinaldesi

University of Verona University of Bologna
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A NEW APPROACH FOR IMMEDIATELY LOADED PTERYGOID IMPLANTS:

PIEZOELECTRIC IMPLANT SITE PREPARATION
Cucchi A1, Caricasulo R2*, Vignudelli E1, Malchiodi L3, Corinaldesi G1
1Department of Biomedical and Neuromotorial Science, University of Bologna, Bologna, Italy
2Department of Surgery, University of Turin, Turin, Italy
3Department of Surgery, University of Verona, Verona, Italy

OBJECTIVES: The aim of this report is to describe a surgical approach to

safely prepare pterygoid implant sites by means of a piezo-electric
device, in order to reduce risks of nerve or vascular injuries during
implant- rehabilitation.

CASE PRESENTATION: A 55-year-old female patient was referred to

authors in order to restore the posterior maxilla with a fixed implant-
prosthetic rehabilitation. Clinical and radiographic examinations
showed mobility of anterior residual teeth and alveolar posterior
atrophy due to maxillary sinus expansion. After discussion with the
patient regarding treatment and reconstruction options, amount of
residual bone, and patient derides, the authors decided for a full-arch
rehabilitation supported by maxillary and pterygoid implants. Under
local anesthesia, all maxillary teeth were extracted. Crestal incisions
were performed and full-thickness flaps were raised in order to expose
the whole maxilla as well as tuberosity regions. Six tapered implants
were placed: 2 straight implants in the premaxilla, 2 tilted implants
engaging the anterior wall of the maxillary sinus, and 2 pterygoid
implants in the pterigo-maxillary regions. While the anterior implants
were placed with a conventional drilling site preparation, the pterygoid
implants were inserted with an exclusive piezoelectric site preparation
with specific tips (IM1S, IM2P-15, and P2-3), with an angulation of about
70° relative to occlusal plane, engaging the pterygoid plates. Since all
implants achieved a good primary stability (insertion torque > 35 Ncm),
standard abutments were connected to the 2 axial implants and
angulated conical abutments were connected on 4 tilted implants.
Within 48 hours, an acrylic resin titanium-reinforced prosthesis was
delivered and screwed on abutments, achieving an immediate loading
full-arch rehabilitation.
The healing period was uneventful. No surgical, healing, or prosthetic
complications occurred. One year later, clinical and radiographic
examinations showed soft tissue contours and crestal bone levels with
no significant changes. No signs of mucositis or peri-implantits were
observed during follow-up period.

DISCUSSION: Implant placement in the posterior maxilla is often

challenging because of the poor quality and quantity of residual jawbone.
Pterygoid implants is a viable alternative technique able to avoid
reconstructive surgery. In addition, they can provide excellent primary
stability avoiding the need of prosthetic distal cantiveler in immediate
loaded rehabilitation. However, this technique is technically demanding
due to the proximity to noble anatomic structures. Piezoelectric implants
site preparation could help to have an easier access and higher visibility
of tuberosity regions, to minimize surgical risks, and to optimize implant
site preparation by means of under-preparation of maxillary tuberosity
(D1) and iuxta-preparation of pterygoid plates (D3).

CONCLUSIONS: This surgical approach could be considered a viable and

safe option for the immediate loading full-arch rehabilitation of the
atrophic maxilla, allowing to prepare implant sites minimizing risks for
anatomical structures.

References:
1. Vercellotti T. “La chirurgia ossea piezoelettrica”. Relazione Ufficiale, Nuove Tecnologie in chirurgia ORL. 2005, pp 15-33.
2. Vercellotti T, Dellepiane M et al. “ Aspetti Istologici della Piezosurgery”. Relazione Ufficiale Nuove Tecnologie in chirurgia ORL. 2005 p 35-43.
3. Stacchi C, Vercellotti T, Torelli L, Furlan F, and Lenarda di R. “Changes in implant stability using different site preparation techniques: twist drills versus piezosurgery. A single blinded, randomized, controller clinical trial”. Clinical Implant Dentistry
and Related Research, vol 15, no.2, pp.188-197. 2013
4. Canullo L et al. “Piezoelectric vs conventional drilling in implant site preparation: pillot controlled randomized clinical trial with crossover design”. Clin Oral Implants Res, 2014 Dec; 25(12):1336-43
5. Agarwal E, Surendra S, Kumar A. “Escalating of Roles of Piezosurgery in dental therapeutics”. Journal of Clinical and Diagnostic Res. 2014 Oct, Vol- 8(10).

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