Treatment of a severely atrophic maxilla using an immediately loaded, implant supported fixed prosthesis without the use of bone

grafts: A clinical report:
Sherry J S et al J Prosthet Dent 2010;103:133-138

Implant therapy and restoration - severely resorbed edentulous maxilla -difficulties -surgeon -restorative dentist. In the past -particulate autogenous bone, with barrier membranes and stabilizing tacks and screws or large autogenous iliac crest block grafts. Other bone grafting options - allograft, xenograft, monocortical blocks,or iliac crest grafts.

Jemt T. Ten-year results for Brånemark implants immediately loaded with fixed prostheses at implant placement.) .Int J Oral Maxillofac Implants 1997. Int J Oral Maxillofac Implants 1991.641 consecutively placed Brånemark dental implants: a study from stage I surgery to the connection of the completed prostheses.) ‡ Difficulty-immediate loading-max-type 3 or type 4 bone-sinus. 1yr ± multiple surgeries-complications . Wöhrle PS. Rubenstein JE. Early failures in 4. Lekholm U. (Schnitman PA. Wang NH.Introduction Grafting -resorbed situations-2-stage implant protocol. (Friberg BS.donor site morbidity.12:495-503.DaSilva J.6:142-6.

Introduction ‡ Pterygomaxillary zygomaticus regions ±viable Rximmediate implant placement.20:45-9).Rx. Immediate function in the atrophic maxilla using zygoma implants: a preliminary study. Clin Oral Implants Res 2009. Malevez C. Bone quality in the midpalate for temporary anchorage devices. (Wehrbein H. (Davo R.97:544-51.dense bone. . Rojas J. JProsthet Dent 2007.) ‡ Median palatal bone.

. functional maxillary fixed prosthesis without bone grafting surgery in a single visit.Purpose«. To provide the patient with an immediately loaded. demonstrating that even the most severely resorbed maxilla can be restored and functionally loaded when the pterygomaxillary and zygomatic regions are used for implant support.

‡ Cc .Clinical report ‡ 69 old woman.and delayed loading.bone grafting. ‡ Fixed. ‡ Prostho Rx options.max denture.controlled type II diabetes. . screw-retained maxillary and mandibular prostheses-immediate loading. implant placement.

‡ Pt evaluated clinically.1yr before.radiographically .definitive ceramic prosthesis. ‡ A mandibular immediate fixed prosthesis.‡ Maxillary fixed implant-supported acrylic resin provisional prosthesis. ‡ 3 months .


‡ DICOM formatted files -CBCT scan . ‡ Prior to scanning-max denture.(3-D) format virtual implant planning. ‡ 14 uniform-perforations-guttapercha. .‡ CBCT-prosthodontic Rx.

‡ The software . midpalatal. lateral-nasal. .implant locations-pterygomaxillary. and zygomaticus areas.

‡ 2 implants each . ‡ Virtual planning-data uploaded-surgical template. ‡ Single short implant ± midpalate.pterygomax and lat nasal areas. .‡ 1 implant each .zygomatic region.

‡ Anaesthetist-G.5% with 1:200.A-nasal intubation-L. ‡ L.A.‡ Pt draped and prepared ± implant surgery. (8 carpules of bupivacaine 0.000 epinephrine and 4 carpules of lidocaine 2% with 1:50.000 epinephrine).A administered high into vestibular areas to avoid changing the volume topography of the palate at the beginning of the surgery .

‡ Surgical template aligned intraorally-surgical index. . ‡ 1. ‡ 1 anchor pin-palate-engage palatal and septal bone.5mm drill ± osteotomies.6 anchor pins.

‡ 2mm followed by 3mm guided drill. .osteotomies. ‡ Soft tissue removed.‡ Surgical guide removed.crestal bone profiled-guided counter bore drill.

Following implants placed A midpalatal implant 4 x 7-mm implant.each side.  Zygomatic implants-removal-surgi-guide.  Premolar and 1st molar areas.  The right and left lateral-nasal sites received 3. .75 x 15-mm implants.  Right and left pterygomaxillary implants 4 x 18 mm.

. ‡ 33o angled conical abutments and long guide pinszygomatic implants. ‡ Low profile abutments-pterygomax implants.‡ Conical abutments-lat nasal implants.

.A maxillary acrylic resin screw-retained provisional prosthesis with a cast. midpalatal strut-before surgery.

zygomatic implants unobstructed placement of the prosthesis onto abutments .lateral-nasal implants. ‡ Trimmed-marked-ink stick-position-implant abutments .pterygomaxillary .‡ The palatal acrylic resin of the maxillary provisional fixed prosthesis .relieved . ‡ To convert max prov fixed prosthesis-implant supported-rubber dam.

underlying tissue.rubber dam . ‡ Acrylic resin mixed.prevent acrylic resin locking -undercuts during the coping luting process . ‡ Prostheis screwed. ‡ Prosthesis fully seated ± 4 implants.‡ Copings .loaded flowed-zygomatic prosthetic cylinders-join-fixed prostheis. .

. so the metal strap that was fabricated was removed.‡ Provisional removed and polished. ‡ Cover screw-palatal implant. ‡ Tissue sutured. ‡ Placed implants could support immediate function without the palatal implant.

‡ All implants stable. ‡ Max provisional-impression template.‡ Completed provisional acrylic prostheis-screwed-15Ncm. . ‡ Provisional replaced-long guide pins-open tray impression. ‡ 3 months later-provisional removed.

.‡ Heavy body impression material syringed-acrylic resin max implant prostheis-pick up impression. ‡ Abutment replicas-placed-temporary cylindersprovisional prosthesis. ‡ Soft tissue definitive cast-separated from provisional. ‡ Max and mand casts articulated-provisional-occlusal registration.

.‡ Definitive maxillary fixed prosthesis fabricated custom-milled titanium framework. ‡ Individual alumina ceramic copings and individual porcelain crowns fused to copings designed-mutually protected occlusion.

‡ All implants have remained in function over the past 30 months. .‡ The patient cleans the prosthesis twice each day using a toothbrush and irrigation device. and the patient follows her prescribed professional hygiene recall schedule.

efficiency. skillful use of the pterygomaxillary and zygomatic regions. ‡ Even patients with the most severe forms of alveolar atrophy of the maxilla can be candidates for treatment with an immediately loaded. . ‡ This treatment can be accomplished without bone grafts. screw-retained prosthesis with trained.Summary ‡ Combined computer-guided and freehand implant surgical techniques improve surgical precision.fixed.and treatment outcomes in the atrophic maxilla.

Rubenstein JE. Jemt T.641 consecutively placed Brånemark dental implants: a study from stage I surgery to the connection of the completed prostheses. Wang NH.Int J Oral Maxillofac Implants 1997.References ‡ Schnitman PA.DaSilva J. Friberg BS. Lekholm U. Wöhrle PS.12:495503. Int J Oral Maxillofac Implants 1991. Ten-year results for Brånemark implants immediately loaded with fixed prostheses at implant placement. ‡ . Early failures in 4.6:142-6.

20:45-9. Malevez C.‡ Davo R. Bone quality in the midpalate for temporary anchorage devices. Implant Dent 2003.12:47-53. JProsthet Dent 2007. ‡ Balshi TJ.97:544-51. Immediate function in the atrophic maxilla using zygoma implants: a preliminary study. Wolfinger GJ. Rojas J. .Quadruple zygomatic implant support for retreatment of resorbed iliac crest bone graft transplant. ‡ Wehrbein H. Clin Oral Implants Res 2009. Petropoulos VC.

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