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Immediate Rehabilitation of the Severely Atrophic Maxilla Using Trans-Sinus Nasal Protocol and Extended Length Subcrestal Angulated Implants. Case Series With 1-Year Follow-Up.

Authors
  • Zaninovich, Michael1
  • 1 Aria Dental Specialist Implant CentreUniversity of Adelaide, Dental School.
Type
Published Article
Journal
The Journal of oral implantology
Publication Date
Apr 01, 2022
Volume
48
Issue
2
Pages
117–124
Identifiers
DOI: 10.1563/aaid-joi-D-19-00307
PMID: 34091678
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Immediate fixed full-arch rehabilitation of the severely atrophic maxilla eliminates use of a tissue-supported prosthesis during the healing phase and maximizes patient comfort and quality of life. The surgical treatment options available for immediate rehabilitation of the severely atrophic maxilla are dependent on the location and availability of the residual alveolar ridge. When bone is only available in the intercanine region, a graftless approach using tilted distal implants may not provide adequate distance between implants for favorable biomechanics. Subsequently, zygomatic implants are the alternative to provide adequate posterior occlusal support. Use of extended length subcrestal angulated implants offers an additional implant option for the clinician to restore the severely atrophic maxilla immediately. The treatment protocol involves anchorage of the implant fixture to the lateral wall of the nasal bone. The distally tilted implant transverses an augmented sinus cavity and extends to the site of the first permanent molar. The novel implant subcrestal angulation and use of a multi-unit abutment promotes passivity of fit of a full-arch fixed immediate prosthesis. Five clinical case reports from private practice are presented that outline the clinical value of the novel implant design in the rehabilitation of the severely atrophic maxilla. In each case, the use of zygomatic implants would be the only alternative to provide an immediate fixed prosthesis due to the absence of residual alveolar bone in the maxilla premolar and molar regions. The use of extended-length subcrestal angulated (ELSA) implants with straight or angulated multiunit abutments have successfully restored the maxillary arch immediately.

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