Edentulous Maxilla with Compromised Bone. Options? Part 2

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Posted on By Maurice Salama In Full Arch & Dentures

Treated this case in 2 parts to avoid Zygomatic reconstruction. Sinus Grafts 1st, followed by posterior implants to support 1st provisional during anterior Bone Grafting and then anterior implants. Final Case Conventional Restoration All on 10. Thoughts? Is this still an appropriate therapy in today's implant era?

Flap Raised Thin Ridge
Implant placement and BG

Fibrin layer over BG & Implants
Large Collagen membrane secure with healing abutments and pins.

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Pre and Post Panoramic films

Panorex preop
Panorex post op


Provisional Stage 2

Provisional Phase 2
Working out tissue levels on temp


Framework and try-in

Framework try-in
Final Try-in Stage



Final Tissue levels
6 yrs post


Great case Mo.... well done!!!!


Thanks my friend. I would think that a Quad Zygoma approach could have also been successful here. regards and see you in Florida. Maurice


Great 6 years result, really beautiful.
You have chosen a safe way and it payed.
An alternative would have been all on six with osseodensification protocol and augmentation, but with your approach the risk is minimal. And there was space and time for corrections. I usually add 2 temporary implants anterior to protect the graft additionally to posterior implants.
Which materials have you utilized for GBR anterior?
And one silly question: the knots from mattress sutures are palatal. Is there any special reason? In generally, the knots shouldn`t be in mobile mucosa, but my patients always complain if the knots are palatally.
Thank you so much for sharing, see you soon


Snjezana; Bone Graft was mix auto/allograft with PRGF and Fibrin then long term collagen membrane X linked! As for knots, I prefer in attached gingiva so they do not become buried into tissue during edema. regards and see you soon at XP.
regards Maurice


Mo: If I were the patient I would prefer this option rather than zygomatics...Well done!
My answer is yes!.
Thanks for sharing


Thanks Jorge....me too! Big hug. Will we see you at XP? regards Maurice


I love the idea of more implants than just 4. The more posterior implants allow teeth to be placed further back than the popular angled fixtures can. It also allows the biomechanical forces to be applied over better support in my mind.
The down side of the "all on 4" is if one fixture is lost, the whole case goes down the tube!
Great case displaying the positive elements of Lateral Wall grafting!


Thanks Jeff. Nice to see you last Friday. regards Maurice


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