Edentulous Maxilla - Limited Bone -What are my options?

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Posted on By mariano estrada In Full Arch & Dentures

Fixed rehabitations in Totally edentolous patients are condition to the bone availability.
Bone graft aumentations can solve this limitations and enable to have fixed rest. in the edentolous patient.
But there are many conditions that not always allows to have this graft augmentations like systemic health, economics, habits (Smokers) , Behavioral disorders and time.
There are options to restore maxillary atrophies without bone grafting and in ashort time, like tilting the implants and the use of other not traditional bone areas.




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12 Comments

Mariano, absolutely great service to your patient! Congratulations!
Isn`t it a little bit scary to place tubero-pterygoide implants without guide? Can you share your approach?
Thank you for sharing, your post opens a horizons.
Best regards
Snjezana


Reply

Dear Snjezana, thanks for your comments, I follow your replys and have a great respect for you. .
The trick is to drill in a tilt direction from vestibular to slightly palatal.
My answer are in the pictures .
Regards


Reply

Mariano,

Once again- great stuff- Few questions, How long are you pterygoid implants? What degree multiunit abutment did you use back there?
What was your provisional restoration ? Did you treat maxilla and mandible at the same time?

Cheers,

Richard


Reply

Hey Rich.
1)I have been using the Tubero / Pterigoid area since 1998.
2)Because of the inclination and almost vestibular aproach, you only can use straight multiunit, otherwise there is no space for any screwdriver.
3)This was Reffered patient without any guide and without sedation.
So I did the upper for a 2 Stage approach and in the next 2 weeks the lower jaw with a immediate function.
Please see the pictures.


Reply

Thank you, Mariano for your really helpful answer!
All my best
Snjezana


Reply

Mariano,\


Thank you for answer- great stuff- I and I love how you had diagram waiting for me to show Pterygoid angles- what average length of implants do you find you use in area?


Cheers,

Richy


Reply

Rich you are my friend it is a pleasure to share.

The average length for this area will depend of the need of anchorage to support the lenght of the AP spread.
And also the time of loading the restoration.

Immediate loading + Longer spand will need longer fixations.

Also depends of the remaining bone, size, consistency.
I think a average can be from 11.5 to 13 mm, in good conditions,
but for severe atrofies and need to load imediately 16- 18mm.

For the longer implants I use a special bur.


Reply

Impressive results. I have no experience with pterygoid implants so I appreciate your explanations and diagram. Great case!! Regards Naheed


Reply

Hi Naheed
It's a pleasure to share.
You will find that this technique is very easy and very
Helpfull for posterior support without graft.
Regards


Reply

Hi Mariano,
Nice case!! i like to see differents ways for atrophic posterior maxilla treatments, it is a great topic for discuss!!
your case with tilted implants and pterygoid implants.
few questions, this is not perform with immediate loading?
how much was the torque of pterygoids implants?
La estructura metálica es colada o fresada?
wich brand of implants do you used for this case?
i don´t know if its solve yet, but take i look of the pterygoid implant of the left side with the multiunit to avoid difficult.
well done thanks for sharing
regards
Vladimir


Reply

Hola Vladimir.
Gracias por tus comentarios, nos hacen seguir trabajando, me gustaría saber de donde eres?
Regarding your questions.

1-In this cases in all implants reach over a 45 Ncm (anteriors and Pterigids) , except in a defect in the left premolar area.
That implant the dital anterior we have a lack of surrounding bone and low torque maybe 20 Ncm
I could do a inmediate load, but I prefer to wait.
That´s why I cancel the immediate loading.

2-This metal structure was hibrid prosthesis with a castable metal subestructure .
3-In this case I use Adin implants from Israel, the insertion is too easy and the bone compresion give a incredible initial stability that asures you very good results.
Regards.



Reply

Hi Mariano,
you do it well in wait for the load in this case!! I have not worked with implants Adin but I have seen that they have good design. thanks for reply!!
Por cierto estoy en España!!
Saludos
Vladimir


Reply


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