Statement of problem
In the posterior maxilla, tooth loss is usually associated with alveolar bone resorption
and sinus pneumatization, limiting the placement of implants without grafting procedures.
Purpose
The purpose of this study was to evaluate a minimally invasive treatment of the atrophic
posterior maxilla, with axial and tilted implants and immediate loading. The research
hypothesis was that the combination of a guided, minimally invasive approach and the
biomimetic features of computer-aided design and computer-aided manufacturing (CAD/CAM)
abutments would be an effective alternative to maxillary sinus floor augmentation
procedures with reduced bone resorption around implants.
Material and methods
Twenty-seven consecutive participants (female=12, male=15) (mean age 54.18 years)
with severe atrophy of the posterior maxilla were treated by using guided surgery
with immediately loaded axial (39) and tilted (42) implants supporting CAD/CAM zirconia
(39) and titanium (42) abutments (81 total) and partial fixed prostheses. Each participant
underwent a computed tomography scan, after which 2 or 3 implants were positioned
with a flapless or miniflap approach. The drilling protocol was adapted to the bone
density of each implant site to obtain an insertion torque ranging between 40 and
50 Ncm. CAD/CAM customized abutments composed of zirconia or titanium were fixed to
the implants with prosthetic screws tightened with a torque of 35 Ncm. An acrylic
resin interim restoration reinforced with metal was placed immediately. Five to 6
months after initial loading, a zirconia framework was manufactured, and a definitive
prosthesis was placed. Clinical and radiological controls were performed at baseline
and after 1 and 3 years to assess implant and prosthesis survival and success rate
and compare marginal bone remodeling of axial and tilted implants. Inferential statistics
for radiological data were acquired by using the Mann-Whitney U-test. All statistical
comparisons were conducted at the .05 significance level.
Results
The mean follow-up period was 43.3 months (ranging from 36 months to 54 months). The
cumulative implant survival rate was 96.3% at 3 years. All prosthetic restorations
were stable and in good function, resulting in a cumulative prosthetic survival rate
of 100%. Three restorations had chipping of the veneer material; thereafter, the cumulative
prosthetic success rate was 91.9%.
Conclusions
Treatment of the posterior partially edentulous atrophic maxilla with guided surgery
and immediate loading of tilted and straight implants supporting short-span partial
fixed dental prostheses is effective.
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© 2012 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.
