Statement of problem
There is debate as to the efficacy of maxillary complete arch reconstructions when
only 4 implants are used.
Purpose
The purpose of this study was to determine what risk factors, if any, may increase
the likelihood for implant failure in immediate function by using a tilted distal,
4-implant approach in the maxilla.
Material and methods
A retrospective analysis of implant performance was conducted for patients treated
with 4 implants placed in 285 maxillae (1140 implants) and 273 mandibles (992 implants)
providing immediate function for complete arch implant-supported prostheses. The consecutively
treated patient cohort consisted of those who provided consent between April 2008
and December 2010. A retrospective chart review was conducted to assess potential
maxillary implant failure factors, including a history of smoking, gender, opposing
occlusion, bone density, bone volume, insertion torque, parafunction, failed implant
site, addiction, and systemic factors. Data were analyzed with descriptive statistics.
A series of risk factors were postulated in an effort to establish guidelines for
modification of treatment planning protocols in response to combined risks.
Results
Several common primary factors in maxillary implant failure scenarios were identified
through this process of patient profiling. Opposing natural dentition, male gender,
lack of bone density, the distal implant site, and parafunction were sufficiently
frequent occurrences in failure situations to suggest that either the use of additional
implants or delayed loading and the provision of a complete denture as an interim
prosthesis may be more appropriate in the management of patients identified as being
high risk. Secondary factors such as bone availability (volume) and smoking were less
common in failure situations.
Conclusions
A preliminary protocol is suggested for both treatment planning and profiling patients
with respect to presenting characteristics that may contribute to implant failure.
A decrease in failure occurrence has been noted anecdotally during the short term
implementation of this protocol.
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Article info
Footnotes
Presented at the Academy of Prosthodontics meeting in Hilton Head, SC, May 2011.
Identification
Copyright
© 2011 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.
