Immediate loading of dental implants placed in severely resorbed edentulous mandibles reconstructed with autogenous calvarial grafts

OBJECTIVE: The aim of this prospective study was to present the clinical outcome of immediately loaded dental implants placed in edentulous, severely atrophied mandibles, after reconstruction with autogenous multilayered calvarial grafts. MATERIALS AND METHODS: Six patients, two males and four females, aged 40-67 years (mean: 56 years) presenting with severely atrophied edentulous mandibles (Cawood and Howell class VI), were reconstructed with multilayered calvarial bone grafts placed in the intraforaminal area of the mandible. Five to 8 months afterwards, 23 dental implants were placed in the reconstructed areas (three to four implants per patient) and immediately loaded with implant-supported overdentures. Patients were followed with clinical and radiographic controls annually. RESULTS: Recovery after the reconstruction was uneventful in all patients. All 23 implants were osseointegrated 1-3 years after the start of immediate loading. The survival and success rates of implants were 100% and 95.7%, respectively. CONCLUSION: Results from this study showed that immediate loading of dental implants placed in severely atrophied edentulous mandibles reconstructed with calvarial bone grafts is a predictable procedure, which permits a successful dental rehabilitation with a shortening of treatment times.     

Le Fort I osteotomy with interpositional bone grafts and delayed oral implants for the rehabilitation of extremely atrophied maxillae: a 1-9-year clinical follow-up study on humans

AIM: The purpose of this clinical follow-up study was to report the clinical outcome of osseointegrated implants placed in extremely atrophied edentulous maxillae after Le Fort I osteotomy and interpositional autogenous iliac bone grafts. PATIENTS AND METHODS: In a 10-year period (1995-2004), 39 patients, 18 males and 21 females, aged from 32 to 76 years, presenting with severely atrophied edentulous maxillae were treated with Le Fort I osteotomy and interpositional iliac bone grafts. Four to 8 months after the reconstructive procedure, 281 osseointegrated implants were placed in the reconstructed maxillae. Four to 8 months afterwards, abutments were connected and the prosthetic rehabilitation started. The mean follow-up period of implants after the start of prosthetic loading was 45.9 months (range: 12-108 months). RESULTS: The reconstructive procedure was successful in 38 of 39 patients. In one patient, partial loss of the inlay graft occurred before implant placement. Six patients (42 implants) dropped out of the study. Fifteen implants were removed during the follow-up period, due to loss of integration. Thirty-two implants, although integrated, presented with peri-implant bone-level changes higher than those proposed for successful implants. Cumulative survival and success rates of implants were 94.5% and 82.9%, respectively. CONCLUSION: Results from this study showed that Le Fort I osteotomy with interpositional bone grafts followed by delayed implant placement is an acceptable means to rehabilitate edentulous patients affected by extremely atrophied edentulous maxillae. Survival rates of implants are consistent with those related to implants placed in native, non-reconstructed bone. Conversely, the success rate of implants resulted to be lower as compared with those obtained for implants placed in native bone.     

Immediate loading of dental implants placed in severely resorbed edentulous maxillae reconstructed with Le Fort I osteotomy and interpositional bone grafting

Background: Reconstruction and rehabilitation of atrophic maxillae with bone grafts is a lengthy and demanding procedure. This study reports the immediate loading of 50 implants placed on six extremely atrophied edentulous maxillae reconstructed with Le Fort I osteotomy and iliac bone grafting. Methods: Six patients, aged 49 to 68 years, with severely atrophied maxillae were treated with Le Fort I osteotomy and iliac bone grafting to allow for implant‐borne prosthetic rehabilitation. Four to 5 months thereafter, 50 implants (seven to 10 per patient) were placed in reconstructed maxillae and immediately functionally loaded with a screw‐retained definitive prosthesis. The patients were followed by clinical and radiographic examinations for 24 months after prosthetic loading. Results: The grafting procedure and healing period before implant placement were uneventful in all patients. Two implants were lost within 2 months after prosthesis insertion in two patients, with an overall survival rate of 96%. The prostheses success rate was 100%. At the end of the follow‐up period, all remaining implants appeared clinically healthy; crestal bone loss was >1.7 mm for six implants, resulting in a cumulative success rate of 84%. Conclusion: Immediate loading of implants placed after Le Fort I osteotomy and interpositional iliac bone grafting could be considered a viable protocol to rehabilitate extremely atrophied edentulous maxillae, considerably reducing the treatment time.     

Palatal positioned implants in severely atrophic maxillae versus conventional implants to support fixed full-arch prostheses: Controlled retrospective study with 5 years of follow-up

Background

To evaluate soft tissue conditions and bone loss around palatal positioned implants supporting fixed full-arch prostheses to rehabilitate edentulous maxillae with horizontal atrophy and compare them with conventional well-centered implants placed in non-atrophic maxillae after a minimum follow-up of 5 years.

Material and Methods

A clinical retrospective study was performed of patients that were rehabilitated with full-arch fixed implant-supported maxillary prostheses and had a minimum follow-up of 5 years after implant loading. Patients were divided into 2 groups: patients with class IV maxilla according to Cawood and Howell and treated with palatal positioned implants (test) and with class III maxilla and treated with implants well-centered in the alveolar ridge and completely surrounded by bone (control). The following variables were assessed: age, sex, frequency of tooth brushing, smoking, type of prosthesis, type of implant, implant success, amount of buccal keratinized mucosa, buccal retraction, probing depth, plaque index, modified bleeding index, presence of mucositis or peri-implantitis and peri-implant bone loss. Statistical analysis was performed applying Chi2 Test and Student’s t-test using alpha set at 0.05.

Results

A total of 57 patients were included: 32 patients with 161 palatal positioned implants (test) and 25 patients with 132 well centered implants (control). No statistically significant differences were found regarding age, sex and smoking, but test group patients reported a significantly higher frequency of daily tooth brushing. Implant success rates were 96.9% for test group implants and 96.0% for control group implants. Peri-implant mucosa retraction was significantly higher in the control group than in the test group (p=0,017). No significant differences were observed either for all the other assessed clinical parameters or for peri-implant bone loss.

Conclusions

Despite its limitations the outcomes of the present study suggest that palatal positioned implants may be a good treatment alternative for patients with severe horizontal maxillary alveolar bone atrophy. Palatal positioned implants presented similar success rates, soft tissue conditions and peri-implant bone loss than well-centered implants placed completely surrounded by bone in non-atrophic ridges. Key words: Atrophic maxilla, bone atrophy, fixed dental prosthesis, dental implants.     

Long‐term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo‐mandibular defects due to extreme atrophy

Purpose: The objectives of this study were to evaluate (a) the clinical outcome of revascularized fibula flaps used for the reconstruction of extremely atrophic jaws and (b) the survival rates of dental implants placed in the reconstructed areas. Materials and methods: Between 1999 and 2004, 12 patients presenting with extreme atrophy of the edentulous jaws were reconstructed with fibula free flaps. Five to 12 months after the reconstructive procedure, 75 titanium dental implants were placed in the reconstructed areas, while prosthetic rehabilitation was started 4–6 months afterward. The mean follow‐up of patients after the start of prosthetic loading was 77 months (range: 48–116). Results: An uneventful healing of the bone transplants occurred in all patients. One out of the 75 dental implants placed was not loaded due to prosthetic reasons. No dental implants failed to integrate before prosthetic loading, while three were removed during the follow‐up period. Despite the high survival rate of dental implants (95.8%), a relevant number of them presented relevant peri‐implant bone‐level loss, ranging from 1 to 7 mm for maxillary dental implants and from 1 to 4.5 mm for mandibular dental implants. Conclusion: Although no failures of the bone transplants occurred and a high long‐term survival rate of dental implants were observed, this study showed that fibula free flaps do not guarantee dimensional stability of peri‐implant bone, despite the immediate blood supply delivered by the vascular pedicle. The peri‐implant bone resorption was higher when compared with the one related to dental implants placed in native bone. To cite this article:
Chiapasco M, Romeo E, Coggiola A, Brusati R. Long‐term outcome of dental implants placed in revascularized fibula free flaps used for the reconstruction of maxillo‐mandibular defects due to extreme atrophy.
Clin. Oral Impl. Res. 22 , 2011; 83–91.
doi: 10.1111/j.1600‐0501.2010.01999.x     

Clinical outcome of dental implants placed in fibula-free flaps used for the reconstruction of maxillo-mandibular defects following ablation for tumors or osteoradionecrosis

OBJECTIVES: (a) To evaluate the clinical outcome of fibula revascularized flaps used for the reconstruction of maxillary and mandibular defects due to resection for tumors or osteoradionecrosis and (b) to evaluate the survival and success rates of implants placed in the reconstructed areas. MATERIAL AND METHODS: In a 8-year period (1995-2002), 59 patients, 38 males and 21 females, aged from 13 years to 69 years (mean age: 48.7 years), presenting with maxillary and mandibular defects due to resection for tumors or osteoradionecrosis, were reconstructed with fibula-free flaps. Of the 59 patients, 16 received 71 implants for the prosthetic rehabilitation of the reconstructed edentulous areas. RESULTS: Out of 59 fibula-free flaps, three failed and had to be removed, nine underwent partial necrosis involving the bone segment and/or the skin paddle but survived, while the remaining 47 healed uneventfully. The mean follow-up of patients after the reconstruction was 55 months (range: 24-120 months). The cumulative survival rate of fibula-free flaps was 94.9%. The mean follow-up of the 16 patients treated with dental implants and implant-supported prostheses was 50.2 months (range: 24-96 months). The cumulative implant success and survival rates of implants were 98.6% and 93.1% respectively. CONCLUSION: The reconstruction of maxillo-mandibular defects following ablation for tumors or osteoradionecrosis with fibula-free flaps has been demonstrated to be a reliable technique with good long-term results. Implants placed in the reconstructed areas were demonstrated to integrate normally, with success and survival rates comparable to those obtained in case of implants placed in native bone.     

Three-year data from a randomizd, controlled study of early loading of single-stage dental implants supporting maxillary full-arch prostheses

PURPOSE: The aim of this 3-year randomized controlled trial (RCT) was to compare biologic and technical treatment outcomes and patient satisfaction after early (< or = 14 days postimplantation) loaded implants with those of implants loaded after a healing period of 3 to 4 months in the edentulous maxilla. MATERIALS AND METHODS: Twenty-four patients with completely edentulous maxillae were randomized into a test group (n = 16) and a control group (n = 8). All patients received 5 or 6 solid screw-type titanium implants with sandblasted, large-grit, acid-etched (SLA) surfaces. In total, 142 implants were placed and 139 implants were loaded with full-arch prostheses. Clinical assessments were obtained at loading and after 3, 6, 12, 24, and 36 months. Radiographs of implants and existing teeth were taken at loading; after 6, 12, 24, and 36 months; and at 12, 24, and 36 months, respectively. RESULTS: The cumulative implant success rate 3 years after loading was 100%. At the 3-year examination the mean (P < or = .005), distal (P < or = .005), and mesial (P > .05) crestal bone levels were better in the test group. No significant differences between the test and control groups were noted for any other outcome measure. The most common adverse event in both groups was tooth-crown fracture. DISCUSSION: A review of the literature, both printed and electronic, revealed no study fulfilling the criteria of an RCT dealing with the early loading of maxillary full-arch prostheses. This study fulfills those criteria. CONCLUSION: In this study population it has been concluded that the early (approximately 2 weeks) loading protocol is a viable alternative to the standard (3 to 4 months) protocol in the rehabilitation of a completely edentulous maxilla with a complete implant-supported fixed prosthesis.     

Immediately loaded implants supporting fixed prostheses in the edentulous maxilla: a preliminary clinical and radiologic report

PURPOSE: To evaluate the survival rate of immediately loaded ITI sand-blasted, large-grit, acid-etched (SLA) solid-screw dental implants in the edentulous maxilla after 8 months of loading. MATERIALS AND METHODS: Twenty-eight patients (mean age 63 years) with edentulous maxillae each received 6 implants and 1 implant-supported fixed provisional prosthesis within 24 hours after surgery. After a mean healing time of 15 weeks, the patient received a definitive, screw-retained, implant-supported fixed prosthesis. A total of 168 implants were placed. Clinical parameters were registered after 1 month of loading with the implant-supported fixed prostheses as well as 8 months after implant placement. Radiologic examinations and assessments were made at implant placement and after 8 months. RESULTS: The mean marginal bone level at implant placement was 1.6 mm (range 0 to 5.1; SD 1.1) apical of the reference point (the implant shoulder). The mean marginal bone level at the 8-month follow-up was 3.2 mm (range 0.4 to 5.9; SD 1.1) apical of the reference point. Three implants failed during the healing period. DISCUSSION: The improved results in the present study might be a result of the positive effect of splinting the implants immediately after placement. CONCLUSION: ITI SLA solid-screw implants immediately loaded (ie, loaded within 24 hours of placement) and supporting fixed prostheses had successful survival rates after 8 months. The present results constitute a solid baseline for future follow-up studies.     

Long-term implant survival in the grafted maxilla: results of a 12-year retrospective study

OBJECTIVE: The aim of this study was to determine the long-term outcome of implant insertion in the augmented severely atrophied maxilla. STUDY DESIGN: Three hundred and twenty-four implants were inserted in 35 patients (eight males, 27 females, average age 57.6 years) in extremely atrophied maxillae after osteotomy and interposition of iliac crest bone. One hundred implants were installed in 12 patients simultaneously with the osteotomy and grafting; 224 implants were placed in 23 patients in a second procedure 6-12 months later. Implant parameters like osseointegration and peri-implant bone loss; peri-implant tissue parameters like bleeding, gingival and plaque index; and patients' satisfaction were evaluated. RESULTS: Of 324 implants, 29 (8.9%) were lost during the entire follow-up: 14 in six patients of the one-step and 15 in 11 patients of the two-step group. The overall input-output survival in 141.1 months was 91.1%. The overall 2-year failure-free fraction of implants was 95.5%; the 5-year failure-free fraction was 89.3%. In the one-step group, the 2 (5)-year failure-free fraction was 95.9% (86.9%), and in the two-step group 95% (91.3%) (log-rank test P=0.57). Marginal peri-implant bone loss was 1.7+/-1.3 mm mesial and 1.8+/-1.3 mm distal. CONCLUSION: Implant insertion after osteotomy and iliac bone grafting is a reliable operation method for the dental rehabilitation of the severely atrophied maxilla showing good long-term results.     

Immediate rehabilitation of the completely edentulous jaw with fixed prostheses supported by either upright or tilted implants: a multicenter clinical study

PURPOSE: The aims of this study were to assess the treatment outcome of immediately loaded full-arch screw-retained prostheses with distal extensions supported by both upright and tilted implants for the rehabilitation of edentulous jaws and to compare the outcomes of upright versus tilted implants. MATERIALS AND METHODS: At 4 study centers, 342 Osseotite NT implants were consecutively placed in 65 patients (96 implants were placed in 24 mandibles and 246 implants in 41 maxillae). The 2 distal implants were tilted by 25 to 35 degrees. Provisional full-arch restorations made of a titanium framework and acrylic resin teeth were delivered within 48 hours of surgery and immediately loaded. The final prosthesis was delivered after 3 months of healing. RESULTS: Three implants failed during the first year and another 2 within 18 months of loading in the maxilla. The cumulative implant survival rate for the maxilla was 97.59% for up to 40 months of follow-up. No implant failure was recorded for the mandible. The prosthetic success rate was 100%. Marginal bone loss around upright and tilted implants was similar. Patients were satisfied of their esthetics, phonetics, and function. CONCLUSION: The preliminary results of this study suggest that immediate rehabilitation of the edentulous maxilla and mandible by a hybrid prosthesis supported by 6 or 4 implants, respectively, may represent a viable treatment alternative with respect to more demanding surgical procedures. The clinical results indicate that immediately loaded tilted implants may achieve the same outcome as upright implants in both jaws.     

下颌套筒冠固位全颌覆盖种植义齿即刻负重的临床研究

目的:探讨下颌无牙颌在种植后即刻进行套筒冠固位覆盖义齿修复技术的可行性和临床效果。方法:10例下颌无牙颌患者,术前常规行传统全口义齿修复,在双侧颏孔之间植入4颗种植体,术后当天即刻完成种植体支持的套筒冠固位覆盖义齿修复,均于负重后2、4、8、12、24、48周复诊,检查种植体的稳固性、种植体周龈组织状况,并拍摄X线片观察种植体骨吸收和骨结合状况。结果:10例患者共40颗种植体术后进行即刻负重,均获得良好的骨结合,临床检查种植体稳定性良好,种植体周龈组织健康,未见X线连续透射影,无边缘骨吸收,患者对修复效果满意。结论:下颌无牙颌患者,在双侧颏孔间植入4颗种植体,如种植体可获得足够的初期稳定性,即刻采用种植体支持的套筒冠固位覆盖义齿修复是可行的,短期临床效果满意。     

Behavior of implants in bone grafts or free flaps after tumor resection

The authors compared bone resorption of autogenous bone grafts and revascularized free flaps used for the reconstruction of mandibular continuity defects following resection for tumors, before and after the placement of endosseous implants. Ten patients (group 1) were treated with autogenous bone grafts taken from the fibula or the anterior iliac crest; 8 patients (group 2) were treated with iliac or fibula revascularized flaps. Four to 8 months later, 72 endosseous implants were placed in the reconstructed areas. After a further healing period of 4-6 months, patients were rehabilitated with implant-borne prostheses. The following parameters were evaluated and compared between the two groups: 1) bone resorption of grafts and free flaps before and after implant placement; 2) peri-implant bone resorption mesial and distal to each implant, immediately after prosthetic rehabilitation and then during yearly follow-ups. Bone resorption before implant placement showed mean values of 3.53 mm in group 1, and 0.96 mm in group 2. Peri-implant bone resorption was: 0.49 mm (39 implants) in group 1, and 0.45 mm (30 implants) in group 2, at time of prosthetic rehabilitation; 0.78 mm (39 implants) in group 1, and 0.89 mm (30 implants) in group 2, 12 months after prosthetic load; 1.16 mm (24 implants) in group 1, and 1.02 mm (13 implants) in group 2, 24 months after the prosthetic load. A significant difference in bone resorption before implant placement was found between the two groups, whereas it was not found after implant placement and prosthetic load. The failure rate according to Albrektsson criteria was 4.9% (2/41 implants) in group 1, and was 3.2% (1/31) in group 2.     

Localised maxillary ridge expansion with simultaneous implant placement: A case series

The placement of implants in edentulous areas is often compromised by a thin alveolar crest, which widens the space between the two cortical bones; this offers advantages from aesthetic, biomechanical, and functional points of view. We present our results using the osteotome technique for the creation of a site for an implant, followed by immediate placement of the implant in thin edentulous maxillae, and the stability of the bony expansion over time. Twenty-three patients (six men and seventeen women) with partial edentulism associated with horizontal resorption of the ridges were treated by this technique to obtain a wider bony base for better placement of the implants. At the same time, 36 endosseous titanium implants were inserted. Three to four months later, the patients were rehabilitated with implant-supported prostheses. All implants were successfully osseointegrated and loading began after 61–197 days. All implants inserted were 4.1 mm in diameter, and between 10 and 15 mm long. All the implant-supported prostheses functioned acceptably, with no signs or symptoms such as paraesthesiae, dysaesthesiae, or pain. Within the limits of this study this technique seems to be reliable and simple with little morbidity, and rehabilitation was as good as that after other techniques such as autogenous bone grafts or guided bone regeneration. Survival and the success of implants placed were consistent with those placed in non-reconstructed bone.     

种植体支持切削杆固位无牙颌种植修复体的临床应用和加工技术研究

目的：探讨种植体支持切削杆固位覆盖义齿的临床效果及工艺特点.方法：28例无牙颌患者（男12例,女16例,年龄22-71岁）,共31个修复体,植入种植体168枚.所有病例在种植体植入4-6个月后开始种植修复,均采用切削杆固位的覆盖义齿修复.修复后追踪最长39个月,最短12个月.观察方法为临床检查和x线片检查.结果：31个修复体固位力好、稳定.23例患者对修复效果非常满意,5例满意.5例患者由于口腔卫生差导致种植体周围软组织炎,4例经过局部冲洗上药,炎症消退,1例在修复后五年发展为种植体周围炎,最终修改修复设计,改用磁性基台固位.X线片示27例患者的160枚种植体周围骨组织稳定,无骨吸收,1例8颗种植体周围骨吸收2-4 mm.28例患者中2例在修复后一年发生修复体树脂基托断裂,2例在修复后四年发生修复体树脂基托断裂,修补后重新使用,无需重做修复体.所有病例在修复后至最后一次复查未见种植体脱落.结论：应用种植体支持切削杆固位修复无牙颌的修复效果满意,种植体受力均匀,但加工工艺及设备要求较高,材料成本高,是该技术推广应用不足之处.     

Immediate function with fixed implant-supported maxillary dentures: a 12-month pilot study

STATEMENT OF PROBLEM: Immediate occlusal loading of dental implants in the edentulous mandible has proven to be an effective, reliable, and predictable procedure. There is little long-term data available on similar treatments in the edentulous maxilla. PURPOSE: The purpose of this study was to evaluate the 12-month implant survival after immediate loading of 4 to 6 implants with fixed screw-retained prostheses in edentulous maxillae. MATERIAL AND METHODS: Twenty-one patients, edentulous or with remaining teeth to be extracted in the maxilla, received 4 to 6 implants (n=111). The patients were restored with screw-retained fixed provisional prostheses supported by palladium-alloy frameworks within 24 hours after surgery. Insertion torques for implants were at least 40 Ncm. Implants, grouped as tapered or cylindrical screws, were placed in healed bone or extraction sockets. Implants were also classified as either vertical or off-angle. Definitive prostheses were placed after a mean healing time of 18 weeks. Radiographic examinations were made at the time of placement of provisional prostheses and 12 months later. Between-groups bone resorption was compared using 2-way ANOVA (alpha=.05). RESULTS: The mean follow-up time for all of the patients was 20 months (range, 13 to 28 months). The cumulative implant survival rate at the 12-month follow-up visits (after surgery) was 92.8%; the prostheses survival rate was 100%. No significant differences were found between the survival of tapered or cylindrical screw-type implants placed in postextraction sockets versus those in healed edentulous sites or between vertical and off-angle placed implants. Eight implants failed during the first 3 months, 5 of which were the most distal implants. The mean reduction in marginal bone height over the 12-month observation period was 0.84 mm (CI 95%; 0.68-0.99 mm). CONCLUSIONS: In this study with 12-month follow-up, 4 to 6 implants were sufficient to successfully support fixed implant screw-retained prostheses in the edentulous maxillae of 21 patients.     

Rehabilitation of a patient with cleft lip and palate with an extremely edentulous atrophied posterior maxilla using zygomatic implants: case report.

OBJECTIVE: This case report describes the clinical and surgical management of a patient with a unilateral alveolar cleft and associated extremely atrophied totally edentulous maxilla. METHOD: Two zygomatic implants and four endosseous oral implants were placed under general anesthesia in a compromised maxilla to rehabilitate a 33-year-old patient with cleft lip and palate. The two specially designed zygomatic implants were utilized to avoid the need for bone grafting in the patient. The final prosthetic rehabilitation was an esthetic and functional maxillary overdenture prosthesis supported by implants. RESULTS: Preliminary results have shown how dental prostheses supported by endosseous implants in grafted alveolar cleft are a reliable possibility in the dental rehabilitation of this malformation. CONCLUSION: The use of zygomatic implants may be considered a reliable alternative to more resource-demanding techniques such as bone grafting in patients with cleft palate.     

Tilted implants in the immediate loading rehabilitation of the maxilla: a systematic review

Tilted implants have been proposed as an alternative to traditional protocols in the rehabilitation of edentulous maxillae. The aim of this meta-analysis was to evaluate the outcomes of upright and tilted implants supporting full-arch fixed dentures for the immediate rehabilitation of edentulous maxillae, after at least 1 year of function. An electronic search of databases and a hand search of relevant journals in oral implantology were performed according to PRISMA guidelines through August, 2011. The literature search yielded 1,069 articles. Eleven articles were available for analysis. A total of 1,623 implants (778 tilted, 845 upright) were inserted into the maxillae of 324 patients. Seventeen tilted (2.19%) and 16 upright implants (1.89%) failed during the first year. No significant difference in failure rate was found between tilted and upright implants (p value = 0.52). Marginal bone level results were obtained from 6 studies. A non-significant mean difference between tilted and upright implants was found with regard to bone loss. Tilted implants demonstrated a favorable short-term prognosis in full-arch immediate loading rehabilitations of the maxillae. Randomized long-term trials are needed to better elucidate long-term success of tilted vs. upright-positioned implants.     

Implant treatment without bone grafting in severely resorbed edentulous maxillae.

PURPOSE: This article describes the surgical technique for implant treatment in severely resorbed edentulous maxillae without any alveolar reconstruction before or combined with implant placement. PATIENTS AND MATERIAL: Fifteen patients with severely resorbed edentulous maxillae were treated with osseointegrated implants and fixed dental prostheses. All patients were initially considered to be treated with bone grafting because of a lack of sufficient bone volume for conventional treatment. Preoperative radiographic examinations showed that the height of the alveolar crest was on average 7.4 mm at the 4-mm-width level (Classes V to VI). RESULTS: By fenestration of the maxillary sinus and uncovering the nasal floor, the maxillary bone could be visualized and used maximally for installation of implants. By angulation of the implants and permitting two to five uncovered fixture threads on the palatal aspect, implants of optimal length could be installed. Eighty-six implants were placed (four to six implants in every patient). One implant was lost during the observation time (range, 36 to 54 months; mean, 45 months). All patients had stable fixed prostheses at the end of the observation time. CONCLUSION: This cost-effective surgical technique may be considered as an alternative to more resource-demanding techniques such as bone grafting in patients with severely resorbed edentulous maxillae. However, further prospective comparative studies are necessary for full evaluation.     

Problems with dental implants that were placed on vertically distracted fibular free flaps after resection: A report of six cases

We report the clinical outcome of dental implants placed on vertically distracted fibular free flaps that were used to reconstruct maxillary and mandibular defects after resection. Distraction osteogenesis (DO) of fibular free flaps was used for six patients (5 men, 1 woman) a mean of 19 months (range 11–38) after 5 mandibular and 1 maxillary reconstructions. A mean of 5 months (range 2–11) after removal of the distractor, 35 implants were inserted and loaded with implant-supported fixed prostheses. The mean (range) follow-up period was 39 (17–81) months. The course of the DO and the clinical and radiographic outcomes of the implants were assessed.Of six vertically distracted fibular free flaps, there was one case of vector lingual tipping during the consolidation phase and a fracture of the basal fibular cortex that necessitated additional grafting with iliac bone to stabilise the distracted area. The mean (range) vertical bone gain was 14 (12–15) mm. Four of 35 implants (11%) failed during the follow-up period. The mean peri-implant bone resorption was 2.5 mm. Cumulative implant survival was 31/35 (89%) and survival after loading 31/33 (94%).Distraction osteogenesis of fibular free flaps caused a remarkable number of complications and pronounced resorption of bone around the implants, probably as a result of the formation of granulomatous tissue; a careful peri-implant follow-up and the maintenance of oral hygiene are essential.     

Survival rate of zygomatic implants in atrophic or partially resected maxillae prior to functional loading: a retrospective clinical report

PURPOSE: The purpose of this article was to evaluate the survival rate of 34 remote anchorage implants placed in 18 patients from placement to uncovering, prior to any prosthetic loading. MATERIALS AND METHODS: A total of 18 patients (9 women and 9 men with a mean age of 63 years) who required rehabilitation with a fixed prosthesis because of severely atrophic maxillae (including 1 patient who had undergone primary and secondary cleft lip and palate repair), traumatic maxillary bone loss, and maxillectomy procedures received 1 or 2 zygomatic implants and 2 to 4 standard maxillary dental implants. The survival rate of the 34 zygomatic implants from placement to uncovering was investigated. Aspects of the placement technique or postoperative complications related to surgical procedures likely to affect the implant failure rate were detected and critically discussed. RESULTS: Osseointegration was evaluated using the reverse torque test and percussion after uncovering. Only 1 patient (5.6%) sustained postoperative clinical complications during the evaluation period which resulted in the loss of both zygomatic implants (5.9%). CONCLUSION: Although the handling of this anchorage implant system is somewhat complex, and the design has certain shortcomings, it might be an alternative to more extensive bone augmentation procedures. However, rehabilitation of partially or completely edentulous patients with fixed implant-supported prosthesis is only feasible when 2 to 4 standard implants are placed in the anterior maxilla and splinted with the zygomatic implants.