Replacing the dental arch evolved fixed prosthesis and later dental implants. Dental implants have intended to cover missing teeth in the maxilla and mandible. However, many areas have insufficient bone, and this is critical to success and prognosis. Therefore, this report case discusses an approach of implant treatment undertaken in a patient with pronounced maxillary atrophy using Pterygoid implants, biomaterials and a new model approach: the titanium Hybrid -Plates.

Objectives:The aim of this study was to compare the effect of the mandibular deformation by medial flexure on Bilaterally Splinted and Non-Splinted Implant-Supported Mandibular Full Arch Prosthesis with Immediately Loaded Implants both clinically & radiographically. In addition to Patients' satisfaction over one year of clinical performance. Materials & methods:For the sake of clinical investigation, twelve completely edentulous patients obtained new mandibular and maxillary complete dentures before implant placement. All patients were educated to use the denture for two months. After two months; patients were indiscriminately divided into two groups; First group (of six patients) obtained an Implant supported, fully-splinted cement-retained full arch prosthesis with immediate functional loading protocol, while Second group (of six patients) obtained an Implant-supported, non-splinted (segmented) cement-retained full arch prosthesis with immediate functional loading protocol. The clinical & the radiographic outcomes of the Implants supporting the cement retained full arch superstructure, had been calibrated at time of implants insertion, 3 months, 6 months and 12 months respectively. In addition, patients' satisfaction was also measured utilizing a customized chart of question (A seven-point scale).Results: regarding parametric data; repeated gauges ANOVA test was used to compare between the two groups as well as to study the changes by time within each group. Bonferroni's post-hoc test was used for pair-wise comparisons when ANOVA test is significant. whereas for non-parametric data; Mann-Whitney U test was utilized to compare between the two groups. Periotest and bone density data showed normal (parametric) distribution while bone loss and satisfaction scores data showed non-normal (non-parametric) distribution. Conclusion:Regarding effect of midline mandibular flexure on bilaterally splinted & nonsplinted(segmented) cement-retained, immediately-loaded mandibular prosthesis, it was found that, there was non-significant effect on both types of prosthesis and hence, splinted or nonsplinted implant-supported prostheses could be used successfully with little superiority of segmentation in midline region. In addition, Patients were completely satisfied with their implant-supported immediatelyloaded prostheses, whatever splinting protocol utilized.

A severely atrophied maxilla presents serious limitations for rehabilitation with osseointegrated implants. This study evaluated the biomechanical and long-term behavior of titanium hybrid-plates in atrophic maxilla rehabilitation with finite elements and probabilistic methodology. A three-dimensional finite element model based on a real clinical case was built to simulate an entirely edentulous maxilla with four plates. Each plate was deformed to become accustomed to the maxilla’s curvature. An axial force of 100 N was applied in the area where the prosthesis was adjusted in each plate. The von Mises stresses were obtained on the plates and principal stresses on maxilla. The difference in stress between the right and left HENGG-1 plates was 3%, while between the two HENGG-2 plates it was 2%, where HENGG means Highly Efficient No Graft Gear. A mean maximum value of 80 MPa in the plates’ region was obtained, which is a lower value than bone resorption stress. A probability cumulative function was computed. Mean fatigue life was 1,819,235 cycles. According to the results of this study, it was possible to conclude that this technique based on titanium hybrid-plates can be considered a viable alternative for atrophic maxilla rehabilitation, although more studies are necessary to corroborate the clinical results.

Dentist and patient have limited treatment options for management of extremely atrophic jaws. The Cortically Fixed at Once implant system was developed to meet challenges in patients with severely resorbed jaw bones. The CF@O protocol requires no bone graft, no sinus lift or nerve displacements. The CF@O implant system consists of several types of components specifically developed for different locations in the jaw. These components are Pterygoid implants, compressive implants and hybrid plates. The Pterygoid implants and the Hybrid plates are developed to be placed in the posterior zones of the maxilla. The compressive implants with specific macro-and micro-threads are used in the cortical and spongy bone, mostly in the frontal bone of the upper and lower jaw. The presented case reports describe the steps followed for the functional restoration of edentulous patients with the CF@O implant system.

b) A second principle is a modification of the implant surface and implant thread so as to make maximal use of the remaining cortical bone enhanced by using compressive implants.