Digital Approach for the Rehabilitation of the Edentulous Maxilla with Pterygoid and Standard Implants: The Static and Dynamic Computer-Aided Protocols

Abstract

A full-arch rehabilitation of the edentulous upper jaw without grafting procedures exploits the residual alveolar or the basal bone, with the necessity of long implants placed with a particular orientation. The precision in planning and placing the fixtures is fundamental to avoid clinical problems and to allow an acceptable connection with the prosthesis. The computer-aided implantology resulted in more accuracy than the traditional one, with a high standard of correspondence between the virtual project and the real outcome. This paper reports about the two different digital protocols, static and dynamic, as support to implant-borne prosthetic rehabilitation of edentulous maxillae. Two pterygoid and two/four anterior standard implants were seated in both cases by two different operators, without flap raising, and immediately loaded. This approach avoided the posterior cantilever by-passing the maxillary sinus and was adequately planned and realized without any surgical or prosthetic error. The two digital flow-charts were described step by step, underlining each other’s advantages and drawbacks compared to a free-hand approach.

Immediate full-arch fixed rehabilitation of a narrow mandible with newly conceived connection system implants: A case report

“… 36 , 37 Two studies verifying the reliability of the last cited attachment, similar to the Orbit system, revealed no variations in stress distribution in a virtual mandibular all-on-four rehabilitation with and without the fastening screws in the anterior implants. 38 , 39 The computational finite elements analyses (FEM) were fundamental in understanding the properties of these attachments before their clinical use, limited up to now to a two-year follow-up, 17 and can support the realization of future studies in vitro and in vivo, now missing, to evaluate the Orbit attachment performance better. The similarity with hip articulation could take advantage of studies about hip prostheses in the literature.…”

“… 14 , 15 At the same time, the conical frictional joint tolerates only minimal implant dis-parallelism. 16 , 17 The snap-fit approach can simplify the connection procedure, and similar systems have been proposed in the literature. 12 , 14 , 18 …”

Virtual pterygoid implant planning in maxillary atrophic patients: prosthetic-driven planning and evaluation

“…Compared to bone grafting, pterygoid maxillary implants provide an alternative solution in making the best use of residual bone of the maxillary-pterygoid complex. In contrast to the bone quality of the posterior maxilla, the implant engaged in the cortical layer of the pterygoid process makes it easy to obtain optimum primary stability [ 13 – 15 ]. Although this approach has been proposed for more than 30 years, its application is still limited.…”

Cirugía virtual guiada para rehabilitación implantosoportada de maxilar edéntulo con carga inmediata

“…En el caso clínico presentado, el resultado de las reconstrucciones tridimensionales obtenidas mediante TCHC, reveló que eran adecuadas la cantidad y la cualidad de hueso en el maxilar, hizo posible la planificación virtual para instalar seis implantes en el software DentalSlide ® , se mostró como una simulación inequívoca de las áreas anatómicas a tratar, permitiendo la predictibilidad de la técnica flapless 8 . Como resultado, el tiempo quirúrgico se hace corto, hay menos riesgos y complicaciones transoperatorias.…”