Trans-sinus dental implants, for immediate placement when insufficient alveolar height is present: an alternative to zygomatic implants – surgical case series

Abstract

Low maxillary bone density associated with physiological bone remodeling and resorption accelerated by the presence or history of periodontal disease can prevent implant placement without either ridge and/or sinus augmentation in atrophic maxillary edentulous cases. As an alternative to avoid bone grafting and provide immediacy in restorative treatment care for the patient, remote anchorages to the basal bones of the maxilla of the patient are being used with zygomatic or pterygoid implants. The trans-sinus implant, when indicated can offer a reliable alternative to the zygomatic dental implant in that treatment of the severely edentulous maxilla. This approach is suggested in Bedrossian zones I and II atrophy and when an ‘L’ (or concave) anterior sinus wall anatomy is present. This approach will be discussed utilizing two case examples on how trans-sinus implants may be considered in treating the maxillary arch.

Treatment alternatives for the rehabilitation of the posterior edentulous maxilla

“…125 Although it is important to remark that the number of publications on the use of trans-sinus is very limited and the level of evidence of these reports is generally low, this treatment seems to be associated with satisfactory outcomes and, therefore, could be considered as a feasible alternative in clinical practice. 102,[126][127][128][129] While tilted pterygoid, zygomatic, and trans-sinus implants are valid treatment options for the rehabilitation of the posterior maxilla, it must be remarked that scrupulous case selection and a refined surgical technique are crucial to prevent the occurrence of severe complications (e.g., nasal mucosa damage, orbital floor perforation, zygomatic bone fracture, nerve damage, or sinusitis) due to incorrect osteotomy preparation and implant positioning. 130,131 In the context of this scoping review, when interpreting the evidence pertaining to the performance of tilted implants, it is important to highlight that the vast majority of available studies on the topic are focused on full-arch prosthetic rehabilitations, often delivered immediately after implant placement, and very few on the treatment of partial edentulism in the posterior maxilla.…”

“…The installation of trans‐sinus implants can be combined with simultaneous bone augmentation, with limited elevation of the Schneiderian membrane, or placed with a graftless approach 125 . Although it is important to remark that the number of publications on the use of trans‐sinus is very limited and the level of evidence of these reports is generally low, this treatment seems to be associated with satisfactory outcomes and, therefore, could be considered as a feasible alternative in clinical practice 102,126–129 …”