Forum Implantologicum 13 (2017), No. 1 (08.06.2017)
Treatment Options for the Posterior Edentulous Jaw: Surgical Options for Implant Therapy in the Posterior Maxilla of Partially Edentulous Patients
Buser, Daniel / Monje, Alberto / Polido, Waldemar
The rehabilitation of the posterior maxilla with an implant-supported prosthesis is often a demanding treatment for the implant surgeon. The local anatomy can be difficult due to a reduced ridge height in potential implant sites. The present clinically oriented paper discusses the three most often utilized surgical options: (i) the utilization of short implants, (ii) sinus floor elevation (SFe) with the lateral window technique, and (iii) SFe with the transalveolar osteotome technique. A thorough clinical and radiographic examination is required to choose the appropriate surgical approach, which should offer a successful outcome with high predictability and a low risk of complications. In addition, treatment should offer minimal invasiveness and morbidity, when possible. low morbidity is offered by short 6-mm implants, which are utilized when multiple implants are feasible with splinted implant crowns. A single tooth replacement with 6-mm implants in molar sites is only used in exceptional situations. In all other situations, SFe is required. Both surgical techniques are well documented, but the transalveolar osteotome technique is utilized less frequently, since it requires a ridge height of 5-8 mm and a flat morphology of the sinus floor. whenever possible, a simultaneous implant placement is performed to avoid a second surgery. For that, sufficient primary stability is important, which can be optimized with tissue level implants. In addition, grafting with a composite graft is preferred, which includes locally harvested autogenous bone chips mixed with a low-substitution bone filler. The various treatment options are discussed and documented with case reports.
Keywords: posterior maxilla, sinus floor elevation, short implants, transalveolar technique, lateral window technique, composite graft