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Fixed prosthetic implant reconstruction of the edentulous maxilla demands skill and state-of-the-art techniques of both the surgeon and the restorative dentist. As discussed in Part I (Implant Dent. 1999;8: 186-193), accurate diagnosis and treatment planning are essential to successful, predictable clinical results. How and where implants are placed have a lasting impact on the quality and prognosis of the final restoration. A series of clinical guidelines and considerations is reviewed with illustrative clinical treatment protocols of edentulous maxillae of unfavorable anatomy including attendant prosthetic difficulties. This article addresses the fixed implant rehabilitation of edentulous maxillas with inadequate posterior bone and favorable arch position, inadequate posterior bone and unfavorable arch position, and inadequate anterior and posterior bone and unfavorable arch position.

When the edentulous condition has existed for many years, extensive ridge resorption may complicate the ability to function with a conventional prosthesis. Implant therapy in conjunction with bone augmentation procedures may provide new options for the predictable restoration of the edentulous state. However, complex implant reconstruction may place considerable stress on the patient's ability to function throughout therapy. Providing stable interim prostheses and smooth transitions between procedures may alleviate the problem. This can be accomplished only with extensive diagnosis, treatment planning, and the judicious use of transitional prostheses. The first part of this case report focuses on the planning stages of a complex implant dental rehabilitation.

The transmandibular implant is specifically designed for the reconstruction and rehabilitation of the severely atrophic mandible utilizing an extraoral approach. The unique design and surgical protocol of the transmandibular system have proven to be predictable and successful. The indications, implant design and materials, surgical technique, advantages, and disadvantages of the transmandibular system are presented in this article.

Adolescent patients with partial anodontia can benefit from fixed implant treatment. Coordinated multispecialty treatment of a young patient is presented and treatment implications are discussed.

Dental implants can be used for the replacement of lost teeth as a result of trauma, even in complex cases with extensive loss of hard and soft tissues. Cooperation between the surgeon and restorative dentist is essential. The sequence of steps each team member must take to reach the definitive prosthesis stage must be clearly defined during treatment planning. A clinical report is presented.

A method for antral augmentation with a composite graft of freshly harvested iliac crest bone marrow and porous hydroxyapatite for implant placement is described. The volume, cellular type, particulate composition, and density of the graft permit rapid implant placement and integration when compared with totally synthetic grafting procedures. A clinical report is presented.