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Purpose: The zygomatic implant is mainly indicated for the rehabilitation of extremely atrophied maxillae when bone augmentation should be avoided. One drawback of zygomatic implants, which typically pass through the sinus, is initial or late bone resorption around the implant neck, which can result in oroantral communications followed by possible infection of the sinus. To decrease the risk of sinus infection, a modified technique was developed to preserve the integrity of the sinus membrane and to regenerate bone around zygomatic implants using an extended sinus grafting approach., Materials and Methods: Patients with extremely atrophied maxillae were provided with one to four zygomatic implants in conjunction with sinus grafting, plus conventional auxiliary implants, for immediate support of a provisional full-arch maxillary prosthesis. Definitive prostheses were delivered at 6 months after implant placement. All patients underwent clinical and radiographic examinations at 6 months., Results: Twenty-two zygomatic and 23 conventional auxiliary implants were placed in 10 patients. The overall 6-month implant survival rate was 90.9% for zygomatic implants and 100% for auxiliary implants placed in the anterior area. Only two minor technical complications were seen, and clinical indicators (including probing pocket depth, keratinized tissue, and plaque and bleeding indices) were good in all patients. A substantial gain of radiographic bone around the zygomatic implants was observed., Conclusion: The proposed technique led to successful prosthetic function for all patients. With the described technique, exposed implant threads within the maxillary antrum are eliminated and the potential for biologic complications is minimized.

The goal of this case series is to present a novel treatment approach for lateral ridge augmentation. Four systemically healthy patients (aged 48 to 59 years) with inadequate dental alveolar ridge widths were selected for inclusion. All ridge defects were augmented using a xenogeneic cortical bone shield in combination with particulated bone substitutes and a thin collagen barrier. At baseline and after 6 months, digital cone beam computed tomography scans were performed. Biopsy specimens were harvested at reentry surgery and processed for histologic analysis. The results revealed a sufficient amount of bone structure for implant placement without additional augmentation procedures. The histologic analysis demonstrated that new bone formation had taken place and the bone shield had resorbed entirely. This case series indicates that the bone lamina technique has the biologic and mechanical properties to successfully achieve hard tissue augmentation of deficient ridges.

Tooth extraction will be followed by marked alterations to the tissue volume, in particular in the anterior zone, which may jeopardize the esthetic outcome of any dental treatment involving tooth extraction. If, however, ridge collapse can eb prevented or minimized after tooth extraction, more predictable outcomes with superior esthetics can be accomplished along with fewer surgical procedures. Therefore, it was proposed that stabilizing the soft tissue architecture with a free gingival graft could minimize the soft tissue shrinkage. The following case report describes some surgical modifications and refinements in order to enhance the predictability of the socket-seal surgery.

Purpose: The purpose of this prospective clinical trial was to evaluate over a 5-year period the treatment outcomes for immediately loaded full-arch fixed prostheses supported by two axially inclined and two tilted implants used to rehabilitate edentulous arches. This report presents preliminary 1-year results., Materials and Methods: Thirty-seven patients were recruited for treatment with either mandibular or maxillary full-arch fixed prostheses supported by four implants. Within 24 hours, the implants were immediately loaded with screw-retained full-arch acrylic resin provisional restorations. Definitive reconstructions were delivered 6 months later. Complete full-arch prostheses were supported by metal frameworks combined with high-density acrylic resin. Follow-up visits were scheduled for 6 and 12 months after initial prosthetic loading and then annually for up to 5 years. Digital radiographs were obtained immediately, 6 months after surgery, and at each annual follow-up visit. Marginal peri-implant bone levels were assessed using digital image analysis., Results: The 1-year implant survival rates were 96.0% for axially positioned implants and 94.6% for tilted implants. The survival rates were 96.6% for maxillary implants and 98.7% for mandibular implants. The prosthetic survival rate was 100%. No significant differences were found in the results for tilted versus axially positioned implants. One year after loading, the mean marginal bone loss was 0.82 ± 0.31 mm around the axially oriented implants and 0.76 ± 0.49 mm around the tilted implants (P ⋜ .05)., Conclusions: Preliminary data from this clinical trial show high implant survival rates for immediately loaded full-arch prostheses supported by four implants. Immediate loading of tilted implants may be considered a viable treatment option for the rehabilitation of edentulous patients.