implants the journal of oral implantology United Kingdom Edition

I 35implants2_2012 case study _ Atrophic maxilla I distinct curvature on exposure of the maxillary jaw. Where the curvature or bulbosity starts is usually the position of the medial wall of the maxillary si- nus, then by use of osseotomes , drills and re confirming this position can be achieved in two ways. Perforation into the sinus via the lateral wall and palpation of the medial wall and mark points at 3,6,11mm - or by intra oral X- rays and check the osteotomy site for perforations during surgery. I recog- nise these are not ever as accurate as a CT guided stent and the author would always recommend a bone supported stent in these cases as opposed to a soft tissue supported guide. The other consideration is the space along the horizontal plane to place four or up to six implants. Although there is a lot of literature relating to “all on four” technique the author prefers where possible to place six implants simply as if a failure occurs (current accepted two in every 100 or two per cent will fail) there is a backup of still making a final prosthesis on 5 or 4 implants if equally spread along the arch. One must also consider the A-P(Anterior - Posterior) spread of the implants. In such cases there must be ade- quate AP spread to allow for favour- able loading of the prosthesis as using this technique cantilevering will be re- quired in most cases. The picture shows a favourable arch form (rounded) for a better AP spread when compared to a squared arch form. After placement of the six dental im- plants a post-operative OPG was taken and the denture relined with soft re- line material over the healing abut- Fig10_Internalhealingabutments. Fig11_Screwholes. Fig12-16_Finalviewsofpatientwith completedprosthesisfitted. Fig. 10 Fig. 11 Fig. 12 Fig. 13