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In an implant-supported restoration of the edentulous maxilla, the esthetic aspects involved in treating the anterior teeth combine with the functional aspects of restoring the posterior teeth. Bio-Gide (Geistlich) membranes were used to cover the augmentation. Fig 6-6e The retained tooth following extraction. The condition of the prosthesis is also satisfactory (Fig 6-6j). As with the single-tooth template, the drill holes can be opened out on the labial/buccal side while preserving the tooth facets as much as possible (Fig 6-2b). However, the continuing progression of the atrophy of the mandibular residual ridge had since caused the implants to become exposed, and the mobile mucosa around the implants may require surgical intervention. the edentulous maxilla is particularly challenging with regard to augmentation because of anatomic limita-tions, such as the nasal floor, maxillary sinus, resorption pattern, and interarch relationship.4,5 Implant survival rates (SRs) are generally lower in the maxilla than in the mandible, especially in the posterior maxilla where One problem in the posterior maxilla is that very little bone tissue is often left after teeth are lost, and that this tissue also offers little retention for implants due to its cancellous structure. The bar connector and the mucosal situation remain stable 5 years after the implants were loaded with the prosthesis (Fig 6-6i). Above all, this means resolving the question of how the masticatory forces in the molar region (the center of occlusal force) are to be absorbed. On the other hand, provisional cementing is usually unnecessary on healing abutments, as the retention is generally sufficient and no hypersensitivity reactions are likely. A removable prosthesis with an open palate with direct attachments to the implants or with a connecting bar requires the support of four dental implants. the edentulous or partially dentate maxilla. Gingival deficit between the anterior implants. In region 26, the drill hole corresponds almost exactly to the contours of the residual ridge (Fig 6-1g). The incision was made on the palatal side, to allow keratinized gingiva to be transposed toward the labial/buccal vestibule. Fig 6-12f Pronounced malocclusion in the left anterior maxilla. To begin with, it is advantageous to plan more implants than will actually be needed. She wanted to have a securely fixed and palateless prosthesis. Fig 6-11i Postoperative panoramic radiograph. Fig 6-6c The retained tooth on the CT scan image. 2.Exposure and long-term provisional restoration. Its further purpose is to suggest a reliable and evidence-based protocol for immediate implant loading of full-arch prostheses in the maxilla. Fig 6-11k Residual ridge made wider by augmentation. In this sort of situation, it is an advantage if a few posterior teeth can continue to carry most of the load during the healing period, at least, and if a sufficient number of long implants can be inserted with primary stability. These screws act as guidance pins, clearly defining the position of the template relative to the maxilla when it is inserted. The palateless prosthesis was stabilized on the bar connector that had been milled at the same time, and additionally “locked on” with two MK1 attachments (Figs 6-3g and 6-3h). Following healing and exposure, the implants were fitted with EsthetiCone and angled abutments (Fig 6-7g). Fig 6-11u Check panoramic radiograph with the impression posts. This bone loss progresses in the caudal and mesial directions. Fig 6-7e Implants inserted further palatally than planned. Fig 6-9n The same restoration after 4 years of functional use. The drilled holes provide good reference points in both CT and CBCT imaging without producing artifacts. Toljanic JA, Ekstrand K, Baer RA, Thor A. Fig 6-11g Palatal augmentation was also necessary. Fig 6-11n Fixing the gingiva into place with sutures. Bar connector restoration on six implants. The mean IC diameter in (c) showed results of 2.84 mm for dentulous maxilla and 3.56 mm for edentulous maxilla; in (d), it was 4.28 mm for dentulous maxilla and 5.40 mm for edentulous maxilla. Fig 6-11q Widening the zone of attached gingiva on the left side. Following the extraction, the implants were successfully inserted into region 21 and five further positions, as planned. In fact, the time of implant exposure offers the best opportunity of correcting this, by transplanting keratinized gingiva from the palate to the vestibule in the form of a pedunculated graft (Fig 6-11m). The overall contours of the residual ridge (Fig 6-12n), but particularly the zones of vertical augmentation in the left premolar region (Fig 6-12q), appeared to have improved markedly relative to baseline (see Fig 6-12f). For a number of years, this female patient had worn an overdenture as her maxillary restoration. Fig 6-3d Postoperative panoramic radiograph. Fig 6-11a The patient’s edentulous maxilla. Fig 6-11l Unattached mucosa on the residual ridge. Fig 6-10c Suturing after implant placement and augmentation. The uniform distribution of thicker bone around the implant ensures a better supply of nutrients to the tissue. Since the dimensions of the bone in the posterior maxilla were still sufficient to anchor implants with primary stability, implant placement was performed in the same session as sinus elevation (Fig 6-11c). Fig 6-11c Implantation performed concomitantly with sinus elevation. 1.Implant placement in the maxilla and mandible. The prosthesis needed to be able to compensate for any irregularities, particularly those caused by mucosal resilience during the operation. The bone was also augmented over the screw threads exposed on the palatal side (Fig 6-11g). The mandibular problem had been largely resolved 5 years before the treatment of the maxilla, by means of a cantilever fixed bridge on six implants placed in the interforaminal region (Fig 6-12a). The first step was to perform sinus elevation on both sides of the maxilla. Fig 6-10d Try-in of the thermoplastic foil. PURPOSE: Successful immediate loading of implants in the edentulous maxilla has been previously reported. Direct comparison of the residual ridge at the start of the treatment and after the surgical and regenerative phase shows a marked improvement (Figs 6-11b and 6-11t), which is even more remarkable, given that the result was achieved by relatively simple means (ie, with no bone block grafts, mucosal distraction or free mucosal grafts) in only two sessions. Definition of jaw, edentulous in the Definitions.net dictionary. Fig 6-2f Implants inserted following removal of the template. Planning and carrying out implant treatment in the edentulous maxilla is a more difficult and more extensive process than that involved in any other indication. The stabilization screw is unscrewed from the palate. Fig 6-7a The patient’s edentulous maxilla. When closed, the attachments were flush with the palate plate, so that they were virtually undetectable by the tongue (Fig 6-3i). The postoperative panoramic radiograph shows the positions of the implants and the extent of sinus elevation (Fig 6-11i). After all the implants were placed, the template was removed, showing how atraumatic this method is (Fig 6-9i). Fig 6-6h Retaining elements in the prosthesis. Any structure resembling a bent bow or an arc. Immediate Loading of Implants in the Edentulous Maxilla with a Fixed Provisional Restoration without Bone Augmentation: A Report on 5-Year Outcomes Data Obtained from a Prospective Clinical Trial. The healing period was uncomplicated and the implants were exposed 10 months after the first operation (Fig 6-11j). The maxillary sinus was then augmented, allowing these implants to also be inserted fully. Using two CBCT scans (patient with prosthesis and the prosthesis alone) as the basis, the 3D planning was carried out with the NobelGuide software. Edentulous maxillary fixed rehabilitation using dental implants is challenging and requires meticulous planning because of anatomic variations and the importance of facial and dental esthetics. If the incisal edges and occlusal surfaces of the teeth are reasonably intact, the template can be supported on the dentition of the opposing jaw, like a prosthesis (Fig 6-2b). What does jaw, edentulous mean? The completed dental prosthesis was finished and polished by the laboratory technician (Fig 6-9k) and attached to the implants in the mouth with screws. Moreover, a stable bone situation is apparent from the follow-up panoramic radiograph taken after 5 years (Fig 6-6k). After the template was inserted, the patient was asked to bite down hard for a few minutes, to reduce the mucosal swelling caused by the infiltration anesthesia. It was to be used as a long-term provisional restoration and, in the best-case scenario, even as the definitive one. Following extensive block and infiltration anesthesia (it is extremely difficult to top up the anesthesia with the template in situ), the template was placed into the mouth with the occlusion rim. Fig 6-4b Gingival deficits distally of the implants. a structure of bowlike or curved outline. If the bone situation is good, it is sometimes possible to insert implants following extraction and load them immediately with a provisional restoration. Fig 6-7j Gold crown 24 fitted at the patient’s request. The distal locking attachments hold the palateless denture securely in place (Fig 6-6h). In region 13, for example, a slight inclination palatally is sufficient to ensure that the implant is anchored in the bone (Fig 6-1f). Fig 6-5a Panoramic radiograph with the template. Fig 6-12v Palatal incision made for implant exposure. Fig 6-12e Pronounced malocclusion in the right anterior maxilla. Since the template did not stay in place securely due to the high proportion of unattached mucosa, it was stabilized further with direction indicators once the first two beds were drilled. It needed to lie over the implant abutments and the patient’s own teeth without tension and be supported by the opposing dentition when the patient was biting down (Fig 6-10d). At the same time, however, the masticatory apparatus loses most of its sensitivity (as there is no periodontal feedback), so that mechanical complications, such as fractures or the prosthesis teeth snapping off, are not uncommon (Figs 6-8a and 6-8b). Fig 6-9a The edentulous maxilla before treatment. Six implants were inserted into the anterior maxilla (Fig 6-3b). This information should not be considered complete, up to date, and is not intended to be used in place of a visit, consultation, or advice of a legal, medical, or any other professional. Therefore, the accumulated mean marginal bone loss was 0.57 mm (SD = 0.21 m; N = 153). It was only possible to insert four implants here, placing them not in line but alternately on the palatal and buccal side of the crest, to leave sufficient space between them (Fig 6-12s). Dictionary, Encyclopedia and Thesaurus - The Free Dictionary, the webmaster's page for free fun content. After this, the template can be stabilized further with the direction indicators, which prevent it from rotating (Fig 6-2d). Fig 6-6i Bar connector after 5 years of functional use. 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