pre-prosthetic surgery for fixed dental implant reconstruction of the atrophic maxilla
Dental implant reconstruction of the maxilla can be most challenging. Treatment planning is predicated upon several factors, including the maxillomandibular relationship, the volume of residual bone in the maxilla, the esthetic requirements and demands of the patient, and the financial resources available for treatment. The presurgical workup should acquire adequate information to help define the various treatment possibilities. However, for the patient who demands fixed dental implant reconstruction, many of the options, such as using removable prostheses, are not possible. This makes reconstruction much more demanding, and planning becomes even more important. For purposes of this presentation, three different conditions will be described and the treatment illustrated.
Ideal Maxillomandibular Relationship, Adequate Alveolar Bone. Though rare, this is the ideal fixed implant restoration candidate. Bone availability and lip support are both sufficient. Sufficient implants are placed to provide for fixed bridgework.
Acceptable Maxillomandibular Relationship, Inadequate Alveolar Bone. This patient has adequate lip support but has deficient bone availability. Most of these patients will require sinus augmentation and possibly lateral augmentation of the anterior alveolus. They will then be good candidates for fixed implant-supported bridgework. However, these patients are a spectrum depending upon how much bone has resorbed, and the amount of lip support they require.
Unacceptable Maxillomandibular Relationship, Inadequate Alveolar Bone. These are the most challenging patients for fixed reconstruction. They have often been edentulous for decades and present with severe hard tissue deficiencies. In addition, the resorption patterns produce an unacceptable maxillomandibular relationship and a large interocclusal space. It is imperative that such patients undergo a complete work-up using diagnostic casts that are mounted on an articulator to determine the possible need for orthognathic surgery, bone graft reconstruction of the alveolus, or both.