Dr. MK, an orthodontist, asks:
I have a patient who presented for an implant retained maxillary overdenture. He has Class V atrophy of the maxilla and alveolar ridges and is not a candidate for implants. I was wondering if we could place implants in the palate, maybe along the midpalatal suture and use these for retention, like maxillofacial prostheses. I have found some information on this approach in the literature. I was wondering if anybody had any recommendations?
Dental Implants in the Palate?
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I use screw in midpalatal suture for surgical guided plate when needed for doing full mouth implant, but only for temporary retention untill i finish placing the implant.
I don’t know if it works for longe time use, but i cann’t see why not.
Hopefully we will get a reply from maxillofacial surgeon.
Thanx
also I think we need to figure how much pressure will the overdenture transfer to the screw or screws u r using for retention.
It printed that I am an Orthodontist. No , I am a restorative DDS and am hoping to later restore this pt. with 3 to 5 implants after removal and grafting of the anterior teeth and sockets. I have absolutly NO posterior ridge for a provisional denture. My thought was to stabilize with two 6mm implants in the suture (ala ortho technique) with zest attachments so that the patient had some amount of retention. Thoughts?
Bilateral sinus lifts would be safe and predictable, if you have not done them get an OMFS to do the lifts and you can do the implants. Yes it’s time and money, but it’s predictable excellence. What would you do on your father or mother? It opens the door for a fixed detachable if later desired.
Mike, are you willing to consider mini implants? If so, I just completed a case where I placed an 8-unit fixed bridge on 7 mini implants which gave my patient nice aesthetics. Then I referred to my OMS for bilateral sinus lifts. Six months later I placed 2 additional mini implants in very solid bone in the sinus area and rebuilt my fixed hybrid bridge to include the molars. Even if you hate mini implants like many on this forum, you could use them to support the anterior bridge during healing and then construct whatever type of restoration you prefer after the sinus lifts are solid. I know the Clear Choice franchises use this technique because I recently did a second opinion for one of their potential patients and was surprised to see that they were doing this. I use the minis for the full fixed bridge and build my bridges with metal reinforcement over all 10 mini implants and denture teeth with acrylic for the final bridge. Again, you don’t have to buy in to the mini implant system except for the temp bridge if that is your preference. Even with 5 extractions and socket augmentation you can usually find room for a few minis for transitional purposes.
I have done over 50 palatal implants, for orthodontic anchorage purposes. They integrate and are very stable. I also dabbled with snap attachments for holding retainers and even transitional dentures. However, they are designed for eventual explantation.
State of the art currently is as Dr. Nelson suggests; Sinus Lifts can be quite predictable.
I would suggest that you consider incorporating some posterior support in your prosthetic plan.
If you replace the anteriors with implants without any posterior support, you may have a prosthetic failure.
Palatal placement of implants for retention of a prosthesis to repair dentoalveolar defects in oncology patients may be possible.
Talk to your local maxillofacial surgeons.
Thanks for the input everyone.
I am having my OMFS do all the grafting and implants. Way out of my skill set! I am looking to have the palatal implants placed and locator attachments for the transition period. The patient has zero retention and I need to come up with a good years worth of stability while we restore him with fixed implant supported prosth work.
We are planning to doing the bilateral sinus lifts along with posterior implants.
sounds like a well planned case
The best solution was made .
well done, & good luck.