Dr. M. asks:
I have always been taught that when treatment planning for a fixed-detachable implant supported prosthesis for an edentulous maxilla, 8 dental implants are the norm. I have recently seen several cases where only 6 dental implants were placed in the edentulous maxilla for this type of restoration, thereby eliminating the need for bilateral sinus lifts. Is this clinically acceptable?
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It’s clinically acceptable as long as they don’t fail.
You’re asking the dreaded “standard of care” question. Watch, for every guy saying that that you should do 8, there’ll be another that says 6 are fine. Is the literature conclusive? Not really – you’re left on your own. I think you are over simpliflying everything here. There are considerations that you need to consider other than # of implants. Are you going to cantiliever? What’s the occlusal scheme? Is it opposed by a denture/other fixed detachable/natural teeth? Quality of bone? Does your patient accept Bilat lifts? Cost factors? So many issues other than straight #’s. There are times when you can do six and there are times you should do eight. Each will work if you evaluate the case correctly. If you are the surgeon, consult with your restorative guy, if you are the restorative guy, talk to your surgeon. If you do both… I don’t know
“If all you have is a hammer, everything looks like a nail”
While sinus lifting is a well documented and predictable procedure it obviously involves an increased cost as well as an additional risk factor and frequently a second operative site. The use of a non-graft technique can be attractive to both the patient and clinician.while it is worth considering an all-on-four technique; a zygomatic protocol is very predictable and provides a very stable platform on six implants.
This is often a good option to avoid grafting as well as provide predictability where max bone is of poorer quality. As this technique can achieve implant emergence very close to the centre of the edentulous ridge it should be another tool in the treatment armanentarium. It all boils down to case selection;treatment planning and the operator having adequate surgical training to allow a number of options to any one scenario.