Full-arch Dental Implant Rehabilitation of an Edentulous Maxilla

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I am treatment planning a full-arch implant rehabilitation of an edentulous maxilla opposing a maxillary complete denture.

Because the mandible is atrophic and only about 5-6mm in buccolingual bone width, even with a sagital split and graft I can only place narrow platform dental implants. I am concerned that pure titanium alloy dental implants will not be as strong as alloyed implants (6% aluminum, 4% vanadaium). This limits my selection of narrow platform dental implants if I am only going to be able to use alloyed dental implant fixtures. Anybody have any thoughts on this?

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9 Responses to “ Full-arch Dental Implant Rehabilitation of an Edentulous Maxilla ”

  • Anonymous November 22nd, 2005

    Why not try an expanded platform? Just remember that you might want to discuss the restorability with whomever is going to restore the case to decide if you prefer an external connection or an internal one. Most importantly, try to avoid the implants with less prosthetic options since you are probably limited in getting good parallelism in that type of a ridge.
    Good Luck.

  • Bill Jameson November 22nd, 2005

    I think you meant to say that you were planning on an implant rehabilitation of the mandibular arch with an opposing existing maxillary complete denture. However you restore the mandibular arch with implants, the maxillary complete denture then becomes the weaker member. Occlusal scheme to be used is as important if not more so than how many implant fixtures are used. No mention was made of redoing the maxillary complete denture, but not doing so limits the treatment approach. It would probably be wiser to treatment plan the rehabilitation by first establishing the correct vertical and centric position, proper lip support and occlusal plane before commiting to a hybrid or PFM restoration in the mandibular arch. The patient is probably complainig of an ill fitting lower denture, but using the existing maxillary complete denture will unduely dictate the final restorative approach. The patients needs may be better served by providing retention and stability of the mandibular denture using fewer implants (for retention only) and using linear occlusion with no interceptive contacts anterior or posterior which will enhance the overall prognosis of the final prosthesis.

  • Anonymous November 23rd, 2005

    If you are placing 4-5 implants in the anterior mandible and splinting you should have adequate strength in the commercially pure titanium implant fixtures. You will have cross-arch stabilization and you are opposing a full upper denture.

  • Anonymous November 24th, 2005

    D. Schwartz-Arad, G. Chaushu
    Full-arch restoration of the jaw with fixed ceramometal prosthesis
    International Journal of Oral & Maxillofacial Implants Vol. 13, (pp. 819-825) 1998

    G. Chaushu, D. Schwartz-Arad
    Full-arch restoration of the jaw with fixed ceramometal prosthesis: Late implant
    Placement.
    Journal of Periodontology Vol. 70, (pp. 90-94) 1999

    D. Schwartz-Arad, N. Gulayev, G. Chaushu
    Immediate versus non-immediate implantation for full arch fixed reconstruction
    following extraction of all residual teeth: A retrospective study
    Journal of Periodontology Vol. 71, (pp.923-928) 2000

  • Rui Pinto Cardoso December 21st, 2005

    you have to put at least 7 implants and you can use attachments reverted in the 2nd premolar. In the oclusion try to think like a total removable. Don´t put excentric movements, only centric and in the excentric lateral movements do it in group with lateral incisor canine an premolars in the protrusion put a slghtly overpass of the incisors that the movement is iniciated with the incisors but terinated with de distal-vestibular cuspide of the superior premolars.

    I think that it is probably better to expand the alveolar bone with osteotomes and even do a traumatic or atraumatic sinus lift before or during the surgery. The narrow implant of 3.3 mm is ok but you have to put at least 11,5 or 13 mm of length to have more surface contacting the bone.

    Use good screws, try torquetite of nobel biocare.

    And don´t forget use external hexagonal implants and not conic and not internal because it causes less problems to the implants and its better to solve a prosthethic problem rather a implant failure.

  • Alexis M. Jr December 22nd, 2005

    To Dr. Rui. I think you didn’t understand.The case is about a mandibular rehabilitation.
    I think a protocol with 5 to 6 implants inter-foramen is a good choice. I don’t think you can’t put regular implants in this area.

  • Adrien Deume December 29th, 2005

    Dear colleagues,

    For ridge expansion I think that it works much better working with ridge expander drills operated with the motor. They provide much better directional and torque control and are far less agressive for our patients. There is a german manufacturer - I do not recall the name right now - and a spanish one - BTI expander drills, the ones I use - with a branch in Philadelphia; I also once heard a conference of Dr. Ernesto Lee and to expand the crest this is by far the best option.

    Best regards,

    Dr. Adrien Deume

  • Andrew biggs DMD October 3rd, 2007

    Dr. Deume - I was very interested in your comments on expander drills. I have a case coming up that would indicate the use of the drills. Can you give me any more advice on which ones to get ? I place NobelBiocare and Imp[lant direct fixtures and they don’t have expanders designed for their implants.

    Thanks, ATB

  • Dr SS December 5th, 2007

    Narrow implants in the mandible for a fixed case is really not a problem per se
    The bone to metal contact is good, density is far better than maxilla
    You need to over engineer the case if you intend to do the same in the upper

    All simple biomechanics
    Splinted (not across midline in mandible )
    Narrow occlusal table /low cusp form
    Longer implants in the anterior
    Restore only to first molar etc
    I would have little concern with 3.5 mm implants in this case as described
    Nothing unusual here
    Place 6to 8

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