Dr. V. asks:
I was reading the recent post about the advisability of using tilted dental implants. I have never tried this before but the post started me thinking about some of the cases I have done where I needed an implant in the maxillary sinus area and the patient was faced with having a sinus lift or going to another treatment plan. I am wondering if in cases like that if there is enough vertical bone where bone support for the implant, the case could be done without the sinus lift. I am also looking at this from a simple geometry perspective. If the implant is tilted, then it forms the hypotenuse of a right triangle and should theoretically provide more bone to implant contact than if the implant were placed vertically. Any thoughts on this?
Implants in the Maxillary Sinus Without a Sinus Lift?
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Dear Dr V., this is a common technique, so one can avoid a sinus lift but most important than that, one can avoid cantilever situations or at least decrease their longitud. By the way you are right on the money in terms of the decomposition of forces in a structure that has this kind of counter tilted implants in their design, especially when due to the angulation one can place a really long implant.
If you want to avoid a sinus lift thee is also the possibility of using an endopore implant (5mm long)that only needs about 3mm to have initial stability and using bone compression with osteotomes you can get great results ( a 5×5 gevies you a single mollar no problem)
best of luck
Look carefully at the studies for bone to implamt contact in percentages, Some shine, some dont.
The more the bone to implant contact. the shorter you can go.
Surface technology in the short term and long term do matter to reduce failures.
An implant that perfs the sinus can have bone growing apically by as much as 4 mm.
Implants that are angled towards the palate can certainly be longer than vertical ones, and when you have 2 or more splinted via bridges or joined crowns, you get a favourable ‘cross-bracing’ effect. You have to decide whether a single angled implant will get acceptable loading forces that will not pathologically challenge the bone (giving either bone loss and loosening, or component fracture)
My respect for new surface technology has not been exceeded by my comfort with longer implants and their greater surface area.
Hi, Tony bet you are enjoying the summer weather down under. Still not sure why all the effort when Sinus augmentation is so safe predictable and generally results in better bone than than the adjacent natural maxillary bone.
Peter
As a resumee: sinus lift in cases of less then 4mm perforation is overtreatment/misstreatment. Bone block implantation is same in this context. Angulation and tilted implants are not. Sinus lift is indicated only when less then 3mm residual bone is left.
Concern is which exit strategies do exist in case of failure regarding patient issue.
The other peculiarity is the importance of dogmata while being judged on this base by expert-testimonial i.e. at court.
Whislt I agree with regard block grafts , as to the sinus without a doubt the best long term results will achieved with augmentation rather than angled or short abutments.
This is evidence based.
The fear of litigation hopefully will not deter us from applying the best treatment plan for our patients.