Tilted Implants

 

Oral Rehabilitation on patients with extreme atrophy using dental Implants

Have you heard that with age comes wisdom? Living your golden years might just be more than accumulating knowledge. The increasing life expectancy nowadays means people live longer, fuller lives. But not everything is so bright.

It is no secret that our bodies have a harder time healing as elders as It did back when one is young. All those bumps we wouldn’t even think about back in the day are cause for discomfort and a healing period usually more extensive than an overnight sleep.

When you lose a tooth, bone becomes idle, as the tooth itself is stimulation for bone level maintenance and remodeling. When the tooth is gone, the body resorbs some of the bone and other structures such as the maxillary sinus in the upper arch (normal air cavity found in our skull) start expanding into this space considered not in use. In the mandible, resorption happens as well, as bone is denser than in the maxilla and loses height and width.

 

Perhaps the solution to all this are novel treatments such as guided bone regeneration, which is a number of techniques to recover lost volume in order to place a dental implant. These procedures are metabolism dependent, which means that one can only place a matrix in order for the body to “rebuild” lost bone. This is great for young patients as well as adults. There is no question that autologous bone, meaning your own bone, is the best for this, unfortunately this means there is a need to take it from somewhere which has a cost in itself. Synthetic materials, as well as bovine bone can also be used with very high success rates.

 

Having seen all this it is fairly reasonable to think this works on almost anyone, and it would be a fair assumption. However, the older the patient, the longer the recovery period and the slower the bone formation will be. Elder patients are grieved with other systemic alterations sometimes related to high cholesterol, hypertension, and diabetes. All these are points against bone healing regarding implant placement and the overall rehabilitation.
 
The good news is not everything is lost. Several researchers and professionals have proven that the use of tilted implants is very favorable for dental rehabilitation. This means that even if there is no adequate bone to place a straight implant, there is a chance to place the implant at a determined angle and still be able to provide reliable dental prosthesis satisfying the patient’s needs.


The “tilted” implant has been studied almost since the discovery of osseointegration, which is the integration of titanium to the bone. Dr. PI Branemark, the first physician to study and develop dental implants based on this principle, was a firm believer on extensive rehabilitations on completely edentulous patients, meaning patients with no teeth, especially on those who lost their teeth a long time ago, causing their maxillary bones to resorb to an alarming point, which is known as atrophy.

 

Using extra maxillary fixations, such as zygomatic implants and pterygoid transtuberal implants, he was able to provide fixed prosthesis for patients who had long lost their teeth. And this was done successfully since the 1990’s. Dr. Alfonso Venturelli in Italy successfully proved that posterior tilted implants were able to assist on load bearing for complete arch restorations.

 

Modern technologies as well as new materials and a better understanding of implant biomechanics have permitted major advances in implant therapy. The concept of “all on 4” permits a whole dental arch to be rehabilitated using 4 implants alone. There is always the option of extra-maxillary fixations for extreme cases, and interdisciplinary approaches among surgeons, dental specialists and medicine doctors can ensure every patient has an individually tailored treatment plan suiting their needs and helping the patient understand the extensions and limitations of implant therapy.

Please contact us to schedule an initial appointment to assess your particular case. Using a multiple array of treatments and techniques, at Demianko Dental Care we will strive to give you back your smile and self-confidence.

 

References


BRÅNEMARK, P. I.; SVENSSON, B; van Steenberghe, D. Ten year survival rates of fixed prostheses on four or six implants ad modum Brånemark in full edentulism. Clin Oral Imlpants Res; 6:227-231. 1995
BRÅNEMARK, P. I. Zygoma fixture in the management of advanced atrophy of the maxilla: technique and long-term results. Scand J. plast. Reconstr. Surg. Hand Surg. v. 38, p. 70-85, 2004
FERRARA, E. D.; STELLA, J. P. Restorations of the edentulous maxilla: The case for the zygomatic implants. J. oral Maxillofac. Surg., v. 62, p. 1418-22, 2004.
MIGLIORANÇA, R. M.; ILG, J. P.; SERRANO, A. S. et al., Exteriorização de fixações zigomáticas em relação ao seio maxilar: uma nova abordagem cirúrgica. Implant News, v. 3, n. 1, p. 30-5, jan.,/fev., 2006.
STELLA, J.; WARNER, M. Sinus slot technique for simplification and improved orientation of zygomaticus dental implants: A technical note. Int. J. oral Maxillofac. Implants. v. 15, n. 6, p. 889-93, 2000.
MIGLIORANÇA, R; SOTTO-MAIOR, BS; SENNA, PM FRANCISCHONE, CE; DEL BEL CURY A. Immediate occlusal loading of extrasinus zygomatic implants: A prospective cohort study with a follow-up period of 8 years. International Journal of Oral and Maxillofacial Surgery, Volume 41, Issue 9, Pages 1072-1076. 2012.

VEGA, L; GIELINCKI, W; FERNANDES, R. Zygoma Implant Reconstruction of Acquired Maxillary Bony Defects. Oral Maxillofacial Surg Clin N Am 25 223–239. 2013.
VENTURELLI, A. A Modified Surgical Protocol for Placing Implants in the Maxillary Tuberosity: Clinical Results at 36 Months After Loading With Fixed Partial Dentures. Int J Oral Maxillofac Implants 1996;11:743–749.
ZORZETTO, D; MARZOLA, C; ILG, J; MENDES-CAMPOS, L; TOLEDO-FILHO, J. Zygomatic Fixation: Literature Review and Clinical Surgical Case Presentation. Work presented for conclusion of the Specialization Course in Buco Maxillofacial Surgery and Traummatology, promoted for the APCD –Regional of Bauru – SP - Brazil. 2006

 

Dr. Mauricio Fonseca
DDS / 2015