[Downloaded free from http://www.jdionline.org on Sunday, June 4, 2017, IP: 115.99.113.

90]

ORIGINAL ARTICLE

A review of management options for rehabilitation of

posterior atrophic maxilla with implants
DR Prithviraj, Richa Vashisht, Harleen Kaur Bhalla, Shruthi Prithvi, Prema Suresh,
DeekshaSharma

ABSTRACT

Purpose: The placement of implants in the alveolar bone remains a challenge because of the resorption
of the residual ridge resulting in insufficient bone volume in one or more dimensions. Need of the
hour is to review the various options to rehabilitate posterior atrophic maxilla with/without bone
modification procedures.
Study Selection: MEDLINE/PubMed searches were conducted using the terms atrophic maxilla,
implants, buttresses, grafts, maxillary sinus, osteotomy as well as combinations of these and related
terms. The few articles judged to be relevant were reviewed.
Results: Appropriate treatment planning is crucial and various factors need to be considered before
placing implants in atrophic alveolar bone Bone grafting, osseodistraction and sinus lifts are invasive
procedures. In addition, they add complexity and increase the number of surgical phases required
for implant therapy. Different therapeutic alternatives, such as, short implants, or implants placed
in specific anatomical areas like the pterygoid region, the tuber or the zygoma has allowed patient
treatment to be expedited and minimally invasive.
Conclusion: Important aspects that need to be considered for implant placement in posterior atrophic
maxilla are discussed in this article and both surgical and nonsurgical options are suggested. There
is no consensus as to which treatment modality is superior to the other in literature. The decision to
opt for either of the options, therefore, depends upon patient factors, and ultimately, the expertise
and skill of the clinician.

KEY WORDS: Atrophic maxilla, buttresses, grafts, implants, maxillary sinus, osteotomy

INTRODUCTION effects and thus also improves the patients quality

The reconstruction of edentulous, atrophic jaws according
to functional and esthetic factors not only restores
chewing function, but leads topositivepsychosocial
Department of Prosthodontics, Government Dental College and
Research Institute, Victoria Hospital Campus, Fort, Bangalore, India
Address for correspondence: Dr.DR Prithviraj,
#7A, Government Dental College and Research Institute, Bangalore, Victoria
Hospital Campus, Fort, Bangalore560002, Karnataka, India. ridges may be unfavorable for implant placement.
Email:prithvidr@yahoo.com
Access this article online
Quick Response Code:
Website:
www.jdionline.org
DOI:
10.4103/0974-6781.111687
oflife.[1]
The rehabilitation of edentulous jaws with
osseointegrated implants has been proven to be a
predictable treatment over the time. A sufficient and
longterm stable bone site is the basis of successful
implant therapy. [2] However, due to atrophy or
periodontal disease, local conditions of edentulous
In particular, severe atrophy of the edentulous
maxilla(classVI according to Cawood and Howell
1988 classification), may result in insufficient bone
volume and unfavourable vertical, transverse, and
sagittal interarch relationship, due to the tridimensional
resorption pattern of longstanding maxillary
edentulism. Finally, maxillary sinus pneumatization
may further reduce the available bone for a safe and
reliable implantsupported dental rehabilitation. This

Journal of Dental Implants | Jan - Jun 2013 | Vol 3 | Issue 1 35

[Downloaded free from http://www.jdionline.org on Sunday, June 4, 2017, IP: 115.99.113.90]
Prithviraj, etal.: Rehabilitation of atrophic maxilla
may render implant placement impossible or incorrect
from a functional and esthetic viewpoint.[3]
During the last 3 decades, several surgical procedures
have been developed to increase local bone volume in
deficient anatomical regions, including total/segmental
bone onlays, Le Forte1 osteotomy with interpositional
bone grafts, and grafting of the maxillary sinus with
autogenous bone and/or bone substitute.[4]
These techniques pose a series of inconveniences, such
as the need for multiple surgical interventions, the use of
extraoral bone donor sites(e.g., iliac crest or skull)with
the morbidity involved in surgery of these zonesand
the long duration during which patients remain without
rehabilitation during the graft consolidation and healing
interval. These factors complicate patient acceptance
of the restorative treatment and limit the number of
procedures carried out.
In order to overcome such limitations, different
therapeutic alternatives have been proposed, such as,
short implants, or implants placed in specific anatomical
areas like the pterygoid region, the tuber or the zygoma.
Any of these procedures requires considerable surgical
expertise and has its own advantages, limits, surgical
risks and complications involving biological and
financial costs.[5]
Treatment without bone modification
Since the development of osseointegrated dental
implants, the standard procedure has been to place
implants vertically within the alveolar bone. However,
when the amount of available bone in the maxillary
alveolar crest is<10mm in the vertical aspect and
4mm in the horizontal aspect, the prognosis for implant
treatment is poor. Alternative methods in which the
severely resorbed alveolar crest is used for implant
placement without bone grafting have been presented
and include placement of implants in anatomic
buttresses, palatal positioning of implants and the tilted
placement of implants along the anterior maxillary
sinus wall.[6]
Anatomical buttresses
The skull presents a series of dense bony buttresses
that conform a protective frame around the different
craniofacial cavities such as orbit, nasal fossae or
passages, oral cavity and paranasal sinuses with mostly
fragile walls. These buttresses distribute forces through
the solid facial bone structure, and are distributed
strategically throughout the three facial thirds of the
skull. In this context, the middle third portion presents
two anterior buttresses namely, frontomaxillary
and frontozygomatic buttresses and a posterior
pterygomaxillary buttress.[7]
36 Journal of Dental Implants | Jan - Jun 2013 | Vol 3 | Issue 1
Frontomaxillary or canine buttress
This region normally presents a compact cortical layer
and dense medullary bonethus allowing the placement
of long implants with parasinusal angulation. [8]
Krekmanov and Rangert introduced implants parallel
to the anterior wall of the sinus, combined with vertical
implants in the anterior region, in a series of 20patients.
This procedure made it possible to extend the fixed
prosthesis 9 mm. No implants were lost during the
2years of followup.[9]
Frontozygomatic buttress
This support is located in the region of the upper first
molar, forming the socalled zygomaticoalveolar crest,
which continues laterally along a concave trajectory
to the zygomatic process of the maxillary bone and
posteriorly, to the zygomatic bone.[7] Two management
options exist in this region.
Implant placement in the palatal vault
This technique involves positioning a tilted implant
in the region of the first molar, using palatal bone
as anchorage, which is entirely composed of cortical
bone. Krekmanov published a series of case reports of
75implants placed in 22 atrophic upper jaws. Fiftyfour
implants were tilted. After 45months of followup, three
nonangulated implants failed to osseointegrate. Implant
survival rate of 94.7% was observed with tilted implants
after followup of 18months.[10] Perales and Aparicio
conducted a retrospective study involving 101 implants
of which 59 were in an axial position and 42 were in a
tilted position. After a mean followup of 33months,
cumulative success rates of 95.2% and 91.3% were
recorded for the tilted and axial implants, respectively.
Several authors have considered this management
approach to be simpler, less costly and faster than the
invasive surgical techniques.[11]
Trans zygomatic implants
Transzygomatic implantation is a novel technique
involving the positioning of two bilateral implants
measuring between 35 mm and 55mm in length,
which are anchored to the zygomatic bone following
an intrasinusal trajectory. These implants in turn must
be combined with a minimum of two implants in the
anterior sector and stentfixated by means of a prosthetic
superstructure.[7]
Stella and Warner described a variant of the technique
in which the implant was positioned outside the
sinus, following the contour of the malar process, and
introducing into the zygomatic bone. This approach
obviates the need for performing a maxillary sinus
window and facilitates implant emergence above the
alveolar crest at first molar level, with a more vertical
angulation. The authors consider that this variant affords
[Downloaded free from http://www.jdionline.org on Sunday, June 4, 2017, IP: 115.99.113.90]
Prithviraj, etal.: Rehabilitation of atrophic maxilla
improved contact between the bone and implant, with
optimum implant positioning, and a better postoperative
course.[12]
Balshi and Wolfinger reported the case of a 20yearold
patient presenting ectodermal dysplasia rehabilitated
with two zygomatic implants in combination with four
anterior implants and two implants positioned in the
pterygomaxillary regionthereby avoiding graftbased
maxillary reconstruction.[13] A survival rate of 96100%
has been reported for this treatment modality.[1417]
Pterygomaxillary buttress
Tulasne in 1989 described the technique for placing implants
in this region. According to him, the pterygomaxillary
implant should anchor in the pterygoid process or even
traverse the latter, avoiding the posterior portion of the
sinus and major palatal duct. To accomplish this, the
implant should be directed posteriorly, superiorly and
medially. The length of the implant is normally between
15mm and 20mm.[8] In a study, Pipublished the results
of 177 pterygomaxillary implants in 136patients, with a
followup of 110years. The success rate was 97.2%.[7] As
per the various studies the success rate of this technique
was between 88% and 98%.[1822]
Short implants
An implant is considered as short when presenting a
length<10mm.[23] Accordingly, in clinical situations with
little bone availability, short implants are a viable, simple
and alternative treatment modality to bone grafting
procedures.[24,25] Moreover, short implants may present
results similar to those of longer implants.[2530] Malo etal.
stated that short implants of 7mm and 8.5mm with
modified surfaces and adequate placement technique
almost matched the success rates of long implants.[24]
Rokni etal.[31] evaluated 199 implants, with short implants
of 5mm and 7mm and long implants of 9mm and
12mm. Long implants showed a greater bone loss of the
alveolar ridge in relation to short implants. More recent
clinical studies on short implants with rougher surfaces
report survival rates similar to implants in general.[3241]
Treatment with grafts
The definition of adequate bone width and height
requirements for implant placement is based mainly
on clinical experience and on physical and mechanical
requirements for the actual implant placement process.
Aminimum width of 5mm and a height of 710mm of
bone are suggested by most clinicians.[42] The minimum
height requirement of 10mm is also supported by several
implant survival studies in which higher failure rates
were consistently reported for shorter implants.[43,44]
Thus, various ridge augmentation procedures have been
described for the enhancement of both height and width
Journal of Dental Implants | Jan - Jun 2013 | Vol 3 | Issue 1 37
requirements, including block grafts, particulate grafts
and ridge expansion techniques.[45]
The use of corticocancellous bone grafts for ridge
augmentation in implant dentistry was first reported
by Breine and Branemark.[45] Autogenous bone has been
successfully used as a grafting material to augment the
site and is generally considered to be the best material
for bone reconstruction surgery.[46,47] It is often obtained
from intraoral sites such as chin and retromolar area
or extraoral sites such as the anterior or posterior iliac
crest, the calvarium and the tibia.[48-50] Extraoral sources
were primarily used for the reconstruction of atrophic
arches, with immediate or delayed implant placement.
Although still indicated for large alveolar ridge defects,
extraoral graft sources have the obvious disadvantages
of greater morbidity and expense. Intraoral graft sites
have therefore been suggested and used for ridge
augmentation procedures for smaller defects.[45]
The main advantage of using autogenous bone is related
to the osteoconductive and osteoinductive capacities of
the graft; the disadvantage is the use of an additional
surgical site, with the risk of donor site morbidity. Hence
bone substitutes such as calcium phosphates, btricalcium
phosphates[51,52] and bioactive glass particles, xenogenic
substitutes such as bovinehydroxyapatites(BioOss) and
allogenic substitutes such as demineralized freezedried
human bone have commonly been proposed as and
shown to be adequate alternatives for autogenous bone.
However, a major drawback of these substitutes is long
healing time that is needed before implants can be placed.
In addition, as clinicians often are looking for tools
to speed up healing, the effect of using plateletrich
plasma (PRP) has been studied aiming to accelerate
bone regeneration, as it has been speculated that growth
factors within PRP could enhance healing of the grafts
and counteract resorption after augmentation.[53,54]
However, Raghoebar etal.[4] and Schaaf etal. showed that
no relevant differences in healing of soft tissues and bone
existed between sites reconstructed with autogenous
bone and autogenous bone mixed with PRP.
With the need to define improvements in bone
augmentation techniques to enhance implant
osseointegration, emphasis has been shifting to the use
of autologous graft materials such as postnatal stem cells
to regenerate new bone.
Mesenchymal stem cells were shown to differentiate to
osteoblasts when being introduced into an environment
prone to the formation of bone. Pieri etal. investigated
whether mesenchymal stem cells and PRP seeded
on a fluorhydroxyapatite scaffold can improve bone
formation and bone to implant contact in maxillary sinus
[Downloaded free from http://www.jdionline.org on Sunday, June 4, 2017, IP: 115.99.113.90]
Prithviraj, etal.: Rehabilitation of atrophic maxilla
grafting. They showed that sinus augmentation with
mesenchymal stem cells may enhance bone formation
and osseointegration of dental implants in minipigs.
Also, McAllister etal. showed that treatment with
mesenchymal stem cells has a positive effect on bone
formation.
Furthermore, Herten etal. evaluated the influence of
different bone substitutes (BioOss) on the viability of
human bone marrow mesenchymal stem cells invitro and
concluded that hydroxyapatite (BioOss) supports cell
viability and allow cell proliferation.[55] In recent animal
studies, it has been shown that seeding BioOss with
mononuclear stem cells derived from concentrated non
mineralized tissue may result in boneforming kinetics
comparable with boneforming kinetics in a region solely
reconstructed with autogenous bone.[56] Inaddition, in
an invitro study osteoblastlike cells were cultured on
various alloplastic biomaterials used for augmentation
and for reconstruction of bone defects in dental and
craniomaxillofacial surgery which offered suitable
growth and proliferation conditions.[57]
Sinus floor elevation
The sinus lift operation has been used since the early
1980s to gain vertical bone height in atrophic regions of
the posterior maxilla, prior to the placement of dental
implants (Boyne and James 1980).[58] Two techniques
used are: The classical approach through a lateral
window and for less severe bone loss, the osteotome
technique(Summers Sinus floor elevation).
The lateral window osteotomy is the most commonly
used and reported technique for sinus augmentation, in
which a fenestration is made through the buccal bone,
the Schneiderian membrane is freed from the maxilla
and elevated. During this elevation procedure, the space
created between the residual maxillary ridge and the
elevated Schneiderian membrane is filled with a grafting
material. This way, a bone volume is created that may
allow for implant placement, either simultaneously
with the elevation procedure when the residual ridge
allows for primary implant stability or at a second stage
after healing of the grafted site.[59] The lateral approach
to sinus augmentation is a successful procedure, with
percentages of success close to 100%.[6062]
An alternative to the most commonly used lateral(major)
window approach involves the apical displacement
of crestal bone using the osteotome technique. The
Summers Sinus floor elevation procedure, introduced
by Summers [1994] is less invasive, less timeconsuming
and reduces postoperative discomfort to the patient.[63]
The procedure consists of elevating the Schneiderian
membrane with osteotomes through a crestal approach,
placing simultaneously the bone grafting material
38 Journal of Dental Implants | Jan - Jun 2013 | Vol 3 | Issue 1
and the implant. After a healing period of 3-6months,
implants are osseointegrated and become surrounded
with bone over the implant apex.[64]
Osteotomy and guided bone regeneration
Various treatment options devised over the years
for inadequate ridge width are, increase of width by
augmentation, bone expansion and ridge splitting.
The Le Fort I osteotomy, first proposed by Obwegeser
[1969], was accurately described by Bell etal. [1977]
as the surgical technique to move the maxilla of
edentulous patients forward, making adequate
prosthetic rehabilitation possible. [65] Displacement
of the osseous segment results in positioning of a
healthy portion of bone into a previously deficient site.
Aregeneration chamber is left at the natural location
of the segment which has a natural capacity to heal by
filling with bone instead of fibrous tissue. As a result
the alveolar housing including the osseous and soft
tissue components are enlarged in a single process. This
technique permits placement of regular sized implants
through the expanded ridge crest. This bone segment is
not regenerated using grafted tissue, it is native bone,
which provides an ideal situation to deal with.[66]
Bone expansion/splitting may be done by means of
osteotomes or chisels. When bone width>34mm,
osteotomes are used and when<3-4 mm, the ridge
splitting is done with sharp blade like chisels.
Another technique proposed with the aim of
reconstructing the resorbed maxillae for more successful
implant surgery was the guided bone regeneration(GBR)
technique, which was developed by Dahlin etal.[1989]:
The authors showed that a barrier membrane makes
it possible to maintain a free space and prevents the
ingrowth of surrounding soft tissue, which could disturb
bone healing.[65] Many studies have demonstrated the
predictability of using both techniques in improving
bone volume and reducing bone resorption after
autologous or heterologous bone grafts. The combination
of both techniques, namely Le Fort I osteotomy and GBR,
was first attempted by Stetzer etal.[67] during a study on
rabbits; the authors reported 40% more new bone if the
osteotomy site was covered with a barrier membrane
than if it was left uncovered.
Distraction osteogenesis
Distraction osteogenesis, first described in the treatment
of long bone fractures by Ilizarov, is a procedure based on
the gradual separation of a mobile but fully vascularized
bone segment from the basal bone, leading to the
formation of an intervening soft callus which gradually
transforms to mature bone.[68] Chin and Toth and Hidding
etal. were the first to report clinical use of distraction
[Downloaded free from http://www.jdionline.org on Sunday, June 4, 2017, IP: 115.99.113.90]
Prithviraj, etal.: Rehabilitation of atrophic maxilla
osteogenesis for alveolar ridge augmentation. The
technique involves freeing a bone segment (thetransport
segment) from the basal bone, but retaining attachment
via the lingual periosteum.[69] Gaggletal. have described
a simplified technique for alveolar ridge augmentation
using distraction implants, which do not require
subsequent removal. Studies have indicated that when
implants are well fixed in the distracted bone and basal
bone, they survive as long as implants in native bone
and also the vertical bone loss, if any, was similar to that
reported for implants placed in native bone. Although
failures of implants have been reported in implants
placed in distracted bone, most authors consider
implantation following distraction to be a highly effective
and useful technique.[70]
Procedural complications
The adjunctive procedures described above to augment
bone and deal with anatomical structures have their own
challenges. Bone grafting, osseodistraction and sinus lifts
are invasive procedures. In addition, they add complexity
and increase the number of surgical phases required for
implant therapy. They are also not without the possibility
of complications resulting from these procedures
themselves. Bone grafting, whether autogenous or
allogenous, carries with it a risk of complications that
include the harvesting procedure itself(for autogenous
grafts) and the possibility of graft infection, poor flap
closure, dehiscence and resorption of the graft. Esposito
etal. reviewed 10 randomized controlled clinical trials
on ridge augmentation published prior to January
2008 where treatment was reported on at least up
until the placement of abutments. They determined
from their review that ridge augmentation by major
autogenous bone grafting may be unjustifiable, and it
was also not clear if any specific technique for ridge
augmentation was superior to others.[71] Although high
and predictable success rates can be achieved with
alveolar ridge augmentation, onlay bone grafts were
found in one review to be associated with a 9.6% failure
rate of implants subsequently placed at these sites, and
alveolar ridge augmentation is considered to be a factor
in possible longterm failure of implants.[72,73] GBR using
membranes and autogenous bone grafting is much
less commonly performed in these situations and has
also been found to result in complicationsincluding
exposure of the membrane and wound dehiscencein
up to 45% of cases.[74,75]
Although high successs rates have been reported for
implants placed in the augmented sinus, clinicians have
experienced various complications, including perforation
of the sinus membrane, excessive bleeding, hematoma,
swelling, maxillary cyst, infection of the grafted sinuses,
development of an oroantral fistula, infraorbital nerve
laceration and failure of the bone formation during and
Journal of Dental Implants | Jan - Jun 2013 | Vol 3 | Issue 1 39
after sinus augmentation.postoperative acute maxillary
sinusitis may cause implant and graft failures. The
reported cases of maxillary sinusitis developed after
the lift procedure are all associated with the external
techniques. On the contrary, internal procedure appears
to be a safer method with rare complications.[76]
The reported complications associated with zygomatic
implants include postoperative sinusitis, oroantral fistula
formation, periorbital and subconjunctival hematoma
or edema, lip lacerations, pain, facial edema, temporary
paresthesia, epistaxis, gingival inflammation, and orbital
penetration/injury. Postoperative concerns regarding
difficulty with speech articulation and hygiene caused
by the palatal emergence of the zygomatic implant and
its effect on the prosthesis suprastructure have been
reported.[77]
CONCLUSION
The reconstruction of edentulous, atrophic jaws according
to functional and esthetic factors not only restores
chewing function, but leads topositive psychosocial
effects and thus also improves the patients quality of life.
Appropriate treatment planning is crucial and various
factors need to be considered before placing implants in
atrophic alveolar bone. Important aspects that need to be
considered for implant placement in posterior atrophic
maxilla are discussed in this article and both surgical and
nonsurgical options are suggested. There is no consensus
as to which treatment modality is superior to the other
in literature. The decision to opt for either of the options,
therefore, depends upon patient factors, and ultimately,
the expertise and skill of the clinician.
REFERENCES
1. McGrathC, BediR. Severe tooth loss among UK adultswho
goes for oral rehabilitation? J Oral Rehabil. 2002;29:2404.
2. AdellR, ErikssonB, LekholmU, BranemarkPI, JemtT. Longterm
followup study of osseointegrated implants in the treatment
of totally edentulous jaws. Int J Oral Maxillofac Implants
1990;5:347.
3. ChiapascoM, BrusatiR, RonchiP. LeFort I osteotomy with
interpositional bone grafts and delayed oral implants for the
rehabilitation of extremely atrophied maxillae: A19year
clinical followup study on humans. Clin Oral Implants Res.
2007:18:7485.
4. RaghoebarGM, TimmengaNM, ReintsemaH, StegengaB,
VissinkA. Maxillary bone grafting for insertion of endosseous
implants: Results after 12124months. Clin Oral Implants
Res.2001;12:27986.
5. AgliardiE, PanigattiS, ClericoM, VillaC, MaloP. Immediate
rehabilitation of the edentulous jaws with full fixed prostheses
supported by four implants: Interim results of a single cohort
prospective study. Clin Oral Implants Res 2010;21:45965.
6. RosenA, GyntherG. Implant treatment without bone grafting in
edentulous severely resorbed maxillas: Alongterm followup
study. JOral Maxillofac Surg 2007:65:10106.
[Downloaded free from http://www.jdionline.org on Sunday, June 4, 2017, IP: 115.99.113.90]
Prithviraj, etal.: Rehabilitation of atrophic maxilla
7. SorniM, GuarinosJ, PenarrochaM.Implants in anatomical
buttresses of the upper jaw. Med Oral Patol Oral Cir Bucal
2005;10:1638.
8. TulasneJF. Implant treatment of missing posterior dentition.
In: AlbrektssonT, ZarbGA. The Branemark Osseointegrated
Implant. Chicago: Quintessence; 1989. p.10315.
9. KrekmanovL, RangertB. Tilting of posterior implants for additional
support of bridge base. Report of the 13thInternational Conference
on Oral and Maxillofacial Surgery, October 2024, 1997, Kyoto,
Japan. Int J Oral Maxillofac Implants 1997;39.
10. KrekmanovL. Placement of posterior mandibular and maxillary
implants in patients with severe bone deficiency: Aclinical report
of procedure. Int J Oral Maxillofac Implants 2000:15:72230.
11. AparicioC, PeralesP, RangertB. Tilted implants as an alternative
to maxillary sinus grafting: Aclinical, radiologic, and periotest
study. Clin Implant Dent Relat Res 2001;3:3949.
12. Stella JP, Warner MR. Sinus slot technique for simplification
and improved orientation of zygomaticus dental implants:
Atechnical note. Int J Oral Maxillofac Implants 2000:15:88993.
13. Balshi TJ, Wolfinger GJ. Treatment of congenital ectodermal
dysplasia with zygomatic implants: Acase report.Int J Oral
Maxillofac Implants 2002:17;27781.
14. DavoR, MalevezC, RojasJ, RodriguezJ, RegolfJ. Clinical
outcome of 42patients treated with 81 immediately loaded
zygomatic implants: A12to 42month retrospective study. Eur
J Oral Implantol 2008;1:14150.
15. DuarteL, FilhoH, FrancischoneC, PeredoL, BranemarkP. The
establishment of a protocol for the total rehabilitation of atrophic
maxillae employing four zygomatic fixtures in an immediate
loading system: A30month clinical and radiographic followup.
Clin Implant Dent Relat Res 2007;9:18696.
16. MaloP, de AraujoM, LopesI. Anew approach to rehabilitate
the severely atrophic maxilla using extramaxillary anchored
implants in immediate function: A pilot study. JProsthet Dent
2008;100:35466.
17. StievenartM, MalevezC. Rehabilitation of totally atrophied
maxilla by means of four zygomatic implants and fixed
prosthesis: A 6-40month followup. Int J Oral Maxillofac Surg
2010;39:35863.
18. WorthingtonP, BranemarkPI. Osseointegration in skeletal
reconstruction and joint replacement. Advanced osseointegration
surgery, applications in the maxillofacial region. Chicago:
Quintessence Publishing Co; 1992. p.1828.
19. VenturelliA. Amodified surgical protocol for placing implant in the
maxillary tuberosity: Clinical results at 36months after loading with
fixed partial denture. Int J Oral Maxillofac Implants 1996;11:7439.
20. BalshiTJ, WolfingerGJ, BalshiSF. Analysis of 356 pterygomaxillary
implants in edentulous arches for fixed prothesis anchorage. Int
J Oral Maxillofac Implants 1999;14:398406.
21. BalshiTJ. Single tuberosityosseintegrated implant support
for a tissueintegrated prosthesis. Int J Periodont Rest Dent
1992;12:34557.
22. Fernadez ValeronJ, Fernandez VelazquezJ. Placement of
screwtype implants in the pterygomaxillarypyramidal region:
Surgical procedure and preliminary results. Int Oral Maxillofac
Implants 1997;12:8149.
23. AnituaE, OriveG, AguirreJJ, AndiaI. Five year clinical
evaluation of short dental implants placed in posterior areas:
Aretrospective study. JPeriodontol 2008:79:428.
24. RavivE, TurcotteA, HarelRavivM. Short dental implants in
reduced alveolar bone height. Quintessence Int 2010:41:5759.
25. ArlinML. Short dental implants as a treatment option: Results
from an observational study in a single private practice. Int J
Oral Maxillofac Implants 2006:21:76976.
40 Journal of Dental Implants | Jan - Jun 2013 | Vol 3 | Issue 1
26. CecchinatoD, OlssonC, LindheJ. Submerged or nonsubmerged
healing of endosseous implants to be used in the rehabilitation
of partially dentate patients. JClin Periodontol 2004;31:299308.
27. StevelingH, RoosJ, RasmussonL. Maxillary implants loaded at
3months after insertion: Results with Astra Tech implants after
up to 5years. Clin Impl Dent Rel Res 2001;3:1204.
28. Van SteenbergheD, De MarsG, QuirynenM, JacobsR,
NaertI. Aprospective splitmouth comparative study of two
screwshaped selftapping pure titanium implant systems. Clin
Oral Implants Res 2000;11:2029.
29. WarrenP, ChaffeeN, FeltonDA, CooperLF. Aretrospective
radiographic analysis of bone loss following placement of TiO2
gritblasted implants in the posterior maxilla and mandible. Int
J Oral Maxillofac Implants 2002;17:399404.
30. EllegaardB, KolsenPetersenJ, BaelumV. Implant therapy
involving maxillary sinus lift in periodontally compromised
patients. Clin Oral Implants Res 1997;8:30515.
31. RokniS, TodescanR, WatsonP, PharoahM, AdegbemboAO,
DeporterD. An assessment of crowntoroot ratios with short
sintered poroussurfaced implants supporting prostheses in partially
edentulous patients. Int J Oral Maxillofac Implants 2005;20:6976.
32. FugazzottoPA, BeagleJR, GanelesJ, JaffinR, VlassisJ, KumarA.
Success and failure rates of 9mm or shorter implants in the
replacement of missing maxillary molars when restored with
individual crowns: Preliminary results 0 to 84months in
function. Aretrospective study. JPeriodontol 2004;75:32732.
33. RenouardF, NisandD. Short implants in the severely resorbed
maxilla: A2year retrospective clinical study. Clin Implant Dent
Relat Res 2005;7:S10410.
34. BuserD, MericskeSternR, BernardJP, BehnekeA, BehnekeN,
HirtHP, etal. Longterm evaluation of nonsubmerged ITI implants.
Part1:8year life table analysis of a prospective multicenter study
with 2359 implants. Clin Oral Implants Res 1997;8:16172.
35. BrocardD, BarthetP, BaysseE, DuffortJF, EllerP, JustumusP,
etal. Amulticentre report on 1,022 consecutively placed ITI
implants: A7year longitudinal study. Int J Oral Maxillofac
Implants 2000;15:691700.
36. NedirR, BischofM, BriauxJM, BeyerS, SzmuklerMonclerS,
BernardJP. A7year life table analysis from a prospective
study on ITI implants with special emphasis on the use of short
implants. Results from a private practice. Clin Oral Implants Res
2004;15:1507.
37. MericskeSternR, GrutterL, RoschR, MericskeE. Clinical
evaluation and prosthetic complications of single tooth
replacements by nonsubmerged implants. Clin Oral Implants
Res 2001;12:30918.
38. LevineRA, ClemD, BeagleJ, GanelesJ, JohnsonP, SolnitG,
etal. Multicenter retrospective analysis of the solidscrew
ITI implant for posterior singletooth replacements. Int J Oral
Maxillofac Implants 2002;17:5506.
39. RomeoE, GhisolfiM, RozzaR, ChiapascoM, LopsD.
Short(8mm) dental implants in the rehabilitation of partial and
complete edentulism: A 3to 14year longitudinal study. Int J
Prosthodont 2006;19:58692.
40. GrantBT, PanckoFX, KrautRA. Outcomes of placing short
dental implants in the posterior mandible: A retrospective study
of 124cases. JOral Maxillofac Surg 2009;67:7137.
41. FugazzottoPA. Shorter implants in clinical practice: Rationale and
treatment results. Int J Oral Maxillofac Implants 2008;23:48796.
42. MischCE, DietshF. Autogenous bone grafts for endosteal
implantsindications and failures. Int J Oral Implantol
1991;8:1320.
43. Van SteenbergheD, LekholmU, BolenderC, FolmerT, HenryP,
HerrmannI, etal. Applicability of osseointegrated oral implants
[Downloaded free from http://www.jdionline.org on Sunday, June 4, 2017, IP: 115.99.113.90]
Prithviraj, etal.: Rehabilitation of atrophic maxilla
in the rehabilitation of partial edentulism: A prospective
multicenter study on 558 fixtures. Int J Oral Maxillofac Implants
1990; l5:27281.
44. MinskL, PolsonAM, WeisgoldA, RoseLF, SanaviF,
BaumgartenH, etal. Outcome failures of endosseous implants
from a clinical training center. Compend Contin Educ Dent
1996;17;84850,8524,856.
45. WangHL, AlShammariK. HVC ridge deficiency classification:
A therapeutically oriented classification. Int J Periodontics
Restorative Dent 2002;22:33543.
46. BoynePJ, JamesRA. Grafting of the maxillary sinus floor with
autogenous marrow and bone. JOral Surg 1980;38:6136.
47. Tatum H Jr. Maxillary and sinus implant reconstructions. Dent
Clin North Am 1986;30:20729.
48. WoodRM, MooreDL. Grafting of the maxillary sinus with
intraorally harvested autogenous bone prior to implant
placement. Int J Oral Maxillofac Implants 1988;3:20914.
49. Kent JN, Block MS. Simultaneous maxillary sinus floor bone
grafting and placement of hydroxylapatitecoated implants.
JOral Maxillofac Surg 1989;47:23842.
50. HirschJM, EricssonI. Maxillary sinus augmentation using
mandibular bone grafts and simultaneousinstallation of implants.
Asurgical technique. Clin Oral Implants Res 1991;2:916
51. TrisiP, RaoW. The bone growing chamber: Anew model to
investigate spontaneous and guided bone regeneration in human
artificial jaw bone defects. Int J Periodontics Restorative Dent
1998;18:1519.
52. SzaboG, SubZ, Hrabk K, Barabs J, Nmeth Z. Autogenous
bone versustricalcium phosphate graft alone for bilateral
sinus elevations(2and 3dimensional computed tomographic,
histologic, and histomorphometric evaluations): Preliminary
results. Int J Oral Maxillofac Implants 2001;16:68192.
53. MarxRE, CarlsonER, EichstaedtRM, SchimmeleSR, StraussJE,
GeorgeffKR. Plateletrich plasma: Growth factor enhancement
for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 1998;85:63846.
54. PoeschlPW, ZiyaGhazviniF, SchichoK, BuchtaC, MoserD,
SeemannR, etal. Application of plateletrich plasma for
enhanced bone regeneration in the grafted sinus. JOral
Maxillofac Surg 2012;70:65764.
55. HertenM, RothamelD, SchwarzF, FriesenK, KoeglerG, BeckerJ. 73. TonettiMS, Hmmerle CH. European Workshop on
Surfaceand nonsurfacedependent invitro effects of bone
substitutes on cell viability. Clin Oral Investig 2009;13:14955.
56. GutwaldR, HaberstrohJ, KuschnierzJ, KisterC, LysekDA,
MaglioneM, etal. Mesenchymal stem cells and inorganic
bovine bone mineral in sinus augmentation: Comparison with
augmentation by autologous bone in adult sheep. Br J Oral
Maxillofac Surg 2010;48:28590.
57. SchmittSC, WiedmannAlAhmadM, KuschnierzJ, AlAhmadA, 75. SimionM, FontanaF, RasperiniG, MaioranaC. Vertical ridge
HuebnerU, SchmelzeisenR, etal. Comparative invitro study
of the proliferation and growth of ovine osteoblastlike cells on
various alloplastic biomaterials manufactured for augmentation
and reconstruction of tissue or bone defects. JMater Sci Mater
Med 2008;19:144150.
58. GrayCF, RedpathTW, BaintonR, SmithFW. Magnetic
resonance imaging assessment of a sinus lift operation using
reoxidised cellulose(Surgicel) as graft material. Clin Oral
Implants Res 2001;12:52630.
59. LaiHC, ZhuangLF, LvXF, ZhangZY, ZhangYX, ZhangZY.
Osteotome sinus floor elevation with or without grafting:
Apreliminary clinical trial. Clin Oral Implants Res 2010;21:5206.
60. WallaceS, FroumS. Effect of maxillary sinus augmentation on
the survival of endosseous dental implants. Asystematic review.
Ann Periodontol 2003;8:328343.
Journal of Dental Implants | Jan - Jun 2013 | Vol 3 | Issue 1 41
61. SchwartzAradD, HerzbergR, DolevE. The prevalence of
surgical complications of the sinus graft procedure and their
impact on implant survival. JPeriodontol 2004;75:5116
62. FugazzottoPA, VlassisJ. Report of 1633 implants in 814
augmented sinus areas in function for up to 180months. Implant
Dent 2007;16:36978.
63. UlmCW, SolarP, KrennmairG, MatejkaM, WatzekG. Incidence
and suggested surgical management of septa in sinuslift
procedures. Int J Oral Maxillofac Implants 1995;10:4625.
64. NedirR, BischofM, VazquezL, NurdinN, SzmuklerMonclerS,
BernardJP. Osteotome sinus floor elevation technique without
grafting material: 3year results of aprospective pilot study. Clin
Oral Implants Res 2009;20:7017.
65. De SantisD, TrevisiolL, DAgostinoA, CucchiA, De GemmisA,
NociniPF. Guided bone regeneration with autogenous block
grafts applied to LeFort I osteotomy for treatment of severely
resorbed maxillae: A4to 6year prospective study. Clin Oral
Implants Res 2012;23:609.
66. CruzM, ReisCC, MattosFF. Implantinduced expansion of
atrophic ridges for the placement of implants. JProsthet Dent
2001;85:37781.
67. StetzerK, CooperG, GassnerR, KapucuR, MundellR,
MooneyMP. Effects of fixation type and guided tissue
regeneration on maxillary osteotomy healing in rabbits. JOral
Maxillofac Surg 2002;60:42736.
68. IlizarovGA. Clinical application of the tensionstress effect for
limb lengthening. Clin Orthop Relat Res 1990;250:826.
69. ChinM, TothBA. Distraction osteogenesis in maxillofacial
surgery using internal devices: Review of five cases. J Oral
Maxillofac Surg 1996;54:4553.
70. SaulacicN, GandaraVilaP, SomozaMartn M, GarciaGarciaA.
Distraction osteogenesis of the alveolar ridge: Areview of the
literature. Med Oral 2004;9:3217.
71. EspositoM, GrusovinMG, KwanS, WorthingtonHV,
CoulthardP. Interventions for replacing missing teeth: Bone
augmentation techniques for dental implant treatment. Cochrane
Database Syst Rev 2008;3:CD003607.
72. AghalooTL, MoyPK. Which hard tissue augmentation techniques
are the most successful in furnishing bony support for implant
placement? Int J Oral Maxillofac Implants 2007;22:4970.
Periodontology GroupC. Advances in bone augmentation
to enable dental implant placement: Consensus Report of the
Sixth European Workshop on Periodontology. JClin Periodontol
2008;35:16872.
74. RocchiettaI, FontanaF, SimionM. Clinical outcomes of vertical
bone augmentation to enable dental implant placement:
Asystematic review. JClin Periodontol 2008Sep; 35:20315.
augmentation by expandedpolytetrafluoroethylene membrane
and a combination of intraoral autogenous bone graft and
deproteinized anorganic bovine bone(BioOss). Clin Oral
Implants Res 2007;18:6209.
76. AlkanA, CelebiN, Ba B. Acute maxillary sinusitis associated
with internal sinus lifting: Report of a case. Eur J Dent
2008;2:6972.
77. BlockMS, HaggertyCJ, FisherGR. Nongrafting implant options
for restoration of the edentulous maxilla. JOral Maxillofac Surg
2009;67:87281.
How to cite this article: Prithviraj DR, Vashisht R, Bhalla HK, Prithvi S,
Suresh P, Sharma D. A review of management options for rehabilitation of
posterior atrophic maxilla with implants. J Dent Implant 2013;3:35-41.
Source of Support: Nil, Conflict of Interest: None.