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Short Implants : A Viable Treatment Option in the “ Anatomically Challenged ” Patient
| Content Provider | Semantic Scholar |
|---|---|
| Author | Toffler, Michael |
| Copyright Year | 2008 |
| Abstract | Patients with fully or partially edentulous alveolar ridges comprised of markedly reduced bone volume must accept the higher risk of complication, extended treatment duration, and heavier financial burden associated with their implant-supported rehabilitation.1 The clinical challenge is exacerbated by postextraction ridge resorption and increased pneumatization of the maxillary sinus often creating proximity to both the inferior alveolar nerve and antral floor. This reduced residual bone volume frequently prohibits the placement of implants 10 mm in length or longer without invoking ridge augmentation,2,3 sinus floor elevation,4-6 alveolar osseosdistraction,7 or nerve transpositioning8 procedures. As a less invasive alternative, the placement of short implants (9 mm or less) often minimizes or obviates the need for more extensive surgery, reducing treatment duration, morbidity, and associated costs. In this article, five cases are presented that clearly demonstrate the clinical and practical benefits of using short implants in the atrophic alveolus. In the deficient posterior maxilla, a variety of sinus floor elevation techniques have been successfully implemented using different graft materials in a delayed or simultaneous approach to implant placement.4-6,9-14 The lateral window osteotomy is the most commonly used and reported technique for sinus augmentation,5,6,9-11 but it does have some disadvantages including increased cost, increased morbidity, risk of serious infection, and delayed healing times.15 As a less invasive alternative, osteotome techniques1,6,1214,16 can obtain a localized elevation of the sinus floor through a 3-mm to 6-mm diameter crestal osteotomy, minimizing the degree of flap elevation and thus eliminating the need for preparation of a larger bony window in the lateral aspect of the alveolus.An osteotome-mediated approach offers the advantages of a more conservative surgical entry, more localized augmentation of the sinus, a lesser degree of postoperative morbidity, and an ability to load the implants in a shorter time period.17 When there is adequate subantral bone for primary stabilization of implants, osteotome-mediated sinus floor elevation (OMSFE) procedures procure 2 mm to 7 mm of localized sinus floor elevation, usually permitting the simultaneous placement of implants 10 mm in length.18-21 Studies by Toffler18 and Rosen et al19 found a significantly reduced survival rate of 73.3% and 85.7%, respectively, when the residual subantral bone height (RSBH) was 4 mm or less. Based on these studies, it would seem that in the more severely resorbed posterior maxilla (< 5 mm RSBH), minimally invasive OMSFE with simultaneous implant placement is not the treatment of choice and a staged approach using a lateral window technique9-11 or crestal core approach6,13,14,16 would be preferred. However, the recently reported success with short implants with a variety of roughened surfaces22-28 may transcend these boundaries, requiring less RSBH as well as minimal sinus floor elevation to achieve successful long-term results. Similarly, the inherent risk of nerve lateralization8 and the extreme challenge of vertical ridge augmentation2,3,7,29 may be avoided by using short implants in the atrophic posterior mandible. The following case reports clearly demonstrate the clinical and practical benefits of using short implants in the deficient alveolus where the residual bone volume is significantly diminished, resulting in proximity to the nasal floor, sinus floor, or inferior alveolar nerve (IAN). |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://www.michaeltoffler.com/wp-content/uploads/2009/01/shortimplants.pdf |
| Alternate Webpage(s) | http://www.practicalreviews.com/My_Media/PDF/Cosmetic%20Dentistry,%20July%2030%202009.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
