Comprehensive Overview of Graftless Methods for Prosthodontic Management of Edentulous Patients: A Review

Abstract

Implant treatment in severely resorbed and atrophic jaws is difficult due to anatomical and mechanical challenges. Because of its complexity, the maxillary sinus floor augmentation procedure is still not a very regular practice among clinicians and requires skills and precise manoeuvrability. The conventional approaches include All-on-four, Columbus bridge protocol and Co-Axis implant while the non-conventional approaches include Zygomatic and Pterygoid implants. In this study, a combination of tilted and axial implants was used in patients with severely resorbed posterior maxilla as an alternative to sinus floor augmentation. Prosthetic rehabilitation of the edentulous maxilla in­cludes the placement of tilted implants as a relatively recent option. The advantages of tilted implants are: (a) avoidance of the use of bone grafts and sinus lift procedures - with the resulting reduction in complexity; (b) improved primary stability by anchoring in more than one cortical layer; (c) the avoidance of cantilever extremities by placing the implants more distal and with better load distribu­tion over the dental arch; and (d) the use of longer implants, thereby increasing the con­tact surface. Results indicate that the use of tilted implants is an effective and safe alternative to maxillary sinus floor augmentation procedures where grafting is done.