Implants and Oral Rehabilitation of the Atrophic Maxilla: Advanced Techniques and Technologies

Acknowledgements
Contents
About the Contributors
Part I: Theory and Rational Bases
1: General Considerations on the Surgical Techniques in the Treatment of the Atrophic Maxilla
1.1 Introduction
1.2 The Impact of Edentulism on the Quality of Life
1.3 Techniques and Technologies for Implant Rehabilitation
1.4 Indications of Treatment Techniques Based on the Degree and Location of Bone Atrophy
1.5 Reasons for This Book
References
2: Surgical Anatomy of the Atrophic Maxilla
2.1 Introduction
2.1.1 Cone-Beam Computed Tomography (CBCT): The Second Level of Image-Guided Diagnosis
2.2 The Physiopathology of Edentulism
2.3 The Anatomical and Radiological Aspects of the Edentulous Maxilla
2.3.1 Premaxilla
2.3.2 Midmaxilla
2.3.2.1 Surgical Anatomy of the Midmaxilla
2.3.2.2 Iuxtameatal Implants
2.3.3 Posterior Maxilla
2.3.3.1 Radiological Landmarks
2.3.3.2 Implants in the Pterygoid Region, Radiological Diagnosis and Planning
References
3: Integrating Modern Diagnostic Tools with Digital Engineering
3.1 Introduction to Applied Digital Technologies
3.1.1 Medical Imaging
3.1.1.1 Short Basics of CT and CBCT Technology
Computed Tomography (CT)
Cone-Beam Computed Tomography (CBCT)
3.1.1.2 Radiation Dose
3.1.1.3 Generic Imaging Protocols
3.1.1.4 Accuracy of 2D and 3D Measurements
3.1.1.5 Image-Based Classification of Bone Quality
3.1.1.6 Digital Imaging and Communications in Medicine (DICOM)
3.1.2 Computer-Aided Design (CAD)
3.1.3 Finite Element Analysis (FEA)
3.1.4 Additive Manufacturing
3.2 The Method of Concurrent Anatomical Engineering
3.2.1 Image Acquisition
3.2.2 Image Processing
3.2.3 Interfacing CAD, FEA, and AM
3.3 Potential of Digital Engineering in Clinical Practice
References
4: Surgical Planning Softwares and Computer Guided Implantology
4.1 The Importance of 3-D Diagnosis and Treatment Planning in the Atrophic Maxilla
4.2 Bone Grafting Surgical Protocols Using Three-Dimensional Technologies
4.2.1 Ganz–Rinaldi Sinus Augmentation Lateral Approach Protocol
4.2.1.1 Special Cases
4.2.1.2 Post-operative Use
4.2.2 Ganz–Rinaldi Protocol for Bone Harvesting from Mandibular Symphysis or Body Ramus
4.2.3 Ganz–Rinaldi Reconstructive Surgery Protocol
4.2.4 Ganz–Rinaldi Zygomatic implants Protocol
4.2.4.1 Introduction
4.3 Ganz–Rinaldi Bone Grafting Surgical Protocols Using Three-Dimension Technologies
4.3.1 Clinical Innovation: Lateral Sinus Lift Surgical Guide—Digital Workflow
4.3.1.1 Summary
4.3.2 Clinical Innovation: Ramus Harvest Guide—Digital Workflow
4.3.2.1 Summary
4.4 Conclusion
References
5: Dynamic Navigation Systems for the Rehabilitation of the Atrophic Maxillae
5.1 Introduction and Historical Background of Guided Surgery
5.2 An Overview of Dynamic Navigation
5.3 Dynamic Navigation Workflow(s) and Key Concepts
5.3.1 Workflow: Stent, Scan, Plan, and Place
5.3.1.1 Stent and Scan
5.3.2 Workflow Improvements: The Trace Registration (TR) Protocol
5.3.2.1 Plan
5.3.2.2 Trace
5.3.2.3 Place
5.3.3 Full-Arch Implant Prosthetic Treatment Workflow
5.3.3.1 Workflow for Transitioning the Terminal Natural Dentition to an Implant-Supported Full-Arch Prosthesis
5.3.3.2 Use of a Mini Implant
5.3.3.3 Use of Mini Screws
5.3.4 Potential Sources of Guidance Errors
5.4 Discussion
5.5 Pterygoid Implants for Totally Edentulous Patients
5.6 Conclusions
References
6: Robotics for Implant Reconstruction of the Edentulous Maxilla
6.1 An Overview of Robotic Surgery
6.2 Computer-Guided Surgery Options for Implant Placement in the Edentulous Maxilla
6.3 Workflow of Robotic Surgery for the Edentulous Maxilla
6.4 Extramaxillary Applications in Robotic Surgery
References
7: Tilted Implants
7.1 Introduction and a Brief History of the Development of the Malo Protocol
7.1.1 1990: Establishment of the Immediate Load Protocol
7.1.2 1993: The First Case of the All-on-4 Standard Mandible
7.1.3 1996: The First AO4 Standard Maxilla
7.1.4 2004: Beginning of the Development of the All-on-4 Hybrid and Double Zygoma
7.1.5 2005: Adaptation of the All-on-4 Concept to Guided Surgery
7.2 Malo Classification of the Edentulous Maxilla
7.3 The Biomechanics of AO4
7.4 The Malo Protocol—AO4: Rehabilitation for the Edentulous Maxilla
7.5 The Malo Bridge
7.6 Maintenance
References
8: Short® Implants and TRINIA® Full-Arch Prostheses for the Rehabilitation of the Atrophic Maxilla
8.1 Introduction to Implant Reconstructions in the Edentulous Maxilla: Current Status and Materials Perspective
8.2 Introduction to SHORT® Tapered Implants
8.2.1 Atrophic Maxilla: Introduction
8.2.2 Materials and Methods
8.2.3 Patient Group with Four Implants
8.2.4 Results
8.2.5 Case Reports
8.2.5.1 “All on Four” with Full-Arch TRINIA® Prosthesis
Front and Premolar Region Implants
8.2.6 Patient Group with Three Implants
8.2.7 Results
8.2.8 Case Reports
8.2.8.1 “All on Three” with Full-Arch TRINIA® Prosthesis
Nasopalatine and Premolar Region Implants
8.2.9 Patient Group with One Implant
8.2.10 Results
8.2.11 Case Report
8.2.11.1 “All on One” with Nasopalatine Implant and Full-Arch TRINIA® Prosthesis
8.2.11.2 Minimal Crestal Widening and Spreading After Epiperiosteal Preparation in the Premolar Region
8.2.11.3 Tuber Implants
8.3 Discussion
8.4 Conclusion of the Three Study Groups
References
9: Bone Grafting
9.1 Introduction
9.2 Graft Types
9.2.1 Autologous Bone Donor Sites
9.2.2 Bone Grafts Cellular Healing
9.2.3 Morphological Structure of Donor Sites
9.3 Bone Grafts from the Iliac Crest
9.3.1 Background
9.3.2 Anatomic Evaluation
9.3.3 Pharmacological Aspects
9.3.4 Surgical Techniques
9.3.5 Iliac Crest Surgical Harvesting Techniques
9.3.6 Surgical Procedures for Grafting in the Upper Maxilla
9.3.6.1 Sinus Lift with Iliac Crest Graft
9.3.6.2 Onlay Blocks
9.3.6.3 Titanium Mesh
9.3.6.4 Interpositional Blocks (Inlay Technique)
9.3.7 Complications
9.3.7.1 Harvesting Issues
9.3.7.2 Graft Positioning Issues
9.3.8 Discussion
9.4 Bone Grafts from the Mandible
9.4.1 Background
9.4.1.1 Osteoconduction
9.4.2 Anatomic Evaluation
9.4.3 Pharmacological Aspects
9.4.4 Surgical Technique
9.4.4.1 Graft Harvesting
9.4.4.2 Mandibular Branch
9.4.4.3 Chin Symphysis
9.4.4.4 Edentulous Mandibular Areas
9.4.5 Graft Positioning
9.4.6 Surgical Procedures for Grafting in the Upper Maxillae
9.4.7 Complications
9.4.8 Discussion
9.5 Bone Grafts from the Calvaria
9.5.1 Background
9.5.2 Anatomic Evaluation
9.5.3 Pharmacological Aspects
9.5.4 Surgical Technique
9.5.4.1 Graft Harvesting
9.5.5 Graft Positioning
9.5.6 Complications
9.5.7 Augmentation Methods
9.5.8 Discussion
References
10: Post-oncological and Post-traumatic Maxillary Reconstruction
10.1 Introduction
10.2 Diagnostics
10.3 Clinical Case I (Surgery by Rolf Ewers and Clemens Klug): Point-to-Point Navigation-Assisted Repositioning of the Zygoma by Means of Pre-bent Osteosynthesis Plates
10.3.1 Preoperative Planning
10.3.2 Surgical Procedure
10.4 Clinical Case II (Surgery by Arnulf Baumann): An Orbito-Zygomatico-Maxillary Complex (OZMC) Fracture Is Corrected by Using a Combination of Titanium Mesh and Synthetic Material, Accompanied by Intraoperative Navigation
10.4.1 Preoperative Planning
10.4.2 Surgical Procedure
10.5 Clinical Case III (Surgery by Franz Watzinger): Correction of Midfacial Deformity (Hypoplasia) by Means of Individualized Polyether-Ether-Ketone (PEEK) Implants
10.5.1 Preoperative Planning
10.5.2 Surgical Procedure
10.6 Clinical Case IV (Surgery by Emeka Nkenke): Maxillary Reconstruction with Prefabricated Vascularized Free Fibula Flap with Dental Implants Already Inserted Before Harvesting the Flap
10.6.1 Preoperative Planning
10.6.2 Surgical Procedure
10.7 Discussion
References
11: Zygomatic Implants. The ZAGA Concept
11.1 Indications
11.2 Technique Evolution
11.2.1 PI Brånemark Original Technique
11.2.2 The Slot Technique
11.2.3 The Extra-Sinus, Exteriorized, and Extra-Maxillary Approach
11.2.4 The Zygoma Anatomy-Guided Approach (ZAGA)
11.3 The ZAGA Concept
11.3.1 The ZAGA Classification
11.3.2 The ZAGA Zones
11.3.3 The ZAGA Concept
11.3.3.1 The ZAGA “Tunnel Osteotomy” for a Round Implant Design
11.3.3.2 The “ZAGA Channel Osteotomy” and Flat Implant Design
11.4 The ZAGA Flat and ZAGA Round Zygomatic Implants: The Story of a Breakthrough
11.4.1 The Clinical Pain Points to Solve
11.4.2 ZAGA and Adapted Implant Design
11.4.3 A Design Becoming a Reality
11.5 ORIS Criteria to Evaluate Zygomatic Implant Rehabilitation
11.6 The use of ZAGA Concept and the New Zygomatic Implant Designs on the Extremely Atrophied Maxilla
11.7 Zygomatic Implant Network: www.zagacenters.com
11.7.1 What Is the Goal of the ZAGA Center Network?
11.7.2 Benefits and Responsibilities Associated with the ZAGA Network
11.7.3 Educational Programs
11.8 Conclusions
References
12: Additively Manufactured Subperiosteal Jaw Implant (AMSJI)
12.1 Introduction: Subperiosteal Implants and the AMSJI Concept
12.1.1 Introduction
12.1.2 Macroscopic, Morphological, and Structural Characteristics of the AMSJI
12.1.3 Microscopic Surface Characteristics of the AMSJI
12.1.4 Structural and Biomechanical Characteristics of the AMSJI
12.2 Surgical and Prosthetic Procedures
12.2.1 Scan Prosthesis
12.2.2 Surgical Technique
12.2.2.1 Instrumentation
12.2.2.2 Flap Incision and Dissection
12.2.2.3 Exposure of Maxillary Bone and Implant Placement
12.2.2.4 Connect the Interim Superstructure
12.2.2.5 Screw Fixation of the AMSJI
12.2.2.6 Suture of the Flaps
12.2.2.7 Assembly of the Temporary Prosthetic Structure
12.2.2.8 Final Prosthetic Structure
12.2.2.9 Double Structure
12.2.2.10 Aftercare (from AMSJI® Manual 2019)
12.3 Resection Guides for AMSJI: VOG and HOG
12.4 Consensus Online Meeting Report, Gent, September 14, 2020
12.4.1 Introduction
12.4.2 Number of Screw Holes per Wing
12.4.3 Different Types/Brands of Osteosynthesis Screws
12.4.4 Space Between the Arms and Loop Crossing the Maxillary Crest
12.4.5 Position of the Buccal Horizontal Part of the Main Frame and Configuration of the Screw Holes in the Posterior Wing
12.4.6 Shape of the Posts
12.4.7 Retention of the Temporary Restoration
12.4.8 Prevention and Management of Local Infection
12.4.8.1 Preoperative Prophylactic Antibacterial Protocol
12.4.8.2 Post-operative Prophylactic Antibacterial Protocol
12.4.8.3 Treatment of Dental Peri-Implant Mucositis
12.4.8.4 Treatment of Chronic Periodontitis and Dental Peri-Implantitis
12.4.8.5 Treatment of Infected Orthopedic and Craniofacial Implants
12.4.9 Buccal Recessions and Gingival Biotype
12.4.10 Vertical and Horizontal Ostectomy Guides
12.4.11 Biomechanical Evaluation Using Finite Element Analysis
12.4.12 A Simplified Temporary and Definitive Suprastructure for Acrylic Coverage
References
Part II: Clinical Cases and Surgical Techniques
1.1 Introduction
13: Clinical Case No. 1: Computer Aided Implantology, Tilted Implants
13.1 Medical and Clinical Picture
13.2 Preoperative Considerations
13.3 Surgical Procedures
13.4 Postoperative Considerations
14: Clinical Case No. 2: Full Arch Guided Surgery - Immediate Load
14.1 Medical and Clinical Picture
14.2 Preoperative Considerations
14.3 Surgical Procedures
14.4 Postoperative Considerations
15: Clinical Case No. 3: All-on-4
15.1 Medical and Clinical Picture
15.2 Preoperative Considerations
15.3 Surgical Procedures
15.4 Postoperative Considerations
16: Clinical Case No. 4: All-on-4
16.1 Medical and Clinical Pictures
16.2 Preoperative Considerations
16.3 Surgical Procedures
16.4 Postoperative Considerations
17: Clinical Case No. 5: All-on-4, Immediate Loading
17.1 Medical and Clinical Picture
17.2 Preoperative Considerations
17.3 Surgical Procedures
17.4 Postoperative Considerations
18: Clinical Case No. 6: Dynamic Navigation, Pterygoid Implants
18.1 Medical and Clinical Pictures
18.2 Preoperative Considerations
18.3 Surgical Procedures
18.4 Postoperative Considerations
19: Clinical Case No. 7: Robotic Surgery, Immediate Loading
19.1 Medical and Clinical Picture
19.2 Preoperative Considerations
19.3 Surgical Procedures
19.4 Postoperative Considerations
References
20: Clinical Case No. 8: Robotic Surgery, Full Arch
20.1 Introduction
20.2 Medical and Clinical Picture
20.3 Preoperative Considerations
20.4 Surgical Procedures
20.5 Postoperative Considerations
References
21: Clinical Case No. 9: Extra Short Implants, Immediate Loading
21.1 Medical and Clinical Picture
21.2 Preoperative Considerations
21.3 Surgical Procedures
21.4 Prosthetic Procedures
21.5 Postoperative Considerations
22: Clinical Case No. 10: Tilted Implants, Iuxtameatal Implants, Immediate Loading
22.1 Preoperative Considerations
22.2 Surgical Procedures
22.3 Postoperative Considerations
22.3.1 Prosthetic Phase
23: Clinical Case No. 11: Zygomatic Implants, Immediate Function
23.1 Medical and Clinical Considerations
23.2 Preoperative Considerations
23.3 Surgical Procedures
23.4 Postoperative Considerations
24: Clinical Case No. 12: Zygomatic Implants, Computer Guided Approach
24.1 Medical and Clinical Picture
24.2 Preoperative Considerations
24.3 Surgical Procedures
24.4 Postoperative Considerations
25: Clinical Case No. 13: Dynamic Navigation, Pterygoid Implants
25.1 Medical and Clinical Picture
25.2 Preoperative Considerations
25.3 Surgical Procedures
25.4 Postoperative Considerations
26: Clinical Case No. 14: Zygomatic Implants in Cleft Palate Patient
26.1 Medical and Clinical Picture
26.2 Preoperative Considerations
26.3 Surgical Procedures
26.4 Postoperative Considerations
References
27: Clinical Case No. 15: Zygomatic Robotic Implant Surgery
27.1 Medical and Clinical Picture
27.2 Preoperative Considerations
27.3 Surgical Procedures
27.4 Postoperative Considerations
References
28: Clinical Case No. 16: Double Zygoma, Zaga Flat
28.1 Medical and Clinical Picture Resume
28.2 Preoperative Considerations
28.3 Surgical Procedures
28.3.1 Right Side
28.3.2 Left Side
28.4 Postoperative Considerations
29: Clinical Case N° 17: Zygoma Quad, Zaga 4
29.1 Medical and Clinical Picture Resume
29.2 Preoperative Considerations
29.3 Surgical Procedures
29.4 Postoperative Considerations
30: Clinical Case N° 18: Zygoma Quad, Dynamic Navigation
30.1 Medical and Clinical Picture
30.2 Preoperative Considerations
30.3 Surgical Procedures
30.4 Postoperative Considerations
31: Clinical Case N° 19: Short Implants, Incisal Foramen, Trio-Trinia
31.1 Medical and Clinical Picture
31.2 Preoperative Considerations
31.3 Surgical Procedures
31.4 Possible Pitfalls and Complications
31.5 Postoperative Considerations and Conclusion
References
32: Clinical Case N° 20: Short Implants, Trio-Trinia
32.1 Medical and Clinical Picture
32.2 Preoperative Considerations
32.3 Surgical Procedures
32.4 Postoperative Considerations
33: Clinical Case N° 21: Bone Grafting, Sinus Augmentation, Reconstructive Surgery
33.1 Medical and Clinical Picture
33.2 Preoperative Considerations
33.3 First Intervention
33.3.1 Surgical Procedures
33.4 Second Intervention
33.4.1 Preoperative Considerations
33.5 Surgical Procedures
33.6 Third Intervention
33.6.1 Preoperative Considerations and Surgical Procedures
33.7 Final Prosthesis
34: Clinical Case No. 22 Zygoma Quad, Computer Guided Implantology
34.1 Medical and Clinical Picture
34.2 Preoperative Considerations
34.3 Surgical Procedures
34.4 Postoperative Considerations
35: Clinical Case No. 23: Hemimaxillectomy, Zygomatic Implant, Computer Guided Approach
35.1 Preliminary Remarks
35.2 Medical and Clinical Pictures
35.3 Preoperative Considerations
35.4 Surgical Procedures
35.5 Postoperative Considerations
36: Clinical Case No. 24: AMSJI, Patient Specific Implants, Subperiosteal Implant
36.1 Medical and Clinical Picture
36.2 Preoperative Considerations
36.3 Surgical Procedures
36.4 Postoperative Considerations
37: Clinical Case No. 25: AMSJI, Patient Specific Implants, Subperiosteal Implant
37.1 Medical and Clinical Picture
37.2 Preoperative Considerations
37.3 Surgical Procedures
37.4 Postoperative Considerations
38: Clinical Case No. 26: AMSJI, Patient Specific Implants, Cutting Guide VOG and HOG
38.1 Medical and Clinical Picture
38.2 Preoperative Considerations
38.3 Surgical Procedures
38.4 Postoperative Considerations
39: Clinical Case No. 27: AMSJI, Patient Specific Implants, Cutting Guide VOG and HOG
39.1 Medical and Clinical Picture
39.2 Preoperative Considerations
39.3 Surgical Procedures
39.4 Postoperative Considerations
40: Clinical Case No. 28: AMSJI, Temporomandibular Joint Prosthesis, Patient Specific Implants
40.1 Medical and Clinical Picture
40.2 Preoperative Considerations
40.3 Surgical Procedures
40.4 Postoperative Considerations