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

Description

This book covers the most suitable techniques for the rehabilitation of patients experiencing tooth loss, trauma or other situations resulting in bone atrophy. The book discusses current technologies, from diagnosis to treatment and surgery, applied to atrophic jaws using innovative tools and new PSI (patient specific implant) approaches. Oral Rehabilitation of the Atrophic Maxilla and the selection of the best treatment options for patients is one of the most difficult tasks facing the profession today. Readers will be able to solve complex problems and evaluate all available applications for patient management. Zygomatic implants, reconstructive surgery with bone grafts, post-oncologicasl and post traumatic reconstructions as well as dynamic navigation and robot assisted dental surgery are covered. The book is written by recognized experts and leaders in the field, and includes simpler techniques within the reach of many implantologists and more complex techniques that require specific surgical skills. It is relevant for, implanologist, periodontists, oral and maxillofacial surgeon, prosthodontists and every clinician treating maxillary atrophy. 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