Trans-crestal dental implants in the rehabilitation of a severely atrophic maxilla: A retrospective case series.

Enrico Luigi Agliardi, Davide Romeo, Stefano Panigatti, Bianca D'Orto, Jacopo Agliardi, Enrico Gherlone, Massimo Del Fabbro
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Abstract

Purpose: To evaluate the mid-term clinical and radiographic results of immediate fixed full-arch prosthesis supported by two anterior axial and two posterior trans-crestally placed tilted implants in patients with severely atrophic posterior maxilla.

Materials and methods: Patients with posterior maxillary ridge less than 4 mm high and 3 mm wide were rehabilitated with an immediate fixed provisional prosthesis supported by two anterior axially placed and two trans-crestal posterior tilted implants within 3 h after implant surgery. The final prosthesis, consisting of a CAD-CAM titanium framework and composite teeth was delivered 6 months later. Patients were scheduled for follow-up visits every 6 months to assess clinical and radiological parameters. Patients' satisfaction was assessed by a questionnaire up to 5 years.

Results: From April 2008 to May 2017, 56 implants (28 axial and 28 tilted) were inserted in 14 subjects (eight female and six male). The average bone loss for the anterior axial implants was 0.99 ± 0.19 mm at 1 year (n = 28 implants), 1.37 ± 0.31 mm at 5 years (n = 28), and 2.05 ± 0.32 mm at 10 years (n = 14). Only for three implants in two subjects the marginal bone loss was higher than 2 mm after 60 months. No implant was lost, and no prosthetic failure occurred after a mean follow-up of 125 months (range 79-186 months), leading to 100% implant and prosthesis survival rates. The upper 95% confidence limit of the failure rate was 23% and 6% at patient and implant level, respectively. High level of satisfaction was reported at 5-year follow-up.

Conclusion: Wider sample sizes will be required to determine whether the presented technique is a reliable treatment option for the immediate rehabilitation of the atrophic maxilla.

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在严重萎缩的上颌骨修复中使用经冠种植体:回顾性病例系列。
目的:评估上颌后部严重萎缩患者在两个前部轴向和两个后部跨嵴倾斜种植体支持下的即刻固定全牙弓修复体的中期临床和影像学效果:上颌骨后嵴高不足 4 毫米、宽不足 3 毫米的患者在种植手术后 3 小时内接受了由两颗前部轴向放置的种植体和两颗后部跨嵴倾斜的种植体支撑的即刻固定临时假体修复。6 个月后,由 CAD-CAM 钛框架和复合牙组成的最终修复体交付使用。患者每 6 个月接受一次随访,以评估临床和放射学参数。患者的满意度则通过问卷调查进行评估,评估期长达 5 年:从 2008 年 4 月到 2017 年 5 月,共为 14 名受试者(8 名女性和 6 名男性)植入了 56 个种植体(28 个轴向种植体和 28 个倾斜种植体)。前轴种植体的平均骨质流失量为:1 年 0.99 ± 0.19 毫米(28 个),5 年 1.37 ± 0.31 毫米(28 个),10 年 2.05 ± 0.32 毫米(14 个)。只有两个受试者的三个种植体在 60 个月后的边缘骨损失超过了 2 毫米。在平均 125 个月(79-186 个月)的随访中,没有种植体脱落,也没有修复体失败,种植体和修复体的存活率均为 100%。患者和种植体的失败率 95% 置信上限分别为 23% 和 6%。5年随访的满意度很高:要确定所介绍的技术是否是一种可靠的上颌骨萎缩即刻康复治疗方案,还需要更广泛的样本量。
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