Rehabilitación implantosoportada del sector posterior del maxilar superior severamente atrófico mediante la inserción simultánea de implantes zigomáticos y pterigoideos

Abstract

Nowadays, the implant-supported rehabilitation of the severely atrophic posterior maxilla remains a challenge, due to its anatomical and functional features, which hinder, and in many cases preclude, the classical insertion of intraosseous fixtures, leading to the development of a series of special surgical techniques such as application of bone grafts (onlay, inlay), insertion of short-length fixtures, insertion of narrow-diameter fixtures, bone-guided regeneration, crestal expansion with osteotome, osteogenic distraction, insertion of specific- designed fixtures (pterygoid, zygomatic)_x000D_ Pterygoid and zygomatic specific- designed fixtures are inserted in pterygoid and zygomatic anatomical buttresses, respectively, areas not affected by physiological resorption secondary to any edentulous process; this feature should lead to consider this type of fixtures as a very good alternative to bone grafts in implant-supported rehabilitation of the severely atrophic posterior maxilla because they do not require the creation of two surgical fields and therefore there is no donor site that could be damaged, there is no delay in the treatment duration and literature refers zygomatic survival rates between 86-100% and 88-100% for pterygoid fixtures. The insertion of this type of fixtures is a reality nowadays, but, to the best knowledge of the author, this reality is raised alternatively, i.e., it has not been published the implant-supported rehabilitation of the severely atrophic posterior maxilla by the combined insertion of both types of specific-designed fixtures_x000D_ This study is based on 71 patients with severely atrophic edentulous posterior maxilla, in which were inserted a total of 133 zygomatic fixtures, 122 pterygoid fixtures and 100 anterior maxillary fixtures; all patients received zygomatic fixtures (single or double insertion) and were divided into groups according to the type of reinforcement applied to the zygomatic fixture: only anterior reinforcement by inserting regular fixtures in the anterior maxilla, only posterior reinforcement by inserting pterygoid fixture, double reinforcement both anterior and posterior level. The purpose of the study was to determine whether the implant-supported rehabilitation of the severely atrophic posterior maxilla by the insertion of zygomatic specific- designed fixtures (single or double insertion) in simultaneous combination with pterygoid specific-designed fixture and regular anterior maxillary fixture (in cases where feasible) is a viable and valid option from a surgical point of view and, if so, identify which of the possible combinations of insertion may be more advantageous to present a higher survival rates and analyze all surgical variables that might interfere with the correct osseointegration of both types of specific- designed fixtures

Date of Award	18 Nov 2016
Original language	Undefined/Unknown
Awarding Institution	Vall d'Hebron University Hospital (HUVH)
Supervisor	Socorro Bescós Atín (Director) & Jose Maria Balibrea del Castillo (Tutor)