Fixed Rehabilitation of Severely Atrophic Jaws Using Immediately Loaded Basal Disk Implants After In Situ Bone Activation
Rehabilitation of severely atrophic jaws is facilitated when basal disk implants are used after activation of the future bony implant bed with a purpose-designed instrument (Osteotensor) 45 to 90 days before implant surgery. Fabrication of a highly rigid, screw-secured fixed prosthesis that acts as an external orthopedic fixator permits immediate functional loading. This protocol also represents a second chance for patients who have experienced complete implant loss and/or bone graft failure.
Figure 1. Extreme maxillary atrophy. Basal bone (human dry skull). Figure 2. Osteotensor in the sinus area. Figure 3. Transparent acrylic stent with impact markings. Osteotensor with diamond-like carbon coated tip.
Figure 4. Severely atrophic maxilla before and after implant placement and immediate installation of a rigid, screw-secured fixed prosthesis (4 disk implants, 2 root-form implants, 2 microthreaded pterygoid implants). Figure 5. Four disk implants screw-secured onto the canine pillars and the zygomatic processes. The screw-secured transitional fixed prosthesis acts like an external orthopedic fixator. (Human dry skull). Figure 6. The fixed appliance was retrieved after 6 months of function. The computerized tomography scan reveals the bone growth around the titanium implants after osteogenic activation of the implant sites with bone matrix osteotensors. The sinuses appear healthier than they did initially. All implants were checked individually; none were painful or mobile, and the gingiva appeared healthy. Figure 7. The final full-zirconium rehabilitation can be fabricated after 12 months of function with a transitional prosthesis. Figure 8. Full-zirconium prosthesis (tissue/implant interface view). The machined titanium copings glued into the frame guarantee a totally passive fit and reduce shear and wear at the implant/zirconium interface.
Contributor Notes