Atrophic Maxilla Rehabilitation Through Dental Implants Using the V-4 Strategy Associated With Guided Surgery: A Case Report and Technique Description
Atrophic maxilla rehabilitation through dental implants is always a challenging procedure. However, alternative approaches such as guided surgery and the installation of short implants are progressively supplanting more invasive bone regeneration procedures. A V-4 technique described in 2016 facilitates the installation of dental implants in patients with atrophic maxilla; however, its authors recommend incision, flap opening, and elevation of the anterior area of the maxillary sinuses. This case report describes a less invasive proposal for modifying the technique through the association of guided surgery, which improves implant placement accuracy, shortens surgical time, and reduces morbidity.
Figure 1. Illustration adapted from Jensen et al8 demonstrating the positioning of the implants for the M-4 and V-4 techniques, respectively. (a) Implants positioned within the bone envelope between the maxillary sinuses and nasal cavity and above the level of the nasal floor. (b) Implants are anchored in the midline, adjacent to the pyriform aperture and nasal crest and to the anterior walls of the maxillary sinuses.
Figure 2. Illustration of the modification of the technique described by Jensen et al,8 associating the V-4 strategy with guided surgery.
Planning for guided surgery. (a) Cone-beam computerized tomography. (b) Virtual surgical planning. (c) Making the surgical guide. (d) Surgical guide adapted and fixed on the maxillary ridge.
Figure 4. Placement of implants and prosthetic connections. (a) Implants installed and surgical guide removed. Note the absence of soft-tissue trauma. (b) Mini-abutments angled at 17° installed on implants. (c) Immediate loading of implants with screwed provisional prosthesis.
Figure 5. Making the definitive prosthesis and postoperative control. (a) Final prosthesis completed and installed after 6 months. (b) Proof and installation of the definitive prosthesis. Tomographic control of implant placement and marginal bone loss.
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