IM0110

10 I I case report _ sinus elevation Fig. 11d_Situation post surgery. Per- fect seating of the individually casted angulated abutment. Fig. 11e_Final prosthetics. Fig. 12_Disk Implant X-Ray. (Martin Schweppe 2007 Wikipedia). Fig. 13_Lateral insertion of a disk implant. implants1_2010 distribution in fixed prosthetic constructions. The different follow up studies prove that patients with severely resorbed maxillae can be treated success- fully with conventional implant treatment (Kerk- manow L et al. 2000). Relatively easy to be applied, the implant tilting technique decreases the treatment time compared with bone grafting and more extensive procedures suchaszygomaimplants.Theneedforothermorere- source demanding techniques is sometimes overes- timated. However, bone augmentation may be still necessary in case bone volume is severely limited (Annika R et al. 2007). Tuberosityimplants The few studies on implantation in the tuberosity show high percentage of success rate on condition thatstrictprotocolsandcarefulhandlingareapplied to preserve the soft bone in this area (Venturelli A 1996). In combination with tilting the implants the indications for this therapy concept even increase. Diskimplants Despite the shortage of clinical studies in the lit- erature,theuseofdiskimplantmaybeanalternative to bone augmentation in both moderately and se- verely resorbed posterior maxillae. The initial multi- cortical anchorage provided by the disk-design im- plant,coupledwithbiomechanicalsplintingthrough arigidprosthesis,permitsaonestagepredictableal- ternative offering rapid restoration of masticatory function (Scortecci G 1999). _ Conclusion The thesis highlights alternatives to sinus eleva- tion and bone augmentation in the atrophic poste- rior maxilla. These alternatives prove to be (a) safer than,and(b)aseffectiveas,maxillarysinuselevation and bone augmentation techniques. The overall re- sults show high rate of success: 90% and above. Short implants, tilted implants and tuberosity implantsinvolvemainlylessmorbidityandlessinva- sive surgeries. Patients are likely to be less reluctant compared to sinus elevation and bone grafting. Disk implants are worth considering despite the more invasive procedure and the shortage of high level evidence based studies. Further data, however, are requiredtoelaborateonthesafetyandeffectiveness of this alternative. Recentlypracticed,thethreedimensionalimplant planning software for computed tomographic (CT) scan(e.g.SchützIMPLA-3DNavigation;MerliMetal. 2008) is becoming of benefit as it may help evaluate the exact remaining bone in the maxilla. Such plan- ning allows the application of the most convenient implantlikefshortimplant,tiltedimplantortuberos- ityimplantoracombinationofboth. Interestingly,to avoid a sinus elevation and bone augmentation to the most possible, the examined alternatives in this thesismaybeappliedinsoleorineithercombination to rehabilitate the posterior atrophic maxilla. Iwouldliketothank: Prof. Nabil Barakat , Lebanese University, Beirut, Lebanon; Dr. Mazen Tamimi, Private Practice, Am- man, Jordan; Dr. Rainer Valentin, Private practice, Cologne, Germany; Dr. R. & M. Vollmer, Private prac- tices, Wissen, Germany, for their support._ Editorial note: The literature list can be requested fromtheauthor. Fig. 12 Fig. 13 Fig. 11d Fig. 11e Dr Adel Chidiac International Clinic P.O.Box 6649 Salmiya 22077 Kuwait E-Mail:adelchidiac10@hotmail.com _contact implants

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