IM0110

Fig. 6_Surgical placement of an axial implant following the anterior wall of the maxillary sinus is shown. The mesial axial implant will be the guide for the orientation of the tilted implant. Fig. 7_Implant inserted in the tuberosity. Fig. 8_Situation pre surgery with a small sinus situation. Fig. 9_Osteotomes. Fig. 10_Modified osteotomes (Zepf) for bone harvesting and condensing. Fig. 11a_Insertion of modified osteotomes (Zepf acc. to Vollmer and Valentin). Fig. 11b_Implants in site (IMPLA 3D, Schütz). Fig. 11c_Fixation of the angulated abutment. of tilted implants. Figure 5 (Vollmer R et al. 2008, Ca- landiello R et al. 2005), and Figure 6 illustrate the in- sertion of tilted implants (Aparicio C et al. 2001). Tuberosity implants Recentlythemaxillarytuberosityregionhasbeen increasingly utilized in preprosthetic implantation surgery especially when sinus floor elevation and bone grafting are rejected by patients due to high cost,longerhealingtimeandincreasedriskofintra- operative complications. Implants, however, can beinsertedinthemaxillarytuberosityregionas an alternative to sinus floor elevation (Fig. 7; Regeev E et al. 1995). Osteotomy during the implantation in the maxillary tuberosity is most likely per- formedbyanexpansiveandbonecondens- ing technique with almost no bone re- moval like in the clinical case (Figs. 8 & 11a–e). Such osteotomy is certainly achieved in Type D IV bone acc. to the C. E. Misch classification in the tuberosity by avoiding drilling and thus reducing complications mainly hemorrhage from the palatine artery (Fernandez V. 1997). Efficientinthemaxillarytuberosity,SummersOs- teotomesfavorosseointegrationbyminimizingbone heating, dilating and compacting spongy bone, and maintainingtheremainingmaxillarybone(WhiteGE 1993;Fig.9).Summersosteotomesweremodifiedto improve the access in the challenging areas through adoubleshaftdesigninvolvinglesspressureandless tension on the labial commissural. These modified osteotomes allow obtaining best handling of the implant receiving site (Fig. 10; Valentin, Vollmer & Vollmer, 2002). Figures 11a–e demonstrate the final clinical case (Courtesy of Dr R. Vollmer & Dr M. Vollmer and Dr R. Valentin). Disk implants Disk Implant or basal osseointe- grated implant can be installed where theverticalbonesupplyisreduced.This applies to the posterior areas of the maxilla (Ihde S et al. 2004). The insertion ofthedisk-designimplantislaterallyper- formed.Thetechniqueislessinvasivethan bone grafting and allows a tricortical or multicortical anchorage (Bocklage R. 2001). _Discussion Shortimplants Implantationintheatrophicposteriorareaofthe maxilla is a challenge. The placement of short im- plants in this area is yet another alternative to sinus elevation and bone augmentation. The use of short implants (10 mm) has been a source of debate in the pastdecade.Somestudiesreporthigherfailurerates with short implants; others report comparable re- sults to longer implants (Buser D et al. 2000). Fre- quentlyaffectedbyminimizedbonevolume,edentu- lous sites in the posterior maxilla prevent the place- ment of 10 mm implants without sinus augmenta- tion. If shorter implants are used nevertheless, the need for more extensive sinus floor elevation is di- minishedandbothtreatmentdurationandmorbidity are reduced (Toffler M. 2006). 08 I I case report _ sinus elevation implants1_2010 Fig. 11b Fig. 11c Fig. 8 Fig. 9 Fig. 6 Fig. 11a Fig. 7 Fig.10

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