Augmentation of a severely atrophic maxilla and management of the complications that arised

Background

Maxillary sinus elevation and augmentation techniques are widely and successfully used for many years in order to achieve an implant restoration of a severely atrophic maxilla.

Aim/Hypothesis

The purpose of this poster is to present the implant rehabilitation of a severely atrophic maxilla with various augmentation techniques and also to highlight the management of complications that arised, including the removal of an implant from the maxillary sinus.

Material and Methods

A 58-year-old male patient presented to the Department of Implantology, Dental School, University of Athens, requesting rehabilitation with implants in the edentulous maxilla due to retention failure of his complete denture. Clinical and radiographical examination revealed a severely atrophic maxilla both in the posterior and the anterior area. Bilateral maxillary sinus floor and nasal floor elevation combined with GBR in the anterior region were performed. Six implants were placed 6 months later. An OPG taken 8 months after the implants’ placement, revealed that one of the implants was inside the left maxillary sinus and another one in the right side had failed to osseointegrate.

Results

The implant was removed surgically with Caldwell Luc approach from the left sinus while on the right side, a simple implant extraction was conducted. A new implant on the right side and 2 new implants on the left side were placed after 3 months and finally, after six more months, the prosthetic rehabilitation of the patient was carried out without any further complications. Although maxillary sinus elevation is a very popular and predictable technique, an implant osseointegration failure can always occur. Sometimes the management of this failure may require complex and multiple surgical interventions in order to remove the failed implant from an ectopic position and to create the necessary conditions for a new implant placement.

Conclusion and Clinical Implications

Implant rehabilitation of a severely atrophic maxilla is a real challenge for the clinician. This highlights the importance of the surgeon's and dentist's ability to overcome the complications and to achieve the best possible outcome for the patient.