Virtual Implant Rehabilitation Of The Severely Atrophic Maxilla: A Radiological Study

Abstract Background: Advanced maxillary atrophy is often observed and implant placement could become difficult. Nevertheless, a volumetric evaluation using a proper diagnostic software could facilitate the implant planning. The purpose of the present study is to suggest the potential application of the maxillary retro-canine area as the designated place for virtual tilted implants also in severely atrophic maxillae. Methods: A sample of CBCT images from the Department of Dentistry (IRCCS San Raffaele, Milan) was evaluated. After a 3D anatomical evaluation of the maxilla tilted implants has been virtually positioned in the retro-canine regions. All the implants were inserted with the same procedure at 30° and 45° degrees of tilting. The length, the palatal angulation and the diameter of each implant were identified. Results: 220 tilted implants were placed. An average implant measurement of 13.508 mm of length and 3.42 mm of diameter were calculated. Also, an average buccal-palatal angulation of 6° was identified. After the statistical analysis implant length was found significantly higher at 45° degrees than at 30° degree (<0.0001). Conclusions: A considerable amount of patients show a significant degree of bone atrophy. The implant-supported treatment plan can rely on the three dimensional imaging of the residual bone as a guiding tool to establish the most effective implant position for each specific case. In this study it is founded that an implant could be longer if its mesio-distal angulation is more accentuated. In addition, it is possible to virtually insert tilted implants also in severely atrophic maxilla. This could help clinicians to consider the retro-canine area a viable place to insert longer tilted implant.