Hard tissue management - maxilla
- Narrow ridges are often the limiting factor for implant placement
- The ventral extension of the maxillary sinus can cause other limitations to implant placement
- Unless the use of 4 implants only to support a fixed prosthesis or overdenture does not seem predictable, invasive bone augmentation should not be considered
Bone height and width evaluation
3-D imaging seems the best option unless clinical examination reveals an ample bone volume. The bone quality can be derived from density measurements if CT scan images are available or approximately from the trabecular pattern of 2-D images. Panoramic radiographs reveal the morphology of the sinuses. Tuberosities, although often presenting with poor bone quality, can offer a site for implant insertion.
Treatment options for vertical and horizontal deficiency
If the available bone volume does not allow for implant placement, (autologous) onlay grafts have proven to offer a reliable outcome. Those can be fixed by means of implants. The invasiveness of the procedure should be considered towards the benefits and discussed with the patient.
Sacrificing of the incisal nerve does not seem to cause major symptoms and can provide a solution in some patients with very limited bone volume.
In the dorsal areas sinus inlay procedures or elevation of the mucosal lining offer reliable outcomes.
Splitting of the alveolar crest to allow for implant insertion has been proposed but the clinical documentation remains limited.