Demystifying the Options for the Compromised Maxilla with a Fixed Prosthesis

The volumetric loss of bone and soft tissues associated with enlarged maxillary sinuses and reduced alveolar ridges pose unique surgical and restorative treatment challenges. The presence of remaining compromised dentition may further affect outcome. The foundation established by the surgical procedures will ultimately determine the successful completion of the prosthetic rehabilitation. Thus, intra- and extra-oral esthetics, function, and phonetics are all integral part of the therapeutic endeavor. The successful fabrication and delivery of a fixed implantsupported prosthesis for this group of patients is dependent upon a systematic interplay between the surgical and prosthetic treatment planning
objectives.

In the totally edentulous patient, a paradigm shift has taken place as the graftless surgical approach has gained credibility. Reduced treatment time, single-stage surgical reconstructions, and immediate loading—which eliminates the need for transitional dentures—have resulted in a higher degree of case acceptance by most patients.

Grafting procedures to replace the loss of bone and soft tissue are viable options when the desired final restoration is a fixed prosthesis without pink porcelain. However, the prolonged treatment period with multiple-staged procedures carries inherent risks and has to be analyzed carefully in advance and communicated to the patient. Other factors to be considered are the severity of the defect, its anatomical location, and the prognosis of the adjacent dental units. Those areas can be reconstructed primarily by surgical or prosthetic means.

This presentation will discuss the critical factors necessary to provide a fixed implant-supported restoration for patients with limited residual maxillary alveolus. The program focuses on the systematic treatment protocol for decision making as to grafting or to adopt the graftless approaches using the tilted-implant or Zygoma concept. Alternative options for treatment of complications and catastrophic failures will be demonstrated. This includes the “rescue concept” and a “Quad-Zygoma” approach.

Edmond Bedrossian, DDS, FACD, FAO
Dr. Edmond Bedrossian received his DDS from the University of the Pacific, School of Dentistry, in 1986 and completed his certificate of oral and maxillofacial surgery at Highland Hospital in 1990. He is the director of Implant Surgical Training at Highland Hospital, Oral and Maxillofacial Surgery Residency Training Program, as well as the director of the Restorative Implant Training at the UOP’s AEGD Residency Program. He
maintains a private practice in San Francisco, California.

Dr. Bedrossian has authored the first internationally published article on the management of the zygomatic implant at stage II surgery. He has extensive experience in placement and restoration of the zygomatic fixtures and has published a study on immediate loading of the Brånemark System® Zygoma implant. Dr. Bedrossian, in collaboration with Dr. P-I Brånemark, has completed a comprehensive chapter on the various indications for the zygomatic implant, both in the fully edentulous and in the partially edentulous patient.

He has lectured nationally and internationally and has multiple publications on osseous grafting and implant surgery. Dr. Bedrossian is a member of the editorial council for the Journal of Clinical Implant Dentistry and Related Research, as well as the International Journal of Oral & Maxillofacial Implants and the Compendium of Continuing Education in Dentistry.

Oded Bahat, BDS, MSD
Dr. Oded Bahat graduated from the University of the Witwatersrand School of Medicine and Dentistry in South Africa in 1977. In 1981 he received his specialty degree in periodontology as well as his MSD from the University of Washington in Seattle, Washington. He has been a diplomate of the American Board of Periodontology since 1986. He was the chairman and director of the postgraduate periodontics program
at the University of Southern California School of Dentistry in Los Angeles, California. From 1983 to 1987 he lectured nationally and internationally and has published over 30 scientific articles. He is on the review board of JOMI and the Journal of Clinical Implant
Dentistry and Related Research. He currently maintains a private practice limited to periodontics in Beverly Hills, California.

Peter Wöhrle, DMD, MMedSc
Dr. Wöhrle received his DMD degree cum laude and master of medical sciences in oral biology from the Harvard School of Dental Medicine. Additionally, he has completed advanced education programs in both prosthodontics and implant dentistry at Harvard, as
well as a four-year certified dental technician program in Switzerland. While at Harvard, he worked with his mentor, Dr. Paul Schnitman, on the groundbreaking concept of immediate loading with Brånemark System® implants. Dr. Wöhrle is a member of the Academy of Osseointegration, the European Academy of Osseointegration, the American Academy of Esthetic Dentistry, and the American College of Prosthodontists. He is renowned as the only dentist with formal training in the interrelated fields of implant surgery, prosthodontics, and laboratory technology.

Nobel Biocare USA, LLC, is an ADA CERPRecognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.


Noble Biocare USA, LLC, designates this activity for 14 continuing education credits.

Approved PACE Program Provider, FAGD/MAGD Credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement (08/01/2013 to 07/31/2016). Provider ID# 208731.