Protetisk rehabilitering af den atrofiske tandlöse maksil med zygomaimplantater eller all-on-four implantatindseattelse
Sammanfattning
Maxillary sinus floor augmentation applying the lateral window technique or osteotome-mediated sinus floor augmentation and placement of standard length implants is the most commonly used surgical procedure for prosthetic rehabilitation of the atrophic edentulous posterior maxilla. However, prosthetic rehabilitation of the posterior part of the maxilla with maxillary sinus floor augmentation is often associated with the use of particulated autogenous bone graft and/or a bone substitute and prolonged treatment time. Prosthetic rehabilitation of the atrophic edentulous maxilla with zygomatic implants combined with 2-4 standard length implants in the anterior part of the maxilla or all-on-four implant placement to support a full-arch fixed dental prosthesis may be considered a reliable treatment alternative to maxillary sinus floor augmentation to avoid augmentation of the atrophic posterior maxilla, intervention on the maxillary sinus and reducing the treatment time. Systematic reviews have demonstrated high survival rate of suprastructure and implants after prosthetic rehabilitation of the atrophic edentulous maxilla with zygomatic implants combined with anteriorly positioned standard length implants to support a fullarch fixed dental prosthesis. However, the use of zygomatic implants is associated with the risk of peri-implant marginal bone loss and severe intra- and postoperative complications. All-on-four implant placement and immediate loading of an implant-supported full-arch fixed dental prosthesis has demonstrated high survival rate of suprastructure and implant, limited peri-implant marginal bone loss and few complications. However, prosthetic rehabilitation of the edentulous atrophic maxilla with all-on-four implant placement has never been compared with maxillary sinus floor augmentation and placement of six to eight standard length implants, and longterm data have not been reported. In the present review, the current knowledge about prosthetic rehabilitation of the atrophic edentulous maxilla with zygoma implants and all-on-four implant placement compared to maxillary sinus floor augmentation and insertion of six to
eight standard length implants is presented. However, further long-term randomized controlled trials are needed before evidence-based treatment guidelines can be provided about the indication for prosthetic rehabilitation of the atrophic edentulous maxilla with zygomatic implants and all-on-four implant placement.