The posterior maxillae present unique anatomic challenges to the implant team. Poor bone quality and limited volume secondary to sinus pneumatization of the maxillary alveolus can lead to the need for surgical site preparation prior to implant placement. Aesthetic and functional considerations unique to maxillae often make removable provisional restorations impractical. New enhanced implant surfaces may provide the implant team with the confidence to immediately load implants in compromised sites.
INITIAL PATIENT PRESENTATION
A 55-year-old male was referred for reconstruction of his posterior maxilla. His chief complaint was, “I must be able to speak and eat in front of my patrons.” He also did not want any type of removable prosthetic replacement for the missing teeth. Radiographic and clinical examination revealed acute, localized bone loss around tooth #3; a radiolucency for tooth #5 and significant mobility of the existing fixed partial denture #’s 4-7 (Figures 1 and 2).
Figure 1
Figure 2
DIAGNOSIS
• Class II malocclusion, without dysfunction • Moderate occlusal abrasion secondary to parafunctional habits • Recurrent dental caries tooth #’s 4 and 5 (maxillary right premolars) • Non-restorable fixed partial denture (FPD) #’s 4-7 • Inadequate bone volume for implant placement, maxillary right cuspid • Severe localized periodontitis tooth #3 (maxillary right first molar) • Significant maxillary right sinus pneumatization • Failing endodontic therapy tooth #5
