Bone resorption in the anterior area may jeopardize esthetic results; and sinus volume following alveolar bone resorption may preclude implant placement in the posterior areas. Consequently, patients who are edentulous at the maxilla are often good candidates for hard and soft tissue augmentation procedures. In addition, the maxillary bone quality is often worse than that of the mandible, making the prognosis for dental implants in the edentulous maxilla less secure than in the mandible.

Thus, the decision-making process depends not only on the surgically available bone volume, but also on the patient’s wishes in terms of esthetics. In other words, treatment choice at the maxilla cannot be reduced to a choice between removable or fixed options, but should be considered in terms of surgical and esthetic feasibility.

Removable Options

Overdenture Supported by Four Implants: Bar Attachment Systems (Fig. 30.1A)

The recommended treatment option as the standard of care is at least four splinted implants using a bar attachment system (Mericske-Stern, 2003). The decision to place the implants in the anterior area is mainly due to reduced volume of bone beneath the sinus floor in the posterior area.

Figure 30.1 Removable options: overdentures with bar attachment systems. (A) Four parallel dental implants. The denture base has full palatal coverage. Distal bar extensions are possible. (B) Six parallel dental implants. The palatal area of the denture is relieved.

In addition to the improvement of denture stability, the dental implants may also allow for the reduction of prosthesis volume by relieving the palatal area of the overdenture. This advantage is important for patients with gag reflex problems. However, this decision must take into account the number and length of dental implants; removal of the palatal support produces a greater effect and more concentrated stress difference for maxillary overdentures than do differences between the attachment designs />