Patients with atrophy of the maxillae, generally the elderly, are usually difficult to handle clinically, mainly due to the lack of retention, stability, and masticatory effectiveness of the total removable prosthesis. A new technique involving osseointegrated implants that are parallel to each other and arranged in the intermaxillary suture seems to provide great advantages over the current options for oral rehabilitation. This technique is quick and effective, being performed with local anesthesia and without a bone graft, and still presents low morbidity and cost.
Atrophy of the maxillae, both in height and thickness, in edentulous patients is a major clinical problem for dentists who need to treat patients with surgery and prostheses. Simplified surgical techniques allow a more comfortable postoperative period, minimizing possible complications. The intermaxillary suture may be a viable option for the placement of osseointegrated implants, as this seems to facilitate the rehabilitation of the patient.
A 74-year-old patient sought treatment for oral rehabilitation. The following clinical and imaging studies were performed: panoramic radiographs, profile teleradiography (PR) ( Fig. 1 A ), and computerized tomography (CT) ( Fig. 1 B and C).
The patient presented with atrophic maxillae but refused to be submitted to reconstructive surgery (iliac crest bone graft, maxillary sinus lift, and zygomatic implant). The use of an overdenture prosthesis supported by osseointegrated implants was recommended.
Local anesthesia along with a vasoconstrictor was used during the surgical procedure, and was applied to the area that received the implants (intermaxillary suture). Drilling was performed with a lance-type drill, without incision, at the planned depth, with further progressive widening; this was performed conventionally ( Fig. 1 D). Following this, three SIN implants (Sistema de Implantes Nacionais ® , São Paulo, SP, Brazil), 3.25 mm in diameter, 4.1 mm platform, and 6.0 mm in length, were inserted in the intermaxillary suture at the following sites ( Fig. 1 E): an anterior implant (near the incisive foramen), a median implant, and a more posterior one ( Fig. 1 F). Cicatrizers were then placed and kept near the mucosa to avoid them being displaced by either the placement or removal of the temporary total removable prosthesis. The temporary prosthesis was worn in the area of the implants and filled with tissue conditioner Coe-soft (GC America Inc., Alsip, IL, USA). After 6 months, a total prosthesis was manufactured to fit the anterior and median implants (O-ring; Signo Vinces, Campo Largo, Paraná, Brazil) ( Fig. 1 G), while the posterior implant received a milled superstructure due to the high retention of the system, allowing better placement and removal of the prosthesis (overdenture).
The patient has been followed up for 5 years, during which no complaints have been made; the implants and prosthesis have remained stable ( Fig. 1 H and I).