The Use of Computer Guided Tall andTilted Pin Hole Immediately Loaded Implants(TTPHIL) Technique for Severe Atrophic Maxilla Rehabilitation: A One Year Follow-Up

For successful placement of dental implants, the clinician needs adequate bone in three dimensions around endo-osseous implants to enhance Bone Implant Contact (BIC) area and primary stability. The absence of optimum bone calls for complex procedures such as sinus lifts, bone augmentations using grafts that aggravates patient morbidity, dramatically higher costs and limited patient satisfaction. To overcome disadvantages of grafting, graft-less solution used in combination or alone, such as tilted implants, use of long, narrow implants, bi-cortical implants, all-on-4 techniques have enhanced patient acceptance and clinical ease. All-on-4 protocol is one such combination treatment concept whose success has been demonstrated mainly in ideal/moderate osseous structures. Further, it accommodates 10-12 teeth per arch, mostly without second molars compromising chewing efficiency and creating cantilevers especially in rehabilitations opposing complete set of natural teeth. Additionally, optimal number of implants required to support full arch prosthesis remains unclear. Therefore, to circumvent the limitations of all-on-4 technique, 6 long (16-25 mm) and tilted implants have been used to restore 14 teeth in severely atrophic maxillary arch of a healthy 75-year-old female in the following case report. Tall implants engage basal cortical bone aiding in immediate fixation and increase in surface area of osseo-integration. All implants were placed using minimally invasive flapless technique and immediately loaded within 3 days with a screw-retained multiunit DMLS prosthesis. The pterygoid cortex engagement of distal implants does not have any deleterious biomechanical effect eliminating the distal cantilever.