Metodica riabilitativa di pazienti con atrofia mascellare severa

Objectives. This study evaluates the rehabilitation of a sample of 32 patients with severe atrophy of upper jaw (V Class according to Cawood and Howell) treated by a two-step sinus lift and autologous bone graft. A total of 138 implants were positioned. In this sample transversal width of bone crests was lower than 4 mm while bone height was lower than 6 mm. In no case a traditional implant-supported rehabilitation was possible. Materials and methods. This is a longitudinal study based on a sample of 32 totally or partially edentulous patients with severe maxillary atrophy. A mono- or a bi-cortical bone onlay was positioned in all patients undergoing sinus surgery. Maxillary sinus lift was always performed by a piezosurgical device. In mono and bilateral sinus lift a graft from iliac crest was inserted. Results. After a two years follow-up, 94.05% all implants positioned after sinus lift showed good osteointegration and efficient prosthetic loading. Anterior iliac crest demonstrated to be a suitable donor site of medullary bone for maxillary sinus lift. Conclusions. Predictability of implant survival is definitely high if healing time and graft maturation time are strictly respected. Good results of sinus lift in all cases are also due to the use of piezosurgery, which allows to open the sinus and to elevate soft tissues with a very low trauma for Schneider's membrane. As this membrane remained intact and autologous bone-chips were used, positioning of resorbable membrane was unnecessary, thus making surgery easier. Anterior iliac crest, as a donor site, offers a large amount of cortical and medullary bone, necessary for onlay positioning and bone defects reconstruction. This kind of procedure, with all its intrinsic complications, is a valid method in the rehabilitation of severely atrophic maxilla. For clinical success patient selection and treatment steps are extremely important.