(22) Conservative Management Of A Deficient Palatal Wall Using An Anatomically Designed Implant: A Case Report

Introduction: Dental implants are highly efficacious in rehabilitating partially dentate or edentulous patients, with a 10-year implant success rate of 97.0%.1 Following tooth loss, alveolar resorption occurs resulting in situations where the horizontal and/or vertical dimensions of alveolar bone is insufficient for predictable implant placement.2 Ridge augmentation therapies have allowed predictable placement of dental implants in atrophic sites. Notwithstanding the efficacy of ridge augmentation, patients are subject to additional surgical procedures posing increased risks, prolonged treatment duration and treatment costs.3-4

As the success of implant therapies have improved, clinicians face the challenge of managing patients’ expectations to achieve expeditious and predictable results with minimally invasive approaches. This case report demonstrates utilization of an anatomically designed implant for sloped ridges to conservatively manage a deficient palatal wall in a patient undergoing sinus augmentation with simultaneous implant placement.

Methods: A 65 year-old female presented to the Periodontics clinic at the University of Pennsylvania School of Dental Medicine for implant therapy to replace her missing left maxillary first molar.

Medical history: ASA II. Osteoporosis. Patient is planned to take oral bisphosphonates following completion of dental treatment. CBCT reveals a sloped palatal ridge with a residual bone height of 5.1mm coronal to the maxillary sinus.
Treatment: A lateral window sinus augmentation was completed with simultaneous placement of a 4.2mm x 11mm anatomically designed implant for sloped ridges, with the slope facing towards the palate.

Results: This design presents a solution for implant placement without the need to submerge the implant or complete ridge augmentation as may be indicated when placing a traditional cylindrical implant into a deficient site. As such, placement was in a prosthetically ideal position, esthetics were optimized and the treatment time significantly reduced as compared to traditional approaches the treatment time significantly reduced as compared to traditional approaches.

Conclusions: Placing anatomically designed implants for sloped ridges is a predictable treatment modality that may negate the need for ridge augmentation and offers a minimally invasive approach to manage ridge deficiencies.

Lead Author's Contributions to the Research Project. : The Lead Author was responsible for the patient care including patient examination, treatment planning, providing surgical management and post-surgical care. The Lead Author was also responsible for writing the abstract.