Tilted trans-sinus implants for the treatment of maxillary atrophy : case series of 35 consecutive patients

Purpose To evaluate tilted trans-sinus implants for rehabilitation of the atrophic maxilla. Materials and Methods A case series of 35 patients (32 consecutive edentulous and 3 partially edentulous patients) treated with trans-sinus dental implants is presented. Edentulous patients received 4 or 6 implants depending on anatomic conditions and a 12-unit final restoration; partially edentulous patients received 2 implants supporting a 3-unit partial fixed bridge. Results Thirty-five patients (14 men, 21 women) underwent rehabilitation. Thirty-two patients with 190 implants placed received a full-arch fixed prosthesis supported by axial and trans-sinus tilted implants. Three patients each received 2 implants with a 3-unit fixed restoration. The mean age at surgery was 59.2 ± 9.5 years. The cumulative survival rate was calculated only for the full-arch fixed prosthesis group and was 98.42%. Crestal bone loss averaged 0.9 ± 0.4 and 0.8 ± 0.5 mm for the axial and tilted implants, respectively, at the 12-month evaluation. Biological complications at the implant level were 1 case of peri-implantitis and 3 cases of mucositis; no patient developed sinus infections. The prosthetic complications encountered were screw loosening in 17.5% of cases and chipping of the esthetic part in 30% of cases. These complications were easily resolved chairside and did not lead to prosthetic failure. Conclusions Trans-sinus tilted implants and sinus membrane distal displacement appear to be a viable minimally invasive alternative for the treatment of maxillary atrophy.