Immediate loading in the fully edentulous maxilla without bone grafting : the V-II-V technique

Background. This prospective study aimed at evaluating a new surgical approach for the immediate rehabilitation of fully edentulous maxilla without any type of bone grafting. Methods. The technique named “V-II-V” consists of an immediately loaded full-arch bridge supported by six implants. Two distal implants engage the posterior wall of the maxillary sinus, being tilted 30-45° relative to the occlusal plane. Two other tilted implants engage the anterior wall of the sinus, and finally two axial implants are inserted in the anterior maxilla. An acrylic provisional restoration is delivered within 4 hours of implant placement. At each follow-up plaque and bleeding indexes were scored, marginal bone level change around tilted and axial implants were evaluated, and a questionnaire was compiled to assess patient’s satisfaction for function and aesthetics. Results. Twenty-one patients were rehabilitated. A total of 126 implants were inserted. Nineteen prostheses were in function for more than 12 months. The average follow-up was 20 months (range 4-35 months). No implant failure occurred to date, leading to 100% survival rate and 100% prosthesis success. No complication was recorded. Peri-implant bone loss at axial and tilted fixtures was similar at one year, being 0.8 mm (SD 0.4, n=28) and.0.9 mm (SD 0.5 mm, n=56) respectively (P> 0.05). Conclusion. The “V-II-V” technique is a viable treatment modality for the immediate rehabilitation of the edentulous maxilla, avoiding bone grafting or sinus augmentation. Long-term evaluation is needed to confirm these encouraging preliminary results.