Ectodermal dysplasia: an 11-year follow-up of siblings with 2 implant treatment approaches.

PURPOSE: To describe 2 different treatment approaches for a 20-year-old Caucasian man and his 22-year-old sister who were affected by ectodermal dysplasia (ED) and compromised maxillary bone. MATERIALS AND METHODS: The sister had a history of an iliac crest transplant with 6 implants placed in the maxillary and mandibular arches, 6 years before complications. It was necessary to debride the right sinus, remove the failing infected bone graft and 2 implants. Her brother presented with missing teeth, few remaining deciduous teeth, and wearing all-acrylic resin temporary partials in both the maxillary and mandibular arches. RESULTS: Zygomatic and pterygomaxillary implants were used to rehabilitate the brother with a screw-retained fixed prostheses. His sister had 6 new maxillary implants. Both siblings' mandibular arches were restored with screw-retained implant-supported prostheses. CONCLUSION: Although these siblings affected with ED had different treatment approaches, they both eventually obtained successful outcomes. The brother's treatment was expedited. Both siblings have been followed for a period of 11 years, and all postoperative evaluations have been uneventful.

The effect of inter-implant distance on retention and resistance to dislodging forces for mandibular implant-tissue-supported overdentures.

OBJECTIVES: The effect of inter-implant distance on retention and resistance of implant-tissue-supported overdentures is lacking in the literature. An in vitro study was performed to evaluate this effect for mandibular implant-tissue-supported overdentures retained by two ball attachments. MATERIALS AND METHODS: An acrylic cast of an edentulous mandible was fabricated. Three pairs of implants were symmetrically placed at both sides of the midline. The inter-implant distance was 10, 25, and 35 millimeters in positions A, B and C, respectively. A framework simulating the overdenture was fabricated on the cast. Six attachment housings were placed within the overdenture. For each sample, two ball abutments were screwed onto the implant pairs and two pink nylon inserts were seated in their respective attachment housings. The samples were tested in three groups of 15 (A, B, and C). The testing machine applied tensile dislodging forces and peak loads were measured in three directions: vertical, oblique, and anterior-posterior. A one-way ANOVA followed by Tukey's HSD was used to determine groups that were significantly different. Tests were carried out at 0.05 level of significance. RESULTS: Peak loads for the anterior-posteriorly directed dislodging forces were significantly the highest for group C (P<0.05); 21.25 N±3.05 N, while there were no statistically significant differences among groups with vertically and obliquely directed forces (P>0.05). CONCLUSION: Inter-implant distance did not affect the vertical retention and oblique resistance of mandibular implant-tissue-supported overdentures; however, it affected anterior-posterior resistance.

A retrospective analysis of mandibular bone height changes associated with 81 screw-retained implant-supported prostheses with distal cantilevers: a long-term follow-up analysis.

PURPOSE: The aims of this study were (1) to evaluate long-term changes in bone height beneath mandibular screw-retained implant-supported prostheses with distal cantilevers and (2) to determine whether the reversal of residual ridge resorption in the posterior mandible is temporary or continues over the long term. MATERIALS AND METHODS: Panoramic radiographs, obtained at surgery and at two follow-up visits, of 81 patients rehabilitated with mandibular screw-retained implant-supported prostheses with distal cantilevers supported by four, five, or six implants were followed for 5 to 19 years (overall mean follow-up, 9.00 years. Changes and trends in bone height adjacent to the most distal implant were evaluated between each follow up visit as well as from time of surgery (baseline) to the final visit using two-way analysis of variance, a two-sample t test, and piecewise linear regression. RESULTS: Average bone height distal to the distal most implant at placement was 10.34 ± 6.87 mm. From baseline to the first follow-up exam, a mean bone gain of 0.68 mm was noticed, and a mean gain of 0.26 mm was observed from baseline to the second follow-up exam. A statistically significant bone gain (0.92 mm) was noticed in women (n = 49) between the first and second exams, compared to 0.33 mm in men (n = 32). Individuals experienced both bone gain and loss during the study, with an overall gain. Patients with lower initial bone height experienced greater growth, but this was not statistically significant. CONCLUSION: Bone growth is associated with mandibular screw-retained implant-supported prostheses with distal cantilevers, and both bone loss and bone growth may occur in the same patient over time. Within the diverse population of this study, women experienced 2.5 times more gain in bone height than men. No correlation could be established between initial bone height and overall bone height changes.

Predoctoral dental students' perceptions and experiences with prosthodontics.

PURPOSE: The aims of this study were to: (1) investigate the perceptions and experiences of predoctoral dental students and advanced standing students on mentorship, exposure to prosthodontics, and future need for the specialty, and (2) establish a baseline of students' perceptions of the impact of prosthodontics on salary, personal and patient quality of life, and the profession of dentistry. MATERIALS AND METHODS: A survey was distributed to 494 predoctoral and advanced standing students at the University of Pennsylvania School of Dental Medicine. Questions focused on the perceptions and experiences with the specialty of prosthodontics. A total of 410 surveys were analyzed using Chi Square tests and univariate and multivariate analysis with statistical software. RESULTS: Response rate was 83%. A positive initial introduction to prosthodontics was reported by 57% of students. Most students had positive experiences with prosthodontic faculty and enjoyed laboratory work and challenging/complex dentistry. A greater need for prosthodontists in the future was perceived by 82% of respondents, with 63% reporting that the future of prosthodontics had been emphasized. Students reported (1) a preclinical course directed by prosthodontists and (2) working in the clinic with prosthodontic faculty (p < 0.006) as having the biggest impact on their introduction to prosthodontics. A desire to pursue training or a career in prosthodontics was reported by 3.4% of the respondents, with 1.7% of them pursuing prosthodontics. Enjoyment of providing care in prosthodontics was the most important factor for those who decided to pursue prosthodontic postgraduate training. When compared to other specialties, prosthodontics ranked low with regards to its impact on salary (7(th) ), personal quality of life (5(th) ), patient quality of life (4(th) ), and strengthening of the dental field (7(th) ). CONCLUSION: Reasons few students are interested in prosthodontics as a career, despite a positive first introduction and high perceived future need for prosthodontists may be attributed to a number of factors. These include insufficient prosthodontically, trained faculty, lack of a mentorship program, lack of an advanced graduate program, a perception of feeling unprepared upon graduation, and misconception of potential income in prosthodontics.

Dental students' perceptions of dental specialties and factors influencing specialty and career choices.

The goals of this study were to 1) evaluate dental students' perceptions of dental specialties, 2) identify factors that play an important role in students' decision to pursue specialty training or career choices, and 3) establish a baseline of students' perceptions of the dental fields with the best future in terms of salary, personal and patient quality of life, and overall impact on the dental profession. Surveys were distributed to 494 students at the University of Pennsylvania School of Dental Medicine. Data were collected from 380 traditional four-year students and thirty advanced standing students. Chi-square tests, multivariate analysis, and logistic regressions were used to determine associations and independent contributions of student demographics to their perceptions of dental specialties and factors influencing specialty training or career choices. Debt was a statistically significant factor (p<0.001) in choosing specialty training or career independent of gender, age, or class year. Enjoyment of providing care in a specialty or field was identified as the single most important factor in choosing a specialty career. Half of the respondents had decided not to specialize. Pursuing postdoctoral general dentistry training and private practice in general dentistry were the most commonly reported plans after completion of dental school. Suggestions are made for ways to inform students about specialty training.

Treatment of a patient with cleidocranial dysplasia using a single-stage implant protocol.

This patient report describes the treatment of a 45-year-old Caucasian woman with cleidocranial dysplasia who had significant dental problems that greatly affected her quality of life. The patient had orthodontic treatment in her earlier years along with surgical removal of supernumerary teeth. Using implants, the maxillary and mandibular arches were restored with fixed screw-retained prostheses. Eight implants and six implants were placed in the maxilla and mandible, respectively. Both arches were immediately loaded following the Teeth in a Day™ protocol using an all-acrylic resin provisional prosthesis. Five months later, definitive maxillary and mandibular prostheses were fabricated. The patient has been followed for a period of 5 years, and all postoperative evaluations have been uneventful.

Comparison of retention and strain energies of stud attachments for implant overdentures.

PURPOSE: The retentive forces and the strain energies absorbed during dislodging of implant overdenture stud attachments are useful parameters to consider in the selection of attachments. The purpose of this study was to compare the retentive forces and strain energies of the Nobel Biocare standard ball, Nobel Biocare newer generation ball (Yorba Linda, CA), Zest Anchor, Zest Anchor Advanced Generation (Escondido, CA), Sterngold-Implamed ERA white, and Sterngold-Implamed orange attachments (Attleboro, MA) on an implant-retained in vitro overdenture model. MATERIALS AND METHODS: The attachments were tested using two permanently placed Brånemark system implants on a test model attached to an Instron machine. Each attachment had one part embedded in a denture-like housing, and the other part screwed into the implants. Dislodging tensile forces were applied to the housings in two directions simulating function: vertical and oblique. Eight tests were done in two directions with six specimens of each attachment. Retentive forces generated and strain energies absorbed during displacement were determined. A 1-way ANOVA followed by the Tukey studentized range test was used to determine groups that were significantly different at the p < 0.05 level. RESULTS: The Zest Anchor Advanced Generation attachment had significantly the highest retentive vertical and oblique forces [37.2 (5.5) N and 25.9 (3.2) N, respectively]. The Zest Anchor had the lowest vertical force [10.8 (4.2) N], and Nobel Biocare Standard had the lowest oblique retentive force [10.6 (3.0) N]. The Nobel Biocare Standard Ball attachment had the highest strain energies [29.7 × 10(-3) (11.9 × 10(-3)) J, 30.3 × 10(-3) (14.3 × 10(-3)) J, respectively, in the vertical and oblique directions]. The Sterngold-Implamed ERA White and Zest Anchor had the lowest strain energies [5.3 × 10(-3) (3.2 × 10(-3)) J and 4.5 × 10(-3) (1.1 × 10(-3)) J, respectively, in the vertical and oblique directions]. CONCLUSION: The retentive forces and strain energies of implant overdenture stud attachments are different and should be considered during prosthesis selection.

Communication between the dental laboratory technician and dentist: work authorization for fixed partial dentures.

PURPOSE: A questionnaire was sent to laboratory technicians to determine the level of communication between dentists and dental laboratories in specific areas of the work authorization forms for the fabrication of fixed partial dentures. MATERIALS AND METHODS: A select number of dental laboratories were randomly chosen from the National Association of Dental Laboratories (NADL) for each of the 50 states. The questionnaire was mailed to the laboratory directors for a total of 199 dental laboratories. The survey asked questions pertaining to the following areas of work authorization: legibility and thoroughness of prescriptions, patient information, choice of materials for the prosthesis, design of the prosthesis, and shade description. For each question, the number of responses received was tabulated and converted to a percentage. RESULTS: Of the 199 laboratories surveyed, 114 (57%) responded to the questionnaire. Results from this survey suggest that there is lack of communication between dentists and dental laboratories through work authorization forms regarding choice of metal alloy, type of porcelain to be used, and choice of margin and pontic design for the prosthesis. CONCLUSIONS: Information obtained from the responding laboratories included effectiveness of work authorization forms. There were some similar trends indicated by the large percentage of dental laboratories agreeing on lack of communication by the dentists as reflected by the work authorization forms.

Dentist communication with the dental laboratory for prosthodontic treatment using implants.

PURPOSE: A questionnaire was sent to U.S. dental laboratories to evaluate the level of communication between dentists and laboratory technicians and to determine trends in procedures and materials used in fixed and removable implant restorations. METHODS AND MATERIALS: Dental laboratories were randomly chosen from the National Association of Dental Laboratories for each of the 50 states. The questionnaire was mailed to the laboratory directors for 199 dental laboratories. One hundred fourteen dental laboratories returned the survey, yielding a response rate of 57%. Of those laboratories, 37 indicated that they did not participate in the fabrication of fixed implant restorations, yielding a response rate of 39%. Forty-two dental laboratories indicated that they did not participate in the fabrication of implant-retained overdenture prostheses, yielding a response rate of 36%. RESULTS: Results from this survey show inadequate communication by dentists in completing work authorization forms. Custom trays are used more frequently for implant-retained overdenture impressions and stock trays for impressions of fixed implant prostheses. Poly(vinyl siloxane) is the material most commonly used for both fixed and removable implant-supported prostheses. Two implants with stud attachments are used more widely than those with bar attachments for implant-retained overdentures. CONCLUSIONS: Most laboratories working on implant prosthodontic cases report inadequate communication between the laboratory and dentists related to materials and techniques used in fabrication of implant restorations.

Teaching implant dentistry in the predoctoral curriculum: a report from the ADEA Implant Workshop's survey of deans.

In 2004, a survey of the deans of U.S. and Canadian dental schools was conducted to determine the implant dentistry curriculum structure and the extent of incorporating implant dentistry clinical treatment into predoctoral programs. The questionnaire was mailed to the deans of the fifty-six dental schools in advance of the ADEA Implant Workshop conference held in Arizona in November 2004. Out of the fifty-six, thirty-nine responded, yielding a response rate of 70 percent. Thirty-eight schools (97 percent) reported that their students received didactic instruction in dental implants, while one school (3 percent) said that its students did not. Thirty schools (86 percent) reported that their students received clinical experience, while five schools (14 percent) reported that theirs did not. Four schools (10 percent) did not respond to this question. Fifty-one percent of the students actually receive the clinical experience in restoring implants, with the range of 5-100 percent. Of those schools that provide clinical experience in restoring implants, four schools (13 percent) reported that it is a requirement for them, while twenty-eight schools (88 percent) reported that it is not a requirement for them. Three schools (9 percent) did not respond. The fee for implants is 45 percent higher than a crown or a denture, with a range of 0-100 percent. Twenty-nine schools (85 percent) indicated that they did receive free components from implant companies, while five schools (15 percent) did not. The conclusions of this report are as follows: 1) most schools have advanced dental education programs; 2) single-tooth implant restorations are performed at the predoctoral level in most schools; 3) implant-retained overdenture prostheses are performed at the predoctoral level in most schools; 4) there is no predoctoral clinical competency requirement for surgical implant placement in all schools that responded to the survey; 5) there is no predoctoral clinical competency requirement for implant prosthodontics in most schools that responded to the survey; 6) prosthodontic specialty faculty are often responsible for teaching implant prosthodontics at the predoctoral level; 7) periodontics and oral and maxillofacial faculty are commonly responsible for teaching implant surgery at the predoctoral level; 8) support from implant companies is common for dental schools, with most providing for implant components at discounted costs; and 9) there is a lack of adequately trained faculty in implant dentistry, which is a significant challenge in providing predoctoral students with clinical experience with dental implants.

Removable partial denture education in U.S. dental schools.

PURPOSE: A survey of U.S. dental schools was conducted in 2001 to determine the curricular structure, techniques, and materials used in predoctoral clinical removable partial denture (RPD) programs. MATERIALS AND METHODS: The questionnaire was mailed to the chairperson of the prosthodontic/restorative departments of 54 U.S. dental schools. Of these, 44 schools returned the completed survey, resulting in a response rate of 82%. RESULTS: Results from this survey show that a large majority of schools are using similar materials in clinical RPDs; for instance, using modeling compound for border molding final impression trays (61%) and using a semi-adjustable articulator for mounting preliminary casts (90%) and final casts (98%). In addition, a large majority of schools are using similar techniques in clinical RPDs, such as border molding the edentulous areas of the final impression tray (80%) and using the altered cast impression technique (59%). A set post-insertion protocol is present for patients who receive partial dentures in the majority of the schools (93%). Only 25% of schools reported incorporating new educational materials such as the use of Portrait artificial teeth at the predoctoral level. Eighteen percent of schools are allowing students to graduate without a set number of RPD clinical requirements as has been traditionally the case. CONCLUSIONS: Predoctoral clinical RPD programs vary from school to school, yet a large percentage of schools agree on many topics.

Complete denture education in U.S. dental schools.

PURPOSE: In 2001, a survey of U.S. dental schools was conducted to determine curricular content, teaching philosophies, and techniques used in clinical complete denture programs. MATERIALS AND METHODS: The questionnaire was mailed to the chairperson of the prosthodontic/restorative department of 54 U.S. dental schools. Of these, 44 schools returned the completed survey, resulting in a response rate of 82%. The mean, median, and range of responses were computed where applicable. RESULTS: Results from this survey show that a large majority of schools are using similar materials in clinical complete denture treatment: irreversible hydrocolloid for preliminary impression (87%); light-cured composite resin for record base fabrication (70%); a semiadjustable articulator (98%); and semianatomic posterior tooth form used exclusively or in combination with other tooth forms (75%). In addition, a large majority of schools are using similar techniques in clinical complete denture treatment: use of a protrusive record (80%); use of extra-oral measurements, speech, and esthetics for establishing the occlusal vertical dimension (59%); use of the conventional compression molding method for processing complete dentures (82%); occlusal equilibration and face-bow preservation (75%); and the clinical remount procedure (91%). A quality control program is present for cases sent to and returned from the laboratory in 73% and 84% of responding schools, respectively. CONCLUSIONS: Clinical complete denture predoctoral programs vary from school to school, yet a large percentage of schools agree on many topics. Only 55% of schools reported incorporating new educational materials such as the use of dental implants and treatment of patients with implant-retained overdentures at the predoctoral level. Sixteen percent are allowing students to graduate without a set number of required complete dentures as has traditionally been the case. Sixteen percent are using newer techniques such as injection molding and microwave processing technique in addition to the conventional processing technique.

Predoctoral implant education in U.S. dental schools.

PURPOSE: In 2002, a survey of American dental schools was conducted to determine the curricular structure, teaching philosophies, and materials used in predoctoral implant dentistry courses. MATERIALS AND METHODS: The questionnaire was mailed to the predoctoral implant dentistry director/chairperson of 54 U.S. dental schools. Of these, 38 schools returned the completed survey resulting in a response rate of 70%. RESULTS: Eighty-four percent of the respondents indicated that an implant dentistry course is part of their school's requirements. Seventy percent indicated that this course is offered by either the Restorative or Prosthodontics Department in the third year of the predoctoral dental curriculum. For 75% of the schools, the duration of the course ranged from 3 to 6 months (mean of 5.5 months), 57% reported offering between 11 and 20 lecture hours (mean of 20.4 hours), and less than half of the schools (41%) have prosthodontists teaching the predoctoral implant dentistry course. In 78% of the schools, a laboratory course is offered in conjunction with the implant course. The majority of the schools (88%) allow predoctoral students to restore implant cases clinically. Seventy-three percent require some of the implant-related laboratory work to be completed by the students and the single-tooth implant restoration is the most popular type of implant restoration for 78% of the schools. CONCLUSIONS: Predoctoral implant dentistry educational programs vary from school to school, yet a large percentage of schools agree on certain topics.

Complications of mandibular molar replacement with a single implant: a case report.

This case report describes prosthodontic complications resulting from the surgical placement of a single implant and treatment following these complications. Both the surgical and prosthodontic procedures are described for the treatment of a 57-year-old man who had previously received a single implant for the replacement of a missing molar. Using 2 implants, 1 mesial and 1 distal to the previously placed single implant proved reliable. A logical treatment solution is to use 2 implants for the replacement of a single molar to avoid prosthodontic complications.

Treatment of a patient with cleidocranial dysplasia using osseointegrated implants: a patient report.

This patient report describes the treatment of a 42-year-old woman with cleidocranial dysplasia. Endosseous implants were used to restore the mandibular and maxillary arches with fixed prostheses. Six implants were placed in the mandible and immediately loaded with an acrylic resin fixed prosthesis. In the maxillary arch, 10 implants were submerged for 4 months prior to functional loading. A transitional denture was relined and placed in the maxilla 10 days after implant placement. Three months later, a definitive mandibular prosthesis was fabricated. The definitive maxillary restoration was delivered 6 months after surgery. The most recent follow-up, 6 months after delivery, confirmed a satisfactory treatment result to date.

Preclinical removable partial dentures curriculum survey.

PURPOSE: In 2001, a survey of U.S. dental schools was conducted to determine the curricular structure, teaching philosophies, and techniques used in preclinical removable partial denture (RPD) courses and to also establish what newer educational techniques and materials are currently being used by U.S. dental schools. MATERIALS AND METHODS: The questionnaire was mailed to the chairpersons of the prosthodontic/restorative departments of 54 U.S. dental schools. Of these, 43 schools returned the completed survey, resulting in a response rate of 80%. The mean, median, and range of responses were computed where applicable. RESULTS: Results from this survey show that the mean student-to-faculty ratio in the preclinical RPD course was 12:1, with a median of 10:1 and a range of 6:1 to 27:1. The mean number of laboratory hours was 55, with a median of 50 and a range of 13.5 to 120. The mean number of lecture hours reported was 21, with a median of 20.5 and a range 10 to 60. The mean number of practical examinations was 2, with a median of 3 and a range of 0 to 8. The mean number of written examinations given was 2, with a median of 2 and a range of 1 to 6. Ninety-five percent of the schools have prosthodontists teaching this course. The mean number of months that this course is taught is 4.4 months, with a median of 4 and a range of 1.5 to 10. Fifty-five percent of the schools used the Hanau semiadjustable articulator. One hundred percent of the schools teach students to use a surveyor when designing an RPD, and 84% percent of the schools teach the Krol or the Kratochvil RPI design or a combination of the 2 designs. CONCLUSIONS: Preclinical RPD educational programs vary from school to school, yet a large percentage of schools agree on certain topics. Only 19% of dental schools are incorporating new technologies, such as the use of the internet, in their preclinical RPD curriculum.

Survey of recently board-certified prosthodontists on the board certification process. Part 1: Demographics.

PURPOSE: A survey of recently board-certified prosthodontists was conducted in 2001. The purpose of this survey was to identify trends that assisted candidates in attaining diplomate status. MATERIALS AND METHODS: A questionnaire was mailed to 176 diplomates who had become board certified between the years 1993 and 2001. Of these, 131 board-certified prosthodontists returned the completed survey, resulting in a response rate of 74%. The mean, median, and range of responses were computed when applicable. RESULTS: Results from this survey show that the mean number of years from completion of a postdoctoral program to achieving board certification was 6 years, with a median of 4 years and a range of 1 to 23 years. The mean number of years from the time of completion of a postdoctoral program to board eligibility was 2.3 years, with a median of 1 year and a range of 0 to 22 years. The mean number of years from board eligibility to board certification was 3.9 years, with a median of 3 years and a range of 0 to 17 years. The military was the most frequently reported employment status at the time the respondents took Parts 1-4 of the boards. A total of 54% of the diplomates reported that they challenged Part 1 separately, and then challenged Parts 2, 3, and 4 together; 79% of the diplomates were encouraged by their graduate program director/faculty to challenge the board; and 48% of the diplomates reported that their patients received free dental treatment. CONCLUSIONS: Certain trends were observed regarding diplomates who succeeded in their efforts to challenge the board examination. The largest group who challenged the board certification examinations comprised members of the armed forces. Most prosthodontists challenged Part 1 before challenging the remaining 3 parts. In an effort to encourage more prosthodontists to challenge the board examination, numerous changes were made between 1992 and 1998; however, most of the diplomates did not take advantage of those changes.

Survey of recently board-certified prosthodontists on the board-certification process. Part 2: Preparation and impact.

PURPOSE: A 2-part survey of recently board-certified prosthodontists was conducted in 2001. The first part of the survey, published in June 2003, determined the trends that assisted the candidates in attaining diplomate status. The second part of the survey was done to determine the preparation methods and resources used to prepare for the examination, the most difficult part of the examination, the most gratifying aspect of becoming board-certified, their current employment status, and whether board certification had any positive impact on their employment. MATERIALS AND METHODS: A questionnaire was mailed to 176 diplomates who had become board certified between the years 1993-2001. Of these, 131 board-certified prosthodontists returned the completed survey, resulting in a response rate of 74%. RESULTS: Results from this survey showed that 91% of the diplomates had taken the American College of Prosthodontists (ACP) Board Preparation course; most of the diplomates (41%) prepared for the boards by reviewing prosthodontic literature, reading textbooks, using the ACP Study Guide, and seeking the help of other board-certified prosthodontists; 89% of the diplomates felt that achieving board certification had a positive influence in their employment; 39% of the diplomates indicated that Part 2 of the examination was the most difficult to prepare for, and 41% indicated that Part 2 was the most difficult section; the majority of diplomates (31%) were employed by the military, and the most gratifying aspect of becoming board-certified was personal accomplishment (83%). CONCLUSIONS: Trends were observed regarding prosthodontists who succeeded with their efforts to challenge the board examination. The majority of the diplomates were employed by the military. Most of the respondents indicated that they took the ACP Board Preparation course and found it helpful. The largest percentage of respondents reported that Part 2 was both the most difficult part to prepare for, as well as the most difficult to complete. The most gratifying aspect of becoming board-certified was personal accomplishment.

Quadruple zygomatic implant support for retreatment of resorbed iliac crest bone graft transplant.

PURPOSE: The purpose of this report is to present a reliable surgical and prosthodontic protocol for the treatment of the atrophic maxilla by placing four zygomatic implants. MATERIALS AND METHODS: The surgical and prosthodontic procedures are described for the retreatment of a 63-year-old woman who had previously undergone an iliac crest bone graft transplant, which had resorbed. RESULTS: It is possible to place double zygomatic implants bilaterally, in addition to conventional implants in the anterior maxilla. Bone grafting procedures can be avoided, resulting in a fixed implant-supported maxillary prosthesis. CONCLUSION: A logical treatment solution is four zygomatic implants for the atrophic maxilla, especially because the previous iliac crest bone graft had resorbed.