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Abstract

The replacement of multiple teeth with dental implants in the posterior maxilla is challenging due to factors including low density bone and sinus morphology. When considering restoration of this region, prosthetic design will dictate implant placement. Additionally, planning must consider spacing between adjacent implants, spacing between implants and adjacent teeth, and irregular alveolar ridge morphology. These key measurements translate to the final prosthesis design and will affect cleanability and future oral hygiene maintenance. These characteristics subsequently affect overall longevity of the implants and prosthesis.

In the following case, multiple closely-placed implants presenting with poor cleanability consequently failed, requiring removal and resulting in a large atrophic span. Multiple useful fixed options exist to restore such a deficiency, including guided bone regeneration, sinus lifting, and extra-maxillary implant placement. Our focus in this area includes the placement of implants in a largely de novo grafted sinus with concerns of long-term stability in grafted bone.

This patient case report presents a complex case including an atrophic posterior maxillary region, a history of multiple failed implants, the complete lack of a sinus floor, and the goal of rehabilitating normal masticatory function. Extensive grafting, 3D modeling, prosthetic splinting, and extra-maxillary anchorage were utilized in management of this case to maximize primary stability.

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