Fixed rehabilitation of the edentulous maxilla: possibilities and clinical outcome

Abstract

Purpose: The aim of the present report was to describe the different treatment approaches available for fixed rehabilitation of the edentulous maxilla in the presence of varying hard and soft tissue conditions and to review the clinical outcome of each treatment approach.

Materials and methods: A review of the published data published from 1980 through 2009 was conducted using electronic databases and manual searching to identify the treatment possibilities for the fixed rehabilitation of the edentulous maxilla and report their clinical outcomes. The search terms used, in simple or multiple conjunctions, were "fixed rehabilitation," "implants," "edentulous," "fixed dental prosthesis," "implant-supported," and "maxilla."

Results: Several treatment modalities were identified for the fixed rehabilitation of the edentulous maxilla, with and without bone augmentation procedures. Regular, tilted, and zygoma implants were identified for treatment modalities that do not require bone augmentation. Sinus floor elevation with the lateral window technique or Le Fort I osteotomy with interpositional bone grafts was identified as a treatment possibility that required bone augmentation procedures. The database initially yielded 230 titles. Of the 230 studies, 42 were finally selected. Although all studies reported the survival rates of the implants, only 20 provided information about the prosthetic outcome. Because of the limited number of studies, at least for the specific treatment modalities, and the heterogeneity in the design of the different studies identified, it was not possible to perform a statistical analysis of the data. Except for regular implants placed in native bone, no sufficient long-term clinical studies were found for the other procedures.

Conclusions: Except for regular implants placed in nonaugmented native bone, the published data provide insufficient evidence about the outcome of other procedures. Until long-term data are available, such procedures should not be considered reliable treatment modalities.