Trans-nasal dental implants: indication and the report of 10 cases

Annals of Medicine and Surgery · 2025-03-20

Background: The rehabilitation of the atrophic maxillae with dental implants represents a challenge that can be addressed with zygomatic dental implants and traditional axial implants. In the event of a severely atrophic pre-maxilla, a quad-zygoma approach may be necessary to provide anchorage for the fixed restoration. The proximity of anatomical features can increase the possible morbidity of the quad-zygoma approach and instead, trans-nasal implants may serve as a viable anterior anchorage alternative in the atrophic pre-maxilla region. Methods: A total of 10 patients diagnosed from a class 2B edentulism received a combined treatment with trans-nasal implants paired with a single zygomatic implant were included in this study. Trans-nasal implant marginal bone level changes were evaluated on CBCT (Cone Bean Computed Tomographic) images taken immediately after trans-nasal implant placement and 1 year of follow-up post loading. The reference point for the CBCT measurement of mesial and distal bone loss after 1 year was the horizontal interface between the implant and the abutment. Secondary measurements taken at the 1 year follow up measured the amount of bone available in the sub-nasal, lateral and apical areas of the dental implant in contact with bone. Results: < 0.0001. While the sub-nasal, lateral and apical engagement shown respectively 5.46, 12.92, and 2.70 mm of radiographical bone contact with the implant. Conclusion: The marginal bone loss observed in trans-nasal implants 1 year post loading is comparable to the marginal bone loss of conventional implants under similar conditions. The cumulative radiographical bone to implant contact between the subnasal and the apical bone seems to be of a value of 8.16 mm which seems to correspond to the size of a conventional dental implant. Therefore, it is believed that trans-nasal implants can be considered as an acceptable anterior anchorage alternative to the superior/ anterior zygomatic dental implant in the atrophic pre-maxilla region when paired with a single posterior zygomatic implant.

Trans-sinus dental implants, for immediate placement when insufficient alveolar height is present: an alternative to zygomatic implants – surgical case series

Annals of Medicine and Surgery · 2023 · 12 citations

• Medicine
• Dentistry
• Orthodontics

Low maxillary bone density associated with physiological bone remodeling and resorption accelerated by the presence or history of periodontal disease can prevent implant placement without either ridge and/or sinus augmentation in atrophic maxillary edentulous cases. As an alternative to avoid bone grafting and provide immediacy in restorative treatment care for the patient, remote anchorages to the basal bones of the maxilla of the patient are being used with zygomatic or pterygoid implants. The trans-sinus implant, when indicated can offer a reliable alternative to the zygomatic dental implant in that treatment of the severely edentulous maxilla. This approach is suggested in Bedrossian zones I and II atrophy and when an 'L' (or concave) anterior sinus wall anatomy is present. This approach will be discussed utilizing two case examples on how trans-sinus implants may be considered in treating the maxillary arch.

The severely atrophic maxilla: Decision making with zygomatic and pterygoid dental implants

Journal of Oral Biology and Craniofacial Research · 2023 · 23 citations

• Dentistry
• Medicine
• Orthodontics

The severely atrophic maxilla can present with some challenges during treatment planning with communication between those performing the surgical and prosthetic aspects of the treatment as well as communication with the patient as to what is being suggested for treatment. This article simplifies the communication and understanding of treating the severely atrophic maxilla and based on the Bedrossian classification gives a guideline for the surgical approach to be adapted based on the patient residual anatomy.

Case report: utilization of Z-Point fixture “Trans-nasal” implants

Annals of Medicine and Surgery · 2023 · 6 citations

• Medicine
• Dentistry
• Orthodontics

Severe bone loss in the anterior maxilla poses challenges to implant placement, especially when treating the entire arch. Utilization of zygomatic implants may not allow positioning of the implant platform anterior enough to properly support the full arch prosthesis, leaving an anterior cantilever in some clinical cases. Importance: Placement of implants into the trans-nasal bone between the pneumatized maxillary sinus and nasal fossa allows utilization of an extralong implant in this residual bone to augment zygomatic implants placed distal to this for better support of a full arch prosthesis. Case presentation: A typical case is presented with insufficient alveolar height for traditional implant placement in the anterior maxilla following extraction of the dentition related to bone loss resulting from periodontal disease. Review of the anatomy and technique for placement of implants into the Z-point area for trans-nasal implants. Clinical discussion: This article discusses the utilization of trans-nasal implants into the Z-point and the technique for placement in this residual bone with a case example. Conclusions: The Z-point implant aids in the elimination of the anterior cantilever that may be present due to the most anterior the platform for the zygomatic implant can be placed. Trans-nasal implants should be considered as part of the treatment plan in severely resorbed maxillary arches to allow better implant to spread and load management during functioning.

“Decision making with zygomatic and pterygoid dental implants in the severely atrophic maxilla: A narrative review"

Dentistry Review · 2022-06-25 · 9 citations

The severely atrophic maxilla can present with some challenges during treatment planning with communication between those performing the surgical and prosthetic aspects of the treatment as well as communication with the patient as to what is being suggested for treatment. This article will review the decision making process to simplify the communication and understanding of treating the severely atrophic maxilla and based on the Bedrossian classification gives a guideline for the surgical approach to be adapted based on the patient residual anatomy.

Osseous Grafts: A Simplified Classification Approach

International Journal of Oral Implantology and Clinical Research · 2018-01-01

Various grafting materials are available for osseous applications in dental surgical procedures. Confusion has become common as to how these various graft materials can or should be used in dentistry. This article will present a common sense classification of osseous graft materials and what applications they may be utilized for dentally.

Platelet Rich Fibrin “PRF” and Regenerative Medicine: ‘The Low-Speed Concept’

Stem cell biology and regenerative medicine · 2017-01-01 · 15 citations

Use of platelet-rich fibrin in regenerative dentistry: a systematic review

Clinical Oral Investigations · 2017-05-27 · 515 citations

A multidisciplinary approach for the rehabilitation of a patient with an excessively worn dentition: A clinical report

Journal of Prosthetic Dentistry · 2014-02-14 · 13 citations

Full mouth rehabilitation of a young patient with partial expressions of ectodermal dysplasia: A clinical report

Journal of Prosthetic Dentistry · 2014-06-19 · 7 citations