Immediate Loading of an Atrophied Maxilla Using the Principles of Cortically Fixed Titanium Hybrid Plates
Henri Diederich*, Alexandre Junqueira Marques, and Léo Guimarães Soares
Dental surgeon, Dental Clinic Henri Diederich, Luxembourg
Submission: September 19, 2016; Published: January 04, 2017
*Corresponding author: Henri Diederich, Dental surgeon, Dental Clinic Henri Diederich, 51 av Pasteur, L-2311Luxembourg, Europe,
How to cite this article: Henri D, Alexandre J M, Léo G S. Immediate Loading of an Atrophied Maxilla Using the Principles of Cortically Fixed Titanium Hybrid Plates. Adv Dent & Oral Health. 2017; 3(3): 555612. DOI: 10.19080/ADOH.2017.03.555612
Replacing the dental arch evolved fixed prosthesis and later dental implants. Dental implants have intended to cover missing teeth in the maxilla and mandible. However, many areas have insufficient bone, and this is critical to success and prognosis. Therefore, this report case discusses an approach of implant treatment undertaken in a patient with pronounced maxillary atrophy using Pterygoid implants, biomaterialsand a new model approach: the titanium Hybrid -Plates.
The term osseointegration proposed by Branemark1 has developed an endosseous implant that forms an immobile connection with bone and has revolutionized oral rehabilitation with a significant advance in restorative dentistry . Despite these success rates, some limitations have often found in sites implanted [1,2].The need for a dental implant to completely address multiple physical and biological factors imposes huge constraints on the surgical and handling protocol .
Implants are the best alternative to traditional prosthodontics; however, designing an implant-supported prosthesis with function and esthetic is very difficult to the dentists. Accuracy in planning and execution of surgical procedures is important in securing a high-success rate .
Dental implants eliminate adjacent teeth required for the placement of fixed partial denture. However, sufficient bone around implants is critical for success. In maxilla region, specifically in the maxillary sinus, reduction of bone height or pneumatised due to periodontal bone loss is a challenge for the placing of implants. In mandible, bone height has compromised; implant placement can lead to nerve damage .
Improvements in surgical reconstructive methods, as well as increased prosthetic demands, require a highly accurate diagnosis, planning, and placement2. New techniques of implants is emerging and search for an effective and adequate strength system to support prosthesis is necessary. Therefore, some authors developed and tested the efficacy of new implant (titanium Hybrid–Plates) for replacing the traditional system. The new implant system can easily overcome difficulties, it is economical, technically less sensitive for patient, and requires minimal arsenal for placement.
Therefore, this report case discusses an approach of implant treatment undertaken in a patient with pronounced maxillary atrophy using Pterygoid implants, biomaterials (Matri™bone) and a new model approach: the titanium Hybrid-Plates.
A70-year-old female who has referred to the clinic for treatment with dental implants. The initial examination revealed that there was severe bone atrophy. The patient failed to adapt to the removable restoration and struggled with a gag reflex. In the maxilla, the resorption was progressive from a cranial and a caudal direction. This was compounded by the presence of
an extremely narrow alveolar “knife” ridge that was not going
to allow screw type implants to be used unless extensive bone
grafting was performed (Figure 1).
The existing denture was used both for bite registration
and to take a silicone impression, which provided the basis for
implementing a temporary fixed restoration immediately after
In the maxilla, a full-thickness flap was prepared from the left
to the incisal centre and freed over a wide area for good exposure
of the zygomatic bone and the palatine bone (Figure 2). At the
left posterior tuberosity (approximately in the 28 region), a 19
mm long and 3. 5 diameter machined implant has inserted in the
pterygoid plate to provide posterior cortical anchorage (Figure
In view of the lack of bone at sites, 26 and 23-24 two hybridplates
were inserted using several osteo-synthesis screws (Figure
4). These plates in titanium grade II can be bent as required to
ensure that the implant fits the bone perfectly. In position 26 the
length of the plate was 43 mm and 9 mm wide and in position 23- 24 the plate was 41 mm long and 7 mm wide.Both plates were
covered with Matri™bone which is aresorbable, osteoconductive
bone substitute matrix consisting of hydroxyapatite, ß-tricalcium
phosphate and collagen which can be invaded with osteoblasts
and thus resorbed partially within a few months (Figure 5).
Following implant placement, closure was obtained using
3.0 silk sutures. Ultracaine anaesthetic (5 ml) was administered
and the bite registration re-taken. The procedure for the right
side has duplicated, inserting a machined 4.5/17 mm implant in
position 18 in the pterygoid plate (Figure 6).
A hybrid plate has put in position 16, 43 mm in length and 9
mm wide and another hybrid plate 41 mm 7mm wide in position
12-13 have installed and fixed with osteo-synthesis screws. Both
plates have covered with Matri™bone.
The patient received Penicillin Antibiotic cover (Augmentin
875 mg twice a day for 10 days), 2 ml injection of cortisone
(Diprophos) in the masseter muscle and Ibuprofen for pain
relief. A follow up appointment have made 5 days later, stitches
haveremoved and bite registration was re-taken.
Together with the Laboratory technician, the smile line was
fixed and the colour of teeth chosen.
At a third appointment, 5 days later, the bridge was positioned
and screwed in all positions with a torque of 15 N/cm (Figure 7).
Occlusion has checked and instructions for hygiene maintenance
has given. Regular follow up checks were scheduled for 1,3 and
then 6 months. The patient had no complications and she has
rehabilitated within 10 days from the surgery. No bone graft or
sinus-lift was required (Figure 8 & 9).
The present report has shown a successful case of immediate
loading of an atrophied maxilla with pterygoid and hybrid plates.
The pterygoidimplants, same as used in this report case, have
the advantage ofallowing anchorage in the posterior atrophied
maxilla. According a literature review , 1053 implants into
maxilla showed an average success of 90%, and the authors
concluded that pterygoidimplants have similar bone loss
level tothose of conventional implants. Another two studies
showed a viable alternativeto rehabilitate of posterior atrophic
maxilla with pterygoid implants: in 1608 implants into the
pterygomaxillary also found an average success of 90%6 and in
evaluation of 68 pterygoid implants over 1year of loading found
a success of 97% [6,7].
The hybrid implants, same as used in this report case,
have tested in fivepatients , showed good stability, and
minimum patient discomfort during 1-year postoperative period
evaluation. The successful incorporation of bone grafts relies
on following factors: surgical asepsis, soft-tissue coverage, graft
space maintenance, graft immobilization, regional acceleratory
phenomenon, host bone blood vessel and optimization of growth
factors . Matri™bone, same as used in this report case, showed
good regeneration results and quickly obtain of sufficient density
for bone implants  and, in two cases reported , generated a
volume of excellent bone around the implants.
Advances in Cortical Implantology in Europe (particularly
in France and Luxembourg) have provided alternative surgical
options for the rehabilitation of certain types of patients whose
prognosis was extremely poor or required highly invasive and
long surgical procedures.
Therefore, the described surgical technique using Pterygoid
implants, hybrid plates and biomaterials has increased the range
of treatment options for some edentulous patients who could be
unsuitable candidates for standard forms of treatment.