Reconstruction of a severely atrophied maxilla using titanium-reinforced membranes: A case report.

Abstract

Background: Severe maxillary alveolar ridge atrophy secondary to advanced periodontal disease presents a challenge for implant rehabilitation, particularly in patients with systemic comorbidities. Guided bone regeneration combined with sinus augmentation may provide an alternative to remote anchorage implants when conditions permit. This case has educational value for clinicians by illustrating a staged reconstructive approach for severe maxillary atrophy, including complication management and subsequent implant rehabilitation.

Methods: A 55-year-old male with uncontrolled diabetes mellitus presented with maxillary edentulism with severe horizontal and vertical bone loss of the maxillary arch due to a history of periodontal disease and requested implant-retained overdenture rehabilitation. After consultation regarding remote anchorage implants, the patient elected a staged regenerative approach. Glycemic control was optimized prior to surgery, with hemoglobin A1c reduced from 8.9% to 7.6%. Bilateral lateral window sinus augmentation was performed, followed by a 5-month healing period. Subsequently, full-arch guided bone regeneration using particulate grafting and a titanium-reinforced polytetrafluoroethylene membrane was completed. Membrane exposure occurred on the left side at 4 months and was managed by membrane removal.

Results: Cone beam computed tomography obtained 9 months after guided bone regeneration demonstrated adequate vertical and horizontal ridge dimensions to permit implant placement. Four implants were placed to support a maxillary implant-retained overdenture. At 1-year follow-up, peri-implant soft tissues and supporting bone levels remained stable.

Conclusion: This case demonstrates that a staged regenerative approach combining sinus augmentation and guided bone regeneration can facilitate implant-supported overdenture rehabilitation of a severely atrophied maxillary arch in a patient with controlled systemic risk factors.

Key points: Staged regenerative therapy combining sinus floor augmentation and guided bone regeneration can facilitate implant placement in the severely atrophied maxilla when systemic conditions are appropriately managed. Titanium-reinforced non-resorbable PTFE membranes provide effective space maintenance for full-arch ridge reconstruction; however, membrane exposure remains a recognized complication that can be managed without compromising subsequent implant placement. Optimization of glycemic control and careful surgical planning may allow successful implant-retained overdenture rehabilitation in patients with a history of advanced periodontal disease and controlled diabetes mellitus.

Plain language summary: Severe bone loss in the upper jaw can make placement of dental implants difficult, especially in patients with medical conditions such as diabetes. Some patients are offered alternative implant options that anchor into distant bones; however, these approaches may not be suitable or preferred by all individuals. This case report describes the treatment of a 55-year-old man with advanced bone loss in the upper jaw caused by periodontal disease. After improving his blood sugar control, a staged treatment approach was used to rebuild the lost bone. This included sinus augmentation and guided bone regeneration using a protective membrane to allow new bone to form. During healing, part of the membrane became exposed and was removed. Despite this complication, sufficient bone developed to allow placement of dental implants. Four implants were placed to support an implant-retained overdenture. At 1-year follow-up, the implants and surrounding tissues remained stable. This case shows that, with careful planning, medical optimization, and staged bone regeneration, implant rehabilitation of a severely resorbed upper jaw may be possible even in patients with controlled systemic risk factors.