Implant placement in the maxillary tuberosity: the Summers' technique performed with modified osteotomes

Abstract

The maxillary tuberosity region is becoming increasingly involved in preprosthetic surgery as part of a comprehensive implant treatment planning. The lower success rates in osteointegrated implant placements seen in the posterior regions of the upper maxilla as compared to the anterior regions of the jaws, most often come from bone quality types and the presence of the maxillary sinus. In order to overcome these limitations and obtain a successful result in such a demanding area, several authors suggest that long implants (15.0 to 20.0 mm long) should be placed in the maxillary tuberosity region as an alternative to sinus floor elevation. The challenges frequently associated with the surgical placement of "maxillary tuberosity implants" (MTI), can be reduced through a "Ridge Expansion Osteotomy" (REO) procedure as described by Summers (1994). This indeed improves the recipient bed bone quality and causes no bone overheating. In order to improve this technique performed for MTI, in co-operation with Ing. Albanese G, authors have developed different prototypes of modified osteotomes. A case report using these new instruments is presented. Clinical and radiographic evaluations are obtained.

Placement of dental implants in the maxillary tuberosity: a systematic review

“…However, a strict protocol was adopted; the authors used adequate primary stability, careful management of bone tissue, and a minimum length of 13 mm for implants, and finally all implants were fully submerged and allowed to osseointegrate unloaded for 6-8 months. On the other hand, Nocini et al, 36 in a case report, stated that corticalization of an implant with suitable surface treatment reduces the need for bicortical anchorage in the pterygoid processes, thus reducing the risk of tuberosity fracture. Longitudinal clinical studies should be performed in order to analyze the geometry and surface treatment of implants for the posterior maxillary region.…”

“…[49][50][51][52][53] Since there are few studies addressing the topic, relevant excluded clinical studies are summarized in Table 2. 22,28,29,36,41 These studies indicate a high predictability of implants placed in the tuberosity region; the survival rate was 100%. 22,28,29 The inter-reviewer agreement for all studies (kappa = 1.0) and the abstract (kappa = 1.0) indicated no disagreement.…”

“…Twenty full-texts were excluded for the following reasons: clinical case studies, 22,[28][29][30]36,40,41 biomechanical study, 42 orthodontic study, 43,44 data not localized, 45 morphometric study, 46 in vitro study, 47 anatomical and radiological study, 35,48 and implants not placed in the region of the tuberosity or missing data. [49][50][51][52][53] Since there are few studies addressing the topic, relevant excluded clinical studies are summarized in Table 2.…”

“…Clinically, there is evidence that implants positioned in the tuberosity region show suitable outcomes in patients with atrophied jaws 21,[26][27][28]36 and in patients with severe maxillary defects. 22 In addition, easy access and visibility of the site of the tuberosity 36 facilitate the surgical procedure.…”

CBCT evaluation of buccal bone regeneration in postmenopausal women with and without osteopenia or osteoporosis undergoing dental implant therapy

“…9,10 Localized alveolar bone expansion through the use of hand and rotational osteotomes, with or without particulate grafting, is also a commonly accepted approach. [11][12][13] Although one or a combination of these procedures has been used to gain bone volume in normal individuals, success in those with compromised systemic bone health remains to be clarified. The introduction of 3-dimensional (3D) cone beam computed tomography (CBCT) imaging to enhance preoperative treatment planning has proved valuable for implant dentistry.…”