Use of long implants as an alternative for severely atrophic maxilla: a clinical case report

Severe edentulism, particularly in older adults, represents a significant public health concern due to its functional, aesthetic, and psychological consequences. Implant-based rehabilitation of the atrophic maxilla remains a clinical challenge, primarily because of extensive bone resorption and maxillary sinus pneumatization, which limit the feasibility of conventional implant placement. This article presents the case of a 65-year-old male with advanced tooth loss, successfully rehabilitated using the All-on-4 protocol with long (25 mm) trans-sinus implants anchored in the canine pillar region. The procedure was complemented by autologous dentin block grafting for sinus floor elevation. Virtual surgical planning with a stereolithographic model enabled accurate and stable implant placement, achieving sufficient insertion torque to allow immediate loading. This technique avoided the need for more invasive procedures such as extensive bone grafting or the use of zygomatic implants. Autologous dentin proved to be a biocompatible and osteoconductive material, demonstrating good tissue integration and minimal resorption. This surgical-prosthetic approach offers an effective and less invasive alternative for the rehabilitation of severely atrophic maxillae, allowing for functional and aesthetic restoration within reduced treatment timelines. However, further studies with larger sample sizes and long-term follow-up are necessary to validate these preliminary outcomes and refine clinical protocols.