An Innovative Technique to Immediately Load a Severely Atrophic Maxilla Without Zygomatic Dental Implants Using the 3B-TB Protocol

Zygomatic dental implants are a standard treatment option in the management of severe atrophic maxilla with a good survival rate. However, zygomatic implants have potential complications, drawbacks, limitations, and risks of failure. The 3B-TB protocol is an innovative technique to immediately load a severely atrophic maxilla without placing zygomatic implants. The aim of this technical note is to avoid zygomatic implants and their associated complications, and elaborates on the management of severely atrophic maxillae using the 3B-TB protocol of implant placement and prosthetic restoration. The 3B-TB protocol was critically planned by implementing a combination of key mechanical and surgical principles for full mouth rehabilitation. Rehabilitation of severely atrophic maxilla by this protocol does not require an implant support in Bedrossian zone 3, 2 (molar and premolar region). Long bending moments and excess micro-movements at the bone implant interface are reduced, which ultimately facilitates immediate loading, safe osseointegration, and long-term stability. Surgical techniques, combined with uniquely designed single-piece compressive multi-unit implants, support engagement even in unfavorable pterygomaxillary areas, with 2-4mm of bone width, and 2-8mm of bone height. The 3B-TB protocol is a successful and promising alternative treatment choice to other available treatment modalities like zygomatic implants and bone grafts in the management of severe atrophied maxilla with minimal to no complications.