Staged Implant Protocol For Severe Alveolar Atrophy

For patients with severe bone defects or poor bone quality, staging the procedures of anterior maxillary implant placement with bone augmentation and bilateral maxillary sinus floor elevation via the lateral window approach can reduce postoperative swelling and alleviate both physiological and psychological stress. A 64-year-old male presented with a chief complaint of multiple missing teeth for over a decade. Clinical examination revealed partial edentulism (only tooth #37 remaining) and severe alveolar atrophy. A cone-beam computed tomography (CBCT) imaging showed that the residual bone height ranged between 1 and 3 mm in the area of teeth numbers 16, 17, 26 and 27. Considering the patient's moderate anxiety and financial constraints, a staged treatment protocol was implemented. The first stage involved implant placement in the anterior maxilla and the mandible, combined with guided bone regeneration (GBR), and immediate loading. The second stage involved bilateral posterior maxillary sinus floor elevation via the lateral window approach, with delayed implant placement. This treatment protocol employs immediate loading during the initial surgeries to rapidly restore occlusal and aesthetic functions. Characterized by minimal postoperative trauma and mild swelling, it leads to high patient satisfaction. Building on the trust established in the early stage, patient compliance is significantly improved during the subsequent surgeries. This comprehensive strategy, focusing on function, aesthetics, and psychological well-being, is designed for patients with severe alveolar atrophy, particularly those with poor surgical tolerance.