Management of Severely Angulated Implants using Both Angled Abutments and Mesostructures: A Clinical Report

Background Rehabilitation of the edentulous maxilla with a pneumatized sinus can be achieved through various approaches, including sinus lift procedures, short implants, and angulated implants. Angulated implants offer advantages by reducing cost, minimizing cantilevers, and avoiding extensive grafting. Optimal angulations (15°–45°) should be planned using cone beam computed tomography, and a surgical guide is recommended to ensure proper implant positioning for full-arch screw-retained prostheses. Case Presentation 55 y old Caucasian female presented to Prosthodontic clinic at New Jersey Dental School with a chief complaint of restoring implants with a fixed prosthesis. Upon examination, the patient had 6 maxillary implants in place with the posterior implants at severe distal angle bilaterally, and the anterior implants at a severe labial angle. An unfavorable angulation between implants remained, even after correction with 30-degree multiunit abutments. Surveying the master cast showed that a single path of insertion between all abutments was not possible. Therefore, 3 separate mesostructures were fabricated to correct the remaining angulation problems, and a prosthesis superstructure was fabricated. Threads were tapped into each mesostructure, allowing the superstructure prosthesis to be screw retained. The patient was pleased with the function, comfort, and esthetics of her new prosthesis. Conclusion Angulated implants can successfully support full-arch fixed prostheses when planned with cone beam computed tomography and guided surgery. When a single insertion path is unachievable, separate mesostructures and a superstructure can help in screw-retained rehabilitation.