Implant repositioning with segmental osteotomy

Abstract

IntroductionThe aim of this study is to assess a pioneering technique for atrophic premaxilla restoration. The objective is to reposition an implant reconstruction zone into a position both anatomically and physiologically suitable for occlusal function. Indeed, unlike the other few articles published on the correctional osteotomy of the implant in an inadequate situation, we have planned here an initially «unsuitable» insertion in order to benefit of the available bone mass. Material and method3 patients aged 14–20 years old (1 woman and 2 men) were operated on at the maxillo-facial department of Lille 2 University Hospital for partial implant-prosthetic rehabilitation on atrophic maxillary and/or mandibular sector.13 implants were seated (85% in the maxilla) in the native bone then moved subsequently by segmental osteotomy. ResultsThe patients were assessed both clinically and radiologically according to the functional and aesthetic criteria of implant-prosthetic restoration.Functionally, a biomechanically favourable implant/number of teeth ratio (80%) was achieved, with consistent occlusal relationships (centric positioning of the midline point and absence of crossbite) in 100% of cases. Aesthetically, the screw access hole is systematically non-apparent (100%) but has a prosthetically substituted reduced gingivo-alveolar architecture. DiscussionThese observations suggest that implant repositioning with segmental osteotomy allows for atrophic premaxilla restoration in implanted bone volume whatever the initial angulation.Peri-implant aesthetic difficulties are not specific to the technique suggested here but are quite common to all premaxilla reconstruction techniques.Lastly, this group of three patients is not enough to be conclusive, and a larger group would be necessary to validate this type of management.