Immediate fixed rehabilitation of the edentulous maxilla: A prospective clinical and radiological study after 3 years of loading

Purpose: The aim of this study was to prospectively evaluate the clinical and radiographic outcomes of immediate full-arch fixed maxillary prosthesis supported by two axial and four tilted implants after 3 years of loading. Materials and Methods: Thirty-two patients with atrophic maxilla were consecutively enrolled and treated. Each patient received a fixed full-arch maxillary rehabilitation supported by four tilted implants that engaged the posterior and the anterior sinus walls and two axial anterior implants. A total of 192 implants (30 Brånemark System MK IV and 162 NobelSpeedy Groovy, Nobel Biocare AB, Göteborg, Sweden) were inserted and immediately loaded. The definitive restorations were placed 6 months later, and follow-up visits were scheduled every 6 months. During follow-ups, marginal bone loss (MBL), plaque and bleeding scores, and patient's satisfaction were recorded. Results: All patients reached at least 3-year follow-up examination (range 36-78, average 55.53 months). Two tilted implants failed before delivering the definitive restoration, resulting in a cumulative survival rate of 98.96%. All final prostheses were stable and functional, resulting in a cumulative survival and success rate of 100%. At the 3-year follow-up there was no significant difference in MBL between axial (1.55±0.31mm) and tilted implants (1.46±0.19mm) (p=.05). Plaque and bleeding scores decreased over time, while patient's satisfaction in both aesthetics and function increased. Conclusions: Implants placement with this configuration could be considered a predictable and cost- and time-effective alternative approach for the immediate restoration of the edentulous maxilla, avoiding bone grafting procedures, even with a medium-term follow-up.