A clinical case created in ImplaStation by Dr. Maxym Prytula (Ukraine)
Severe pneumatisation of the maxillary sinus remains a challenge in many full-arch cases due to limited anatomy. While zygomatic implants have been the gold standard for many years in solving such cases, with the advancement of implant designs, biological understanding and guided techniques we are now looking towards expanding the limits of remote anchorage techniques, specifically trans-sinusal approaches, to limit potential complications associated with zygomatic implant placement & sinusitis.
In recent years we have been utilising a technique which we started to call the “Trans-Sinus V-II-V” , mirroring the original V-II-V technique proposed by Prof. Dr. Enrico Agliardi (Italy) , in cases of severe pneumatisation, in which both the tilted Zone 2 (nasal) and Zone 3 (Pterygoid) are placed via a trans-sinusal approach. This approach tackles and solves both anatomical & prosthodontic challenges, allowing anchorage with high primary stability into the canine pillar and pterygomaxillary complex and eliminating cantilevers for optimal AP-spread , even allowing for Monolithic Zirconia restorations to be used due to the Pterygoid implant emerging usually in the first molar area.
As an added bonus, bone formation in observed around the trans-sinusally placed implants in the following months, ensuring high secondary stability of the implant in an otherwise area of bone-deficiency. Overall, while the market pushes the use of zygomatic implants in cases of severe pneumatisation, it is important to consider alternative approaches and evaluate their benefits to both the doctor and the patient.
