CATEGORY 86 AUSTRALASIAN DENTIST CLINICAL The magic of BioMiniatures Implant rehabilitation in atrophic alveolar ridges remains one of the most complex areas of oral implantology, particularly in full-arch reconstruction. The lack of adequate bone volume and ridge width often forces clinicians toward invasive surgical augmentation procedures aimed at creating sufficient bone for standarddiameter implants. These techniques, while established, introduce significant biological and mechanical risk and require advanced surgical expertise. augmentation procedures continue to demonstrate variable long-term outcomes and remain among the least predictable steps in implant dentistry. Remote anchorage and zygomatic implants In severely resorbed maxillae where conventional augmentation is impractical, zygomatic implants have become an accepted alternative. By anchoring into the zygomatic bone, these implants bypass the atrophic alveolus and provide posterior support for full-arch prostheses. Survival rates are consistently high, systematic reviews report 96–98% survival across 5- to 10-year follow-ups (Jung et al., 2023; Aparicio et al., 2023), yet the associated surgical risks remain substantial. Complications include sinusitis, oro-antral communication, soft-tissue dehiscence, and, in rare cases, orbital penetration or zygomatic fracture. A metaanalysis in Journal of Implant Dentistry (2023) reported sinus pathology as the most frequent postoperative issue, while earlier data by Chrcanovic et al. identified a notable incidence of persistent sinusitis requiring secondary intervention. These procedures demand extensive surgical training, advanced imaging, and precise angulation control to avoid catastrophic outcomes. While zygomatic implants can deliver function in cases once deemed untreatable, their invasiveness, patient morbidity, and potential for severe complications restrict their routine use. They represent a surgical solution for extreme cases rather than a universal approach to atrophic ridge management. The limitations of the all-on-4 approach The all-on-4 protocol, designed to support a full-arch fixed restoration on four implants, revolutionised implant dentistry by reducing the number of implants and surgical interventions. Tilted posterior implants extend the anteroposterior spread, avoiding critical anatomical structures such as the maxillary sinus or mandibular nerve. Long-term data show survival rates of 95–98% in both arches (Maló et al., 2019; Gallucci et al., 2021). Minimally Invasive Implantology By Dr Omid Allan Dr Omid Allan The burden of conventional augmentation procedures Traditional surgical strategies for ridge reconstruction include ridge-split techniques, guided bone regeneration (GBR) with membranes and particulate grafts, block grafting (autogenous or allogeneic), titanium mesh augmentation (customised or conventional), and advanced grafting systems such as Khouri or ring graft techniques. These methods share several disadvantagesmultiple surgeries, prolonged healing, graft resorption, and high complication rates. Soft-tissue complications remain the leading cause of graft failure. A systematic review by Sanz-Sánchez et al. (2022) highlighted wound dehiscence, graft exposure, and infection as the most common early complications following bone augmentation procedures. Another meta-analysis by McKenna et al. (2022) reported significant donor-site morbidity in autogenous graft harvests, often involving secondary surgical fields. In many cases, Exposed Ti Mesh Exposed Membrane graft resorption between 10–30% occurs within the first two years, compromising implant placement and aesthetic outcome. Titanium mesh-based augmentations, though structurally stable, frequently suffer exposure rates between 15% and 25%, as reported by Gu et al. and Zhou et al. Such exposure often leads to bacterial contamination, partial graft loss, or total graft failure. The underlying issue lies in soft-tissue tension and insufficient vascularisation of the grafted area. Once exposed, the reconstructive site rarely regains predictable integration, and subsequent implant therapy becomes more complex. In addition to the biological risks, these methods substantially increase the cost, duration, and morbidity of treatment. The need for hospital-based procedures, secondary donor sites, and extended recovery periods often limits patient acceptance. Despite their long history, Gu, Chunning et al. "Titanium Mesh Exposure in Guided Bone Regeneration Procedures: A Systematic Review and Meta-analysis." International Journal of Oral & Maxillofacial Implants 37.1 (2022)
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