Implant-Prosthetic Rehabilitation of the Atrophic Poste- Rior Maxilla Using "Para-Sinusal" Implants: A Case Series

Objective: The rehabilitation of the atrophic posterior maxilla is one of the most complex challen- ges in implantology, given the reduced amount of available bone due to secondary pneumatization of the maxillary sinus and crestal resorption. Depending on the case, both Major Sinus Lift and zy- gomatic implants are definitive and consolidated solutions, but often invasive and not without pos- sible complications. The objective of this case series is to illustrate a method for partial and, in some cases, full-arch rehabilitation of the atrophic posterior maxilla, through the insertion of im- plants defined as “para-sinusal”. This protocol, which involves the use of tilted implants positioned parallel to the palatal vault, offers in both situations a decidedly minimally invasive therapeutic alternative with benefits in terms of both time and overall costs for the realization of both partial and full-arch rehabilitations. Materials and Methods: The study included patients with residual bone height less than 5 mm, where maxillary sinus pneumatization prevented the insertion of conventional axial implants wi- thout resorting to “sinus lift” techniques. Tilted implants with anchorage in the palatal bone portion of the maxilla were used, thus allowing sufficient primary support for immediate stability. The sur- gical protocol involves the use of guided templates for optimal precision in implant placement and immediate prosthetic management to ensure functionality. Results: During the follow-up period, no implants were lost and patients showed optimal healing without signs of complications. No post-operative infections, nor evidence of peri-implantitis or pathological bone resorption were found. Conclusion: The para-sinusal implant technique represents an innovation in the management of po- sterior maxillary atrophy, reducing the need for complex and invasive surgical procedures. Within the limitations of this study, the results obtained suggest that this method may represent an effective therapeutic option for the implant-prosthetic rehabilitation of patients with severe bone atrophy.