Surgical Anatomy of the Atrophic Maxilla

Advanced maxillary atrophy is one of the most common clinical scenarios in which implant placement could become difficult. Unfortunately, a considerable number of patients show a condition of severe maxillary atrophy with an advanced loss of bone due to previous dental extractions or natural atrophy of the edentulous maxilla. Nevertheless, a volumetric evaluation of the anatomical structures, using suitable diagnostic software, could facilitate diagnosis and implant planning. A computed tomography (CT) scan allows for a better understanding of the jaw’s anatomy and morphology, evaluating the volume of the remaining bone at any given site, particularly when considering an implant rehabilitation for an immediate load. In patients showing a significant degree of bone atrophy, an implant-supported treatment plan can rely on three-dimensional (3D) imaging of the residual bone as a guiding tool to establish the most effective implant position for each specific case. Pre-surgical diagnosis has become more accurate owing to 3D radiodiagnostic techniques, which have expanded the planning accuracy and therefore the applicability of the surgical implant procedure even in significantly atrophic cases. Through the diagnostic software’s multiplanar view matched with the implants’ virtual position, a more accurate, individual and three-dimensional study of the remaining bone is now possible. Different surgical techniques such as sinus lifting, trans-sinus implantology or bone splitting can be planned, in extreme atrophic patients, after an accurate individual anatomical evaluation. In this chapter, the anatomical landmarks and topography of the atrophic maxilla are described via 3D radiological images for a better comprehension of every different case.