Osseointegrated implants in the maxillary tuberosity

Although the first and second molars usually are lost first in a partially edentulous maxilla, titanium implants are seldom placed more distally than at the second premolar site because of the poor quality of bone often found in the posterior maxilla. The present series encompasses 72 Brånemark implants placed in the third molar-tuberosity area with a success rate of 93% and an average follow-up after loading of 21.4 months. Moreover, two of the failed implants were in patients who had a simultaneous successful implant contralaterally. Keys to this high success rate include the meticulous identification and correction of all pathoses, modification of the drilling sequence to maximize initial implant stabilization, achievement of bicortical fixation whenever possible, gentle handling of the soft tissues and periosteum, and elimination or minimization of transmucosal occlusal loading during osseointegration and of nonaxial loading after connection.