The significance of sinus elevation for blade implantology--report of an autopsy case

This paper describes the histopathological examination of an autopsy case featuring reconstruction of an edentulous maxilla by means of uncoated blade implants made of Titanaloy (TI6AL4V) inserted by the first author two years and seven months prior to the patient's death. The naturally induced reparative processes which encourage the success of this method and the optimal geometric flexibility allowed by the use of delicate blades are also examined. The significance of fibro-osseous tissue in blade implant support systems and the term "osseo-integration" often used in implantological literature will be discussed. The present study allows the following conclusions to be drawn: (1) Blade implants can be made in the maxilla. Provided sinus elevation is performed, blade implantation is feasible even when only minimal vertical quantities of bone are available in the distal regions. (2) Even if the opposing jaw bone (in this case the mandible) presents a complete natural dentition, blade implantation therapy remains feasible. (3) As the findings in this study show, the dynamic formation of calcified and non-calcified connective tissue around and within an endosseous implant is a totally natural reaction ensuring (a) fixation, (b) shock absorption, (c) the prevention of infection, and (d) the prevention of epithelial downgrowth. (4) Properly placed blade implants can be subjected to functional loading after six post-operative weeks and do not require a two-stage operative process, with a healing period of three to four months between the first and second surgical interventions. This often-cited three-to-four-month ossification period is thus unnecessary. (5) This case study clearly refutes the claims made by some authors (Tetsch, 1983; Strunz and Tetsch, 1985; Schramm-Scherrer and Tetsch, 1986) to the effect that (1) the maxilla cannot be implanted, and (2) blade implantology is doomed to failure, whether practiced in the maxilla or the mandible.