Treatment of the Complete Edentulous Atrophic Maxilla: The Tall Tilted Pin Hole Placement Immediate Loading (TTPHIL)-ALL TILT™ Implant Option

AIM: A severely atrophied maxilla presents serious limitations for conventional implant placement and the reconstruction of which requires extensive surgical treatments. This original article presents an overview of this evidence-based technique used for maxillary rehabilitation. BACKGROUND: Growing patients' needs to regain proper oral function with limited surgical effort presents a challenge to the surgeon for implant placement in harmony with the planned prosthesis. Different techniques and protocols have been put forward through the ages to improve implant survival, osseointegration, and quality of life. A new technique-Tall Tilted Pin Hole Immediate Loading (TTPHIL-ALL TILT™ technique)-utilizes angulated long bicortical tapered implants placed in a flapless way in immediate loading with screw-retained prosthetic solutions. TECHNIQUE: TTPHIL-ALL TILT™ technique involves flapless subcrestal bicortical placement of a total of six tall threaded tilted implants engaging the nasal cortex and the pterygoid pillars, rigidly splinted maintaining adequate anteroposterior spread, achieving proper primary stability, fit for immediate loading. Screw-retained prosthetic solutions are provided with the elimination of distal cantilever. CONCLUSION: The TTPHIL-ALL TILT™ technique can facilitate surgical rehabilitation of patients with maxillary resorption, as an alternative to other graft less and grafting procedures. CLINICAL SIGNIFICANCE: TTPHIL-ALL TILT™ technique provides a graftless solution for the challenging resorbed maxillary edentulous ridges. By following this protocol, primary stability is achieved which gives way for immediate loading satisfying the patient's functional and aesthetic needs.