Guidelines Now Include Edentulous Maxilla Management



The edentulous maxilla often presents with a range of challenges and solutions that can be difficult for individual clinicians to navigate. To help them make choices that best utilize current research and improve the quality and efficiency of patient care, the Academy of Osseointegration (AO) has expanded its Clinical Practice Guidelines to include management of patients with no teeth in the upper jaw.

“Advanced technology has provided dentistry with enhanced diagnostic tools, improved materials, and better prosthetic options for managing the edentulous maxilla, making a growing number of patients eligible for implant therapy as opposed to the traditional denture,” said AO board member Clark Stanford, DDS, PhD.

“Responsibilities for clinicians managing the edentulous maxilla have also multiplied, which is why AO has sought to define the issues, develop a process, and create a model that can quickly be applied to practice,” said Stanford, who also is the University of Illinois at Chicago (UIC) Distinguished Professor and dean of the school’s College of Dentistry.

In August of 2014, AO hosted the Consensus Summit, which brought together 120 global scientists and clinicians from key professional organizations to conduct a systematic review of the current literature, clinical information, and accepted treatment approaches for the management of the edentulous maxilla.

The results of the meeting, including supporting systematic reviews and detailed clinical practice guidelines, were published in a special edition of the International Journal of Oral and Maxillofacial Implants, Volume 31, Supplement 2016. AO members can access this supplement on the organization’s website.

“The next step is to gain approval by the National Guidelines Clearing House, which provides a formal policy-based stamp of approval to help drive adoption across the profession,” said Stanford.

The guidelines cover 5 domain areas: the role of grafting for ridge development for implant placement, the role of implant design and systems in management of the edentulous maxilla, the role of imaging to guide implant placement, the role of biologics to assist in ridge development, and the role of prosthetic management.

According to the AO, these domains address key questions clinicians should consider for each specific patient, including:

  • What is the maxillary/mandibular ridge relationship?
  • What is the quality and quantity of available hard and soft tissue?
  • Can the patient maintain adequate oral hygiene?
  • Do habits or disease put this patient in an at-risk category?

“Management of the edentulous maxilla cannot be one size fits all,” said AO board member Tara L. Aghaloo, DDS, MD, PhD, professor and assistant dean for clinical research at the Division of Diagnostic and Surgical Services, University of California, Los Angeles School of Dentistry.

“That’s why clinical practice guidelines are so important for dentistry, especially implant dentistry. Some treatment options require advanced training and skill and should not be performed by less experienced clinicians, at least not without the proper training,” Aghaloo said.

“The future is extremely bright for the management of the edentulous maxilla, whether it is severely atrophic or not,” added Aghaloo. “It is apparent that technology will continue to improve, resulting in implants that can be loaded sooner and used in more compromised sites.”

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