The transmaxillary implant is more conservative than the zygomatic implant, because it is installed only in the lower third of the maxilla. The zygomatic implant can reach noble regions of the face and can cause serious risks of injury to support structures, including the face, eye socket, and infratemporal fossa. Long transmaxillary implants are positioned horizontally in the maxillary bone, unlike the zygomatic implants installed in a vertical position. They are 4.3-mm-thick cylindrical implants that vary in length from 23 to 43 mm and have niches in the Morse cone platform next to the body, to couple the prosthetic components for future prosthetic rehabilitation. These transmaxillary implants are anchored from the canine abutment to the maxillary tuberosity for stability and may or may not proceed with the sinus membrane elevation technique for installation.

Preoperative planning

In the preoperative evaluation, all patients were clinically assessed for oral health status, the amount of keratinized gingiva, and the characteristics for rehabilitation: interocclusal space, inter-arch relationship (horizontal/vertical overlap), smile line, support lip, and vertical dimension. Patients with loss of size or occlusal instability were rehabilitated with a provisional total prosthesis before implant placement. All selected patients underwent maxillary computed tomography (CT) scan (Fig. 2) and intra- and extra-oral photographs were recorded. Surgical guides and bio-models were developed.

Individuals were asked to answer the OHIP-14 questionnaire. The instrument includes seven domains of the impact of life to be measured: functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. The answers given are according to a scale coded as 0 = never, 1 = rarely, 2 = sometimes, 3 = often, and 4 = always. The higher the value attributed by the respondent, the worse the perception of the problem [1].