Rehabilitation of the Atrophic Maxilla in Implant Dentistry: Diagnostic Principles and Therapeutic Strategies

The rehabilitation of the atrophic maxilla remains one of the most demanding challenges in implant dentistry due to reduced bone volume, poor bone quality, maxillary sinus pneumatization, and high aesthetic demands. Successful treatment requires a thorough understanding of anatomy, accurate diagnosis, and a prosthetically driven planning approach.

This lecture aims to present a structured overview of the diagnosis and treatment of atrophic maxillae, focusing on both grafted and graftless solutions. Conventional approaches such as sinus floor elevation, guided bone regeneration, and block grafts are discussed, highlighting their indications, limitations, treatment time, and morbidity. In parallel, graftless alternatives including tilted implants, All-on-X concepts, zygomatic implants, and pterygoid implants are presented as predictable options that may reduce surgical complexity and overall treatment duration.

Special emphasis is placed on cone beam computed tomography (CBCT) analysis, anatomical classifications, and decision- making algorithms that guide the selection of the most appropriate treatment modality for each clinical scenario. Prosthetic considerations, immediate loading protocols, and common complications associated with full-arch rehabilitations are also addressed.

By integrating clinical evidence, biomechanical principles, and practical guidelines, this lecture provides a comprehensive framework to support clinicians in achieving predictable functional and aesthetic outcomes when treating patients with atrophic maxillae.

Roberto Gonçalves, DDS, MSc

Current Position
Clinical Director of Dentistry, Trofa Saúde Amadora
Hospital, Portugal
Academic Training
• Doctor of Dental Surgery (DDS)
Universidad Nacional Pedro Henríquez Ureña (UNPHU)
– Santo Domingo, Dominican Republic
April 2006
• Master’s Degree in Oral Surgery, Implantology and Periodontology
Universidad Católica de Murcia (UCAM) – Murcia, Spain
May 2022
• Postgraduate Course in Fixed and Removable Prosthodontics
Universidad Nacional Pedro Henríquez Ureña (UNPHU) – Santo Domingo,
Dominican Republic
October 2008
• Homologation of Dental Degree
University of Coimbra, Faculty of Dental Medicine – Portugal
March 2009

Continuing Education & Advanced Training
• Implantology Course, Instituto Velasco – São Paulo, Brazil, March 2015
• Sinus Lift and Bone Grafting Course, Clitrofa – Trofa, Portugal, October 2019
• Zygomatic Implants Surgery Course, Clitrofa – Trofa, Portugal, November 2019
• Zygomatic and Pterygoid Implants and Mandibular Ramus Grafting
(Cryopreserved Cadaver Head Course) – Barcelona, Spain, October 2023
• Digital Smile Design (DSD) Provider Course – Madrid, Spain, May 2024
• Osseodensification (Hands-on Course), Egas Moniz School of Health & Science
– Lisbon, Portugal, May 2024