The rehabilitation of the compromised maxilla using the Bone Truss Bridge (BTB) approach

Rehabilitation of the severely compromised maxilla remains a significant clinical challenge, particularly in patients presenting with advanced atrophy, pneumatized sinuses, and limited residual bone volume. The Bone Truss Bridge (BTB) approach has emerged as a minimally invasive, graft less alternative that exploits multiple cortical anchorage sites to create a stable, biomechanically efficient foundation for full-arch rehabilitation. Inspired by bowstring truss engineering principles, this concept combines strategically distributed, long, thin implants engaging dense cortices in the pterygoid, pyriform/nasal floor, and anterior maxilla to generate a three-dimensional “truss-like” support for an immediately loaded, screw-retained prosthesis. This abstract describes the clinical and prosthetic workflow for BTB-based rehabilitation of the compromised maxilla and highlights its main indications, advantages, and limitations. Following prosthetically driven planning and three-dimensional imaging, implants are placed using a flap or limited flap approach, aiming for high primary stability in atrophic posterior and anterior segments while avoiding sinus grafting, extensive ridge augmentation, or zygomatic implants. A milled metal framework with angulated screw channels is then fabricated to splint the implants, optimize load distribution, and allow retrievability in case of biological or mechanical complications. Reported benefits include reduced surgical morbidity, shorter treatment times, decreased need for ancillary grafting procedures, and high patient satisfaction with function and aesthetics.