Quad zygoma case with Navigation
Dr Luc Vrielinck, MD DDS Oral and Maxillofacial Surgery Comments at: Luc@Vrielinck.be Genk Belgium
Treatment plan • Total extraction upper jaw, healing • Upper jaw: Quad zygoma implant • Lower jaw: prosthetic reconstruction on short Bicon implants • Navigation upper jaw for placement of zygoma implants • Drill guide lower jaw Aporis guide
Materials and devices • Implants upper jaw: Zygoma Tiunite (NobelBiocare.com) • Lower jaw: prosthetic reconstruction on short Bicon implants (4.5 x 8 mm; 3 mm well) bicon.com • Navigation upper jaw: Brainlab.com (experimental setup) • Drill guide lower jaw Aporis guide (aporis.be) • Bio-oss and Biogide
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06/02/2010: Intake
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06/02/2010: Intake
06/02/2010: Intake
06/02/2010: Intake
06/02/2010: Intake
06/02/2010: Intake
05/08/2010: Healing after extractions
05/08/2010: Healing after extractions
05/08/2010: Healing after extractions
05/08/2010: Planning Quad zygoma upper jaw (all extramaxillary)
05/08/2010: Planning lower jaw (short implants needed on the left)
05/08/2010: Planning lower jaw (short implants needed on the left)
05/08/2010: Planning lower jaw (short implants needed on the left)
de in i u g rill d w is e a j Th r we d, o e l t r e o th upp ical s l a dent s to opt e k h than ning of t d n scan r cast a e te plas n with th n fusio eam sca b cone ages im
05/08/2010: Planning lower jaw (short implants needed on the left)
Aporis Drill guide design for the lower jaw
15/09/2010: Implant placement sheet for upper and lower jaw
Placement of 3 fiducial screws preoperatively
15/09/2010: Implant placement
15/09/2010: Implant placement
15/09/2010: Implant placement
15/09/2010: Implant placement
Working order Navigation • Antrotomy or sinus wall infracture • Registration (select best 4 points out of 6) – Infraorbital formen left and right – Spina nasalis anterior – 3 fiducial screws
• • • • •
Selection of entry point in the zygoma Selection entry point in the maxilla Drilling Implant placement External sinus lifting procedure
15/09/2010: Implant placement
Registration right fiducial screw
Registration midline fiducial screw
Registration left fiducial screw
Entry point zygoma implant 1 left
Entry point zygoma implant 2 left
Entry point zygoma implant 3 right
Entry point zygoma implant 4 right
Antrotomy anterior maxillary wall and distal infracture of bony wall
Zygoma
intraoral
Zygoma
15/09/2010: Implant placement
intraoral
4x extramaxillary implants Right side
Left side
15/09/2010: Implant placement
External sinus lifting with Bio-Oss and Biogide
15/09/2010: Implant placement
Bicon implants in the lower jaw
15/09/2010: Implant placement
15/09/2010: Postoperative radiography
15/09/2010: Postoperative radiography
15/09/2010: Postoperative radiography