Quad zygoma case 2

Quad Zygoma Report of a Case Luc@Vrielinck.be

Situation at Intake • Patient desires: replacement of failing bridge in the Upper Jaw • Team: – Prosthetics: – Surgery:

Ronny Schreurs Luc Vrielinck

• Findings: – Pre existing teeth- supported bridge (>15 year) – Recent trauma to the upper jaw with sudden increase in mobility of the bridge – Periodontal breakdown of several teeth in UJ – Periodontal care needed in the lower jaw

• Medical History – ♂: 50 year old – Non contributing medical findings – Smoker: however quit smoking completely after initial consultation

Intake 29/01/2015

29/01/2015: combined periodontal pathology and traumatic injury to the upper jaw

Treatment plan

Initial Treatment Plan • Total teeth extraction in the upper jaw • After 2 months healing: proceed with implant treatment as requested – Type of implant treatment will be chosen later depending on available bone volume – NB: Extraction therapy and immediate implant therapy was not considered, since approval for implant treatment had to be obtained through an insurance company, and this took some time.

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29/01/2015: combined periodontal pathology and traumatic injury to the upper jaw

23/04/2015: Evaluation of bone volume after teeth extraction UJ

23/04/2015: Evaluation of bone volume after teeth extraction UJ

23/04/2015: Evaluation of bone volume after teeth extraction UJ

23/04/2015: Evaluation of bone volume after teeth extraction UJ

23/04/2015: Evaluation of bone volume after teeth extraction UJ

23/04/2015: Evaluation of bone volume after teeth extraction UJ

Bone Table Width Heigth

23/04/2015: Evaluation of bone volume after teeth extraction UJ

15

12

22

24

Planning for right distal zygoma

Planning for right mesial zygoma

Planning for left mesial zygoma

Planning for left distal zygoma

23/04/2015: Final treatment plan based on bone volume analysis

Discussion of the different treatment options with the patient • Periodontal therapy in the lower jaw (ongoing) • Smoking stopped • For the upper jaw – Full denture – Implant treatment upper jaw • Autogenous bone reconstruction and placement of 6 standard implants • 6 x short implants (requiring alveolectomy on the left side and bilateral sinus lifting) • Quad zygoma implants

– Fixed bridge versus fixed, removable – Delayed versus immediate loading – Fully informed consent on possible surgical, implantological and prosthetic complications

Surgical Procedure 07/08/2015

07/08/2015: Sugery with placement of 4 zygoma implants

Blue line: bone to be removed (= anterior wall of maxillary sinus)

Drilling trajectories in the zygomatic bone

Implant placement according to Stella’s technique

07/08/2015: Sugery with placement of 4 zygoma implants

View after placement of the 4 zygoma implants before covering them with Bio-Ossďƒ’ and Biogideďƒ’

4 multiunit abutments and healing caps connected to the zygoma implants. View after suturing

07/08/2015: Sugery with placement of 4 zygoma implants

Postoperative Radiography 25/08/2015

25/08/2015: Postoperative control radiography

Note the nearly perfect parallelity of the abutments

25/08/2015: Postoperative control radiography

25/08/2015: Postoperative control radiography