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.
X
X X
X
X
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