We not only have to be prepared to place zygoma implants, but also have to be prepared when things go wrong By Dr. Luc Vrielinck Luc@Vrielinck.be
Surgery: Luc Vrielinck Prosthodontics: Tom De Wit Xentro Dental, Genk, Belgium
Patient History • Medically uncompromised • ♀ 48 y • Quad zygoma treatment with: – Extramaxillary placement of both anterior zygoma implants and distal zygoma implant on the left side – Right dorsal zygoma implant: intrasinusally
• Followed by dehiscence and recurrent ascending infections to the cheek • Secondary attempts for closure of the dehiscence failed • Patient requests removal of the two zygoma implants on the left side
Starting Point
2011: Two year follow-up: radiographically everything is OK
The Problem
Dehiscence of the gingiva and mucosa overlying the implants in location 12 22 and 24 with chronic inflammation of the soft tissues of the cheek
After removal of both Zygoma implants on the left hand side
Temporary replacement of the bar and removal of the clips in the prosthesis frontally and on the left side
CBCT Crossectional images
11
21
12
22
13
23
14
24
15
16
25
26
Bone Volume at Selected Locations
21
22
23
24/25
Rescue Treatment Placement of 4 Bicon implants with simultaneous sinus lifting
Placement of 4 Bicon 4,5 x 6 mm (3,0 mm well)
Bio-oss and Biogide
The prosthetic treatment plan was to opt for a fixed bridge This was a unique challenge to combine the zygoma implants with multiunit abutments, to the locking taper mechanism of Bicon abutments.
Second stage: placement of 5x6 healing abutments
Postoperative situation in Nov.2012
Master cast with milled Bicon abutments
Trinia™ bridge
Trinia™ bridge on master cast model
Finalised bridge cemented in place
2013: Final situation
2013: Final situation
2013: Final situation