Fractures of long zygomatic implants Two case reports Luc@Vrielinck.be
• Case 1: Fixed bridge UJ on 4 standard and two long implants (pterygoid anSurgeonorage). Fracture of both long implants • Case 2: Quad zygoma implant with unilateral fracture of both long implants
Case 1 18081941
Situation • Patient whishes: Fixed prosthesis in upper and lower jaw • Team: – Dentist: – Surgeon:
Marc Pauwels LV
• Bevindingen: – UJ: Dorsal bone atrophy – LJ: Sufficient bone volume
• Treatment plan: – LJ: 6 implants, delayed loading, implant supported bridge – UJ: 4 implants, 2 long implants with pterygoid anchorage, delayed loading, implant supported bridge
Surgeonronology • • • •
03/01/2002: 09/07/2002: 17/11/2008: 22/11/2010:
Implant placement UJ and LJ Second stage Follow up 6 years Follow up 8 years
27/03/2001: Intake
27/03/2001: Scanning template
Scanning template
planned implants
27/03/2001: Implant planning
drill guide
Scanning template
planned implants
27/03/2001: Implant planning
drill guide
Scanning template
planned implants
27/03/2001: Implant planning
drill guide
Scanning template
planned implants
27/03/2001: Implant planning
drill guide
Scanning template
planned implants
27/03/2001: Implant planning
drill guide
Scanning template
planned implants
27/03/2001: Implant planning
drill guide
Upper jaw implant placement 4 standard implants 2 long implants with pterygoid anchorage Using SurgiGuide™
Placing the surgical template
‌ and guiding tubes
03/01/2002: Implant placement UJ and LJ
Placing the surgical template
drilling of the long implant
03/01/2002: Implant placement UJ and LJ
Drilling right posterior long implant
‌ and the left
03/01/2002: Implant placement UJ and LJ
After drill guide removal
probing in the direction of the posterior long implant
03/01/2002: Implant placement UJ and LJ
Lower jaw implant placement 5 standard implants Using SurgiGuide™
03/01/2002: Implant placement UJ and LJ
Fixation of the drill guide with Osteosynthesis screws
initial drilling
03/01/2002: Implant placement UJ and LJ
3 mm width drilling
after removal of drill guide
03/01/2002: Implant placement UJ and LJ
03/01/2002: Implant placement UJ and LJ
Implant placement (freehand)
end of the procedure
03/01/2002: Implant placement UJ and LJ
09/07/2002: Second stage
27/08/2002: Try-in
27/08/2002: Try-in
27/08/2002: Try-in
Follow-up 17/11/2008 6 years follow-up after several teeth fractures and 1x bridge loosening
17/11/2008: follow up
Follow-up 8 years 22/11/2010 Bridge lossening: fracture of 3 implants
22/11/2010: FU 8 years
22/11/2010: FU 8 years
22/11/2010: FU 8 years
22/11/2010: FU 8 years
22/11/2010: FU 8 years
22/11/2010: FU 8 years
22/11/2010: FU 8 years
22/11/2010: FU 8 years
22/11/2010: FU 8 years
22/11/2010: FU 8 years
t he , t n a l p m oma i For zyg curs along the oc fracture rew ! c s c i t e prosth
22/11/2010: FU 8 years
For standard implant the fracture occurs just below the apical part of the prosthetic screw
Case 2 10/06/1937
Situation • Patient whishes: Fixed prosthesis in upper jaw and lower jaw • Team: – Dentist: – Surgeon:
Lieven Barbier LV
• Bevindingen: – UJ: Dorsal bone atrophy – LJ: Sufficient bone volume
• Treatment plan: – LJ: 4 implants, delayed loading, implant supported bridge – UJ: Quad zygoma, implant supported bridge (2piece)
Surgeonronology • 29/11/2000: Placement Quad zygoma • … intermittent data missing because patient moved out of the region … • 06/10/2008: Fracture of the suprastructure (implants were intact) • 20/12/2010: Fracture of the two zygomatic implants on the right side
06/10/2008
plants m i 2 f th e o s d a He en off k o r b are
20/12/2010
Discussion • Similarities between the two cases: – Old type zygoma implant (with longer perforating prosthetic screws) – Both cases about 7 -8 year in function – Antagonistic jaw has implant supported bridge – Both patients are bruxists – Both patients had a 2-unit suprastructure in the UJ attaSurgeoned by a central connection