Oral Rehabilitación with Convencional and Zygomatic Implantes

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Posted on By José Ferreira In Implants

Patient with 50 years old that wanted to have the return is aesthetics. He wanted fixe teeth. Most of the maxilar remaining teeth were in a bad shape and the nasal sinus begins in the central incisors apex in a very unfavorable way for conventional implants. Zygomatic and convectional implants were made to able us to do an immediate load in the day of the surgery, occupying all the maxilar bone available.

CB CT Planning
DSD

Incison and prep.
Right Zygomatic


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3 Comments

Great skill and planning. My only questions are why you chose Zygomatic in posterior when perhaps a short or distally angled fixture could have been added to anterior conventional implant? 2nd, I often wonder how Zygomatic splinted to conventional implants work from a biomechanical load standpoint as conventional implants are immobile where as there remains some movement on the Zygomatic implants? How does this work longer term on load, bone loss, screw and fixture loosening or fracture? Any articles that address this? Thanks again for sharing this wonderful case and therapy. Dr. Salama


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Thank you for your comment and your interest in the case Dr. Salama.

I can ensure you that we took the decision of going zygomatic after an extensive analysis of all the possible scenarios. Here in the comments I am afraid its impossible to back our decision with only some images of the CB CT, but I am going to try any way. If any one have the interest, I can send a film of the CB CT analysis or the CB him self. As you will see in the images I send here of the 2 sides of the maxilar, after the 13 and the 22, there wasn't any bone at all, at least for our skills.

We have made the extraction of both molars (they had some movement) and we did bone grafting on both tooth sites. we have decided to wait 6 months before doing the implants on the 17 and 27. In our point of view it was impossible to do any implant in the 7º molars site without previous grafting as you can see in the molar image and it was impossible to do a predictable immediate load on a molar to molar temporary prosthesis (as the patient desired) without the Zygomatic implants on the 2º premolar position.

At this point we are just waiting 1 more month for the osseointegration of the 2 posterior implants (17 and 27) to start the final ceramic prosthesis. This is precisely because of your 2nd question about the different movements between Zygomatic and convencional implants. You are absolutely right. The only way of avoid them its to stabilize the prosthesis with an implant on the back of the Zygomatic, even if its a short one or a Pterygoid implant, to reduce the cantilever effect. This way the Zygomatic will behave like a normal implant, a position supported by Prof. Alexander Salvoni and his immense clinical experience in Zygomatic rehabilitation. On the other end, we have done the Zygomatic implants using the extra-sinus technic. Some studies confirm that this alveolar bone support effect reduces the internal stresses generated by occlusal and lateral forces:(Effect of alveolar bone support on zygomatic implants in an extra-sinus position – an FEA study; by Freedman, Michael;Ring, Michael;Stassen, Leo F.A. in International Journal of Oral and Maxillofacial Surgery).

There are also an article from Dr. Carlos Aparicio concluding "that an extrasinus approach can be utilized when placing zygomatic implants in patients with pronounced buccal concavities in the posterior maxilla. Moreover, the technique results in an emergence of the zygomatic fixture close to the top of the crest, which is beneficial from a cleaning and patient-comfort point of view." (Extrasinus Zygomatic Implants: Three Year Experience from a New Surgical Approach for Patients with Pronounced Buccal Concavities in the Edentulous Maxilla.). Other authors conclude that "The problems reported so far that are related to the zygoma procedure are not severe and are within the magnitude of what is experienced with other methods." as in "Zygomatic Implants/Fixture: A Systematic Review" by Ashu Sharma, MDS, G. R. Rahul, MDS.

But, at the end, I must confesse that there is still a great need of studies and long term follow-ups to put the Zygoma implants predictability in the same level of the convencional ones. Nevertheless, there is some kind of unexplainable myth around zygomatic implants that unable them to be a greater part of oral rehabilitation. there is already a lot of studies and articles supporting there use comparing to the enormous, time consuming, less predictable, more patient behavior dependent bone grafts, sinus lifts and "impossible" convencional implants. In our opinion, Zygomatic implants are only another time of different implants, with a very good predictability and patient acceptance, and they can be done in a normal dental office with local anesthesia or with sedative procedure. There is a very good article about it by Prof. Alexander Salvoni:

"Evaluation of satisfaction of individuals rehabilitated with zygomatic implants as regards anesthetic and sedative procedure: A prospective cohort study"

-I don't have it with me now but tomorrow in the clinic I will include the final Xray with the posterior implants.

bone measurements
Bone on the 27 tooth


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Here it is, the Orthopantomography after the posterior implants (3 months).


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