Impiantologia Zigomatica

Example of zygomatic implant with SurgiGuide

Image 3

The OPT of Image 3 represents the Patient's situation back in 1994: prosthesis above implants and natural pillars in the 1° and 2° toothless quadrant.

The Patient only came back to the surgery in 2009 lamenting, as a consequence of a skull-facial trauma, mobility of the upper bridge. The examination and OPT carried out (Image 4) evidenced as follows:

Image 4

- fracture of the implant in 14 (arrow)
- periodontite of 15 and 17
- mobility of implant in 16

The following were removed: the bridge, the implant in 16, the fractured stump of the implant 14, and pulled out the mobile stumps of 17 and 15. In the next surgery session were put in place: one implant in 17, one in 14 utilizing the bone tissue available between canine and the fractured implant, which was well osteointegrated (Image 5), and one in 27.

Image 5-intra-surgery RVG to control the new implant's correct positioning before completinf its insertion.

The Patient needed further pillars to complete the prosthesization but, since he refused fermly the long period required for the raising of the sinus left and right, we decided to apply the computer aided procedure, in order to better utilize the scarce bone tissue available. The ensuing study (CAT, 3D stereo lithographic model, preparation for SurgiGuide (as seen in Image 6),…….

Image 6: SurgiGuide support dental-mucose for the guided application transmucose of an zygomatic implant by 32 mm at right (green arrow) and of an alveolar implant by 14,5 mm at left (red arrow).
Note the apparently atypical orientation of the guides.

…..it was concluded with the application of a zygomatic implant on the right and an alveolar implant tilted palatally on the left (Image 7).

Image 7: the five implants on site: two applied with the aid of surgery guide (arrows), the remaining three 35 days before without surgery guide.

Image 8: Detail of the zygomatic implant applied via transmucose 7 days after the intervention.

The procedure of prosthesization does not differ from that relevant to other implants (se Image 9): some additional difficulty consists in recording with the mould, the position of the zygomatic implant which is much tilted, and the shaping of the metallic structure necessarily screwed in on the zygomatic implant with protrusion palatally at the equator of the molar. (see Image 11). On the other two implants it is possible to chose, as someone prefers, for the abutment with cementation of the prosthesis or, as we have elected to do in this case, for the screw in of the bridge on the implants.

Image 9: Test metallic structure.

Image 10- Right hand side metallic structure, detail: slanting connection on the zygomatic implant.

Image 11-Photo of the completed job: the screwing spanner still inserted in order to underline the orientation of the zygomatic implant, and with the screw holes not yet closed with aesthetic material, intraoral view………

…….and (Image 12) extraoral view of the 1° quadrant, prosthesized.

Image 13 Ex Ray OPT of the finished job. The zygomatic implant, given its tilt, is shown "slipped" in the ortopanoramic, and appears deprieved of spires and halfed in its actual length (32mm) if compared with the implant more distal to the same (14,5mm). The implant computer aided applied in 25 looks as if invading the jaw sinus, but the control CAT scan confirms that it is completely inserted into the bone palatally to the sinus.

Image 14- Image 15- Image 16

Only the post-surgery CAT scan can render the tri-dimensional idea of the implants, particularly of the zygomatic one.

The method SurgiGuide with muco-dental support applied to the zygomatic implants with transmucose access is guarantee of scarce invasiveness, implant success and early load.