Featured Case 04/22: 'QUAD' ZYGOMATIC IMPLANTS

Patient:

Ed is a 72-year-old gentleman with a fairly unique but all too common challenge.

The problem:

• My dentist stated that I have few options for a fixed replacement of my upper teeth.
• I was told I do not have enough to secure my denture and not enough bone in the upper jaw for traditional @dental implants.
• It is very difficult to eat and chew regular food.
• Severe bone loss of the upper jaw makes reconstruction extremely difficult and presents a uniquely challenging situation.

Patient History:

• Ed has a history of well-controlled diabetes and hypertension.
• He lost all his upper teeth decades ago.
• His upper denture has become progressively more loose and uncomfortable due to severe bone loss over time.
• Over the years, very few opportunities were presented where he could discuss options for fixed replacement of his upper teeth.
• He simply “learned to live with the handicap” of a compromised solution.
• Fortunately, his primary dentist recommended he obtain a consult with Dr. Gilbert to consider advanced techniques for implant replacement of his upper teeth.

Pertinent Information:

• Loss of teeth leads to progressive bone loss.
• The longer one wears a denture, the less bone exists to place dental implants.
• The bone of the upper jaw is less dense than that of the lower jaw.
• Overlying structures such as the nose and maxillary sinuses represent hollow areas above the teeth bearing bone (alveolus).
• A point of critical bone loss is reached where the upper jaw is so thin and ‘egg-shell’ in nature, that the options for traditional implants are almost impossible.

• Ed had such severe bone loss that he was faced with the options of extensive bone reconstruction, no treatment, or the use of advanced implant techniques and fixtures that rely on regional bone anatomy for stability.
• Extensive bone grafting had been the “mainstay” of Oral & Maxillofacial surgical reconstruction in the past.
• Extensive bone reconstruction is associated with more significant recovery, complications, and the inability to wear teeth on the surgical site during the healing phase (occasionally weeks to months).
• Zygomatic implants are a well-established advanced form of dental implants that rely on the cheekbone anatomy for stability.
• These implants traverse the maxillary sinus (internally or externally) from a point in the mouth to the cheekbone.
• Typically, one zygomatic implant is used posteriorly per side in combination with traditional implants in the anterior maxilla.
• In severe bone loss, the use of 2 zygomatic implants per side (“quad zygoma technique”) may be considered as an advanced option.

Procedures:

• Pre-surgical data collection and preparation of immediate prosthesis were performed by his restorative dentist.
• Ed underwent placement of 4 zygomatic implants and 2 traditional root form implants in the upper jaw.
• Good stability of the implants afforded attachment of an immediate fixed prosthesis the same day.

• He came in with a loose, ill-fitting upper denture and left the same day with an implant-fixed provisional prosthesis.

Commentary:

• Zygomatic implants are an advanced form of dental implants for the severely atrophic maxilla or upper jaw bone defect.
• Advanced surgical training, knowledge of facial anatomy, and experience are prerequisites for placing zygomatic implants.
• Highly experienced Oral & Maxillofacial surgeons occasionally utilize the technique of the “quad zygoma”, an advanced solution for very significant maxillary defects.
• Ed was ultimately thrilled to have a secure, dependable, and comfortable solution to his predicament. He now eats whatever he chooses on the menu.
• He enjoys his time supporting his grandkids involved in his passion for ice hockey.