Case 8 Quad zygoma case with Navigation

Quad zygoma case with Navigation

Dr Luc Vrielinck, MD DDS Oral and Maxillofacial Surgery Comments at: Luc@Vrielinck.be Genk Belgium

Treatment plan • Total extraction upper jaw, healing • Upper jaw: Quad zygoma implant • Lower jaw: prosthetic reconstruction on short Bicon implants • Navigation upper jaw for placement of zygoma implants • Drill guide lower jaw Aporis guide

Materials and devices • Implants upper jaw: Zygoma Tiunite (NobelBiocare.com) • Lower jaw: prosthetic reconstruction on short Bicon implants (4.5 x 8 mm; 3 mm well) bicon.com • Navigation upper jaw: Brainlab.com (experimental setup) • Drill guide lower jaw Aporis guide (aporis.be) • Bio-oss and Biogide

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06/02/2010: Intake

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06/02/2010: Intake

06/02/2010: Intake

06/02/2010: Intake

06/02/2010: Intake

06/02/2010: Intake

05/08/2010: Healing after extractions

05/08/2010: Healing after extractions

05/08/2010: Healing after extractions

05/08/2010: Planning Quad zygoma upper jaw (all extramaxillary)

05/08/2010: Planning lower jaw (short implants needed on the left)

05/08/2010: Planning lower jaw (short implants needed on the left)

05/08/2010: Planning lower jaw (short implants needed on the left)

de in i u g rill d w is e a j Th r we d, o e l t r e o th upp ical s l a dent s to opt e k h than ning of t d n scan r cast a e te plas n with th n fusio eam sca b cone ages im

05/08/2010: Planning lower jaw (short implants needed on the left)

Aporis Drill guide design for the lower jaw

15/09/2010: Implant placement sheet for upper and lower jaw

Placement of 3 fiducial screws preoperatively

15/09/2010: Implant placement

15/09/2010: Implant placement

15/09/2010: Implant placement

15/09/2010: Implant placement

Working order Navigation • Antrotomy or sinus wall infracture • Registration (select best 4 points out of 6) – Infraorbital formen left and right – Spina nasalis anterior – 3 fiducial screws

• • • • •

Selection of entry point in the zygoma Selection entry point in the maxilla Drilling Implant placement External sinus lifting procedure

15/09/2010: Implant placement

Registration right fiducial screw

Registration midline fiducial screw

Registration left fiducial screw

Entry point zygoma implant 1 left

Entry point zygoma implant 2 left

Entry point zygoma implant 3 right

Entry point zygoma implant 4 right

Antrotomy anterior maxillary wall and distal infracture of bony wall

Zygoma

intraoral

Zygoma

15/09/2010: Implant placement

intraoral

4x extramaxillary implants Right side

Left side

15/09/2010: Implant placement

External sinus lifting with Bio-Oss and Biogide

15/09/2010: Implant placement

Bicon implants in the lower jaw

15/09/2010: Implant placement

15/09/2010: Postoperative radiography

15/09/2010: Postoperative radiography

15/09/2010: Postoperative radiography