Rescue treatment after failed zygoma implant treatment

We not only have to be prepared to place zygoma implants, but also have to be prepared when things go wrong

By Dr. Luc Vrielinck Luc@Vrielinck.be

Surgery: Luc Vrielinck Prosthodontics: Tom De Wit Xentro Dental, Genk, Belgium

Patient History • Medically uncompromised • ♀ 48 y • Quad zygoma treatment with: – Extramaxillary placement of both anterior zygoma implants and distal zygoma implant on the left side – Right dorsal zygoma implant: intrasinusally

• Followed by dehiscence and recurrent ascending infections to the cheek • Secondary attempts for closure of the dehiscence failed • Patient requests removal of the two zygoma implants on the left side

Starting Point

2011: Two year follow-up: radiographically everything is OK

The Problem

Dehiscence of the gingiva and mucosa overlying the implants in location 12 22 and 24 with chronic inflammation of the soft tissues of the cheek

After removal of both Zygoma implants on the left hand side

Temporary replacement of the bar and removal of the clips in the prosthesis frontally and on the left side

CBCT Crossectional images

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Bone Volume at Selected Locations

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Rescue Treatment Placement of 4 Bicon implants with simultaneous sinus lifting

Placement of 4 Bicon 4,5 x 6 mm (3,0 mm well)

Bio-oss and Biogide

The prosthetic treatment plan was to opt for a fixed bridge This was a unique challenge to combine the zygoma implants with multiunit abutments, to the locking taper mechanism of Bicon abutments.

Second stage: placement of 5x6 healing abutments

Postoperative situation in Nov.2012

Master cast with milled Bicon abutments

Trinia™ bridge

Trinia™ bridge on master cast model

Finalised bridge cemented in place

2013: Final situation

2013: Final situation

2013: Final situation