Quad zygoma after failed maxillary reconstruction

Retreatment of failed bonegrafts for maxillary reconstruction

Treated with Quad zygoma and an overdenture Author: Luc@Vrielinck.be

Situation • Patient desires: fixed prosthesis in Upper Jaw • Diagnosis: – Situation after failed iliac crest reconstruction – Ill- fitting prosthesis

• Treatment plan: – Quad zygoma, – delayed loading, – bar supported overdenture

Chronology • 26/01/2010: • 23/08/2010: • 11/10/2010:

Surgery placement Quad zygoma second stage QZ Prosthesis placed

Parameters • #Failureheupkamgreffe • #quadzygoma • #overkappingsprothese

Intake

20/10/2007: Uitgangssituatie

20/10/2007: Uitgangssituatie

20/10/2007: Uitgangssituatie

20/10/2007: Uitgangssituatie

20/10/2007: Uitgangssituatie

20/10/2007: Uitgangssituatie

Surgery Lefort I advancement & Iliac crest interpositioning

08/10/2008: postoperative after bone reconstruction

08/10/2008: postoperative after bone reconstruction

08/10/2008: postoperative after bone reconstruction

05/11/2008: wounddehiscence finally resulting in total reconstruction failure

05/11/2008: wounddehiscence finally resulting in total reconstruction failure

Zygoma Treatment Rescue therapy after failed bone grafts

19/03/2009: before zygoma treatment

Still s ome b o osteo synth ne seques esis m te ateria rs and l pres ent

19/03/2009: before zygoma treatment

19/03/2009: before zygoma treatment

19/03/2009: before zygoma treatment

02/07/2009: Removal of bone sequesters and osteosynthesis material

03/10/2009: Situation after removal of sequesters and osteosynthesis material

Treatment

01/12/2009: Conebeamscan

21

11

22

12

23

13

24

14

25

26

15

16

16

15

14

13

12

11

21

22

23

24

25

26

H

1.2

4.05 2.25 2.84 5.54 4.68 4.05 6.21 6.39 2.98 2.37 2.78

W

2.5

3.41 2.78 1.92 4.26 5.54 4.47

3.5

6.00 2.35 3.62 5.33

In all teeth location insufficient bone for standard implants Minimum e.g. H: 8 mm, width 6 mm

19/01/2010: Planning for Quad zygoma

19/01/2010: Planning for Quad zygoma

19/01/2010: Planning for Quad zygoma

26/01/2010: Postoperative

26/01/2010: Postoperative

26/01/2010: Postoperative

26/04/2010 Wounddehiscence removal of a membrane (Synpor™) Resulting in a huge buccosinusal communiation‌.

23/08/2010: Just before second stage

23/08/2010: Just before second stage

The b comm uccosin us unica tion h al as we heale ll d

23/08/2010: Just before second stage

23/08/2010: Second stage QZ

23/08/2010: Second stage QZ

23/08/2010: Second stage QZ

23/08/2010: Second stage QZ

02/09/2010: Placing multiunit abutments and impression taking

09/09/2010: Pasbalk

11/10/2010: Placing the bar and prosthesis

11/10/2010: Placing the bar and prosthesis

11/10/2010: Placing the bar and prosthesis

11/10/2010: Placing the bar and prosthesis

11/10/2010: Placing the bar and prosthesis

11/10/2010: Placing the bar and prosthesis

11/10/2010: Check of the occlusion

11/10/2010: Check of the occlusion

11/10/2010: Check of the occlusion

• In the right lower jaw one short implant (Bicon) will be placed as support for a removable partial prothesis