Zygoma Implant | Dental Implant | Dentures


By: Cortey, Philline Espineli, Shermane Robles, Kristina

What is Dental Implant?
a replacement for the root or roots of a tooth.  dental implants are secured in the mandible and are not visible once surgically placed.  they are used to secure crowns bridgework or dentures by a variety of means.

they are made of titanium, which is lightweight, strong and biocompatible  titanium and titanium alloys are the most widely used metals in both dental and other bone implants.  dental implants have the highest success rate of any implanted surgical device.

the two literally grow together to form a permanent biological adhesion.  He named this phenomenon “osseointegration". P I Brånemark whilst conducting research into the healing and regeneration patterns of bone tissue.  . accidentally discovered that bone had that when pure titanium comes into direct contact with the living bone tissue.History of Dental Implants In 1952 the Swedish orthopaedic surgeon.

 To the present day over 7 million Brånemark System implants have now been placed and hundreds of other companies produce dental implants.  .Over the next fourteen years Brånemark published many studies on the use of titanium in dental implantology.  The majority of dental implants currently available are shaped like small screws. with either tapered or parallel sides.

. This is the most commonly used implant and is used where there is plenty of width and depth to your mandible.Types of Dental Implant Procedures Three types of dental implants: Root Form Dental Implant  This screw type implant is shaped like the root of a tooth.

a Plate Form implant is placed into your mandible. Plate Form Dental Implant ◦ If your jawbone is too narrow for bone grafting. .

the Subperiosteal implant is recommended.The Subperiosteal implant is custom made to rest on top of your jawbone and under your gums like the Plate Form implant.If there's not enough bone width or height for the Root Form or Plate Form implants. but the Subperiosteal implant is placed through one of two special methods. .• Subperiosteal Dental Implants . .

So what’s NEW? .

Zygomatic implants are long screw shaped implants developed as an alternative to bone grafting and sinus augmentation. Studies highlight the zygomatic bone as a suitable anatomical structure for placement of dental implants as it cross four cortical bones.   Dental implants have always been more sensitive in the maxilla than in the mandible. . This situation becomes undesirable when the maxilla is severely resorbed and atrophic.

 In such patients conventional implant treatment cannot be performed because of:  1.Severely resorbed maxillae presents a complex problem. Extensive bone resorption 2.Pneumatization of sinus . Lack of internal osseous stimulation results in continued resorption of an atrophic edentulous maxilla.

◦ In their initial study over a 10-year period. ◦ Of the zygoma fixtures placed and restored in the initial study.1999). and three failed in the subsequent 8 years for a long-term success rate of > 95%.ZYGOMA IMPLANT  In 1999 Dr. which was restored with cross arch stabilization. personal communication. Each patient had an additional two to four conventional implants placed in the anterior maxilla. . 110 implants were placed. only two were lost in the first year of occlusal loading. Per-Ingvar Brånemark and colleagues introduced the zygoma implant (P-I Brånemark.

 .  It is an extended-length (30–52.ZYGOMA IMPLANT It has provided a viable alternative for treatment of patients with extreme resorption of the edentulous maxilla or large pneumatized maxillary sinuses.5 mm) machined titanium fixture that is placed through the crestal (slightly palatal) aspect of the resorbed posterior maxilla transantrally into the compact bone of the zygoma.

ZYGOMA IMPLANT Four Osseous Cortices 1. The sinus floor 3. The roof of the maxillary sinus 4. At the ridge crest 2. The superior border of the zygoma .

 .ZYGOMA IMPLANT The zygoma implant provides posterior maxillary anchorage when the existing osseous structures do not allow standard implant placement. prolonged treatment times. and higher complication rates.  The alternative in this situation includes bone graft augmentation (sinus lifts and onlay grafts) with their attendant costs. discomfort.

. orbital rims. or pterygoid plates to support crossarch stabilization. palatal shelves.ZYGOMA IMPLANT It suggested in the following circumstances: ◦ When full maxillary edentulism is accompanied by advanced posterior resorption that would otherwise require grafting. ◦ In partial or incomplete maxillectomy patients when additional implants can be placed in other sites such as the piriform sinus. At least two and preferably four anterior standard implants are needed in combination with bilateral zygoma implants.

When there is contraindication for harvesting iliac crest bone graft 3. .INDICATIONS Insufficient bone volume for placement of regular implants posterior to canine 2. Reconstruction of maxillary defects following tumor resection. cleft palate 4. Systemic disease with atrophy of posterior maxilla like ectodermal dysplasia. nasal reconstruction 1.

. 2. the zygoma implant is not needed. 4. Where there is not enough premaxillary support for at least two stable implants with good potential longevity. 3.CONTRAINDICATIONS 1.  Same as for conventional implants Presence of local infection Systemic compromise Sinus disease Two specific situations: Where adequate maxillary bone exists for implant placement in numbersand positions to support a prosthetic appliance.

B C An impression coping has been attached to the zygoma implant at the final impression appointment. B. There was no sign of bone adherence to any of the implant surface. It was noted that there was rotational instability of this fixture with movement of the coping.ZYGOMA IMPLANT Complications: most significant complication: loss of the implant A A. C. The implant was removed without resistance. .

ZYGOMA IMPLANT  Interim therapy may include the use of a provisional restoration on the remaining integrated implants but should not include a cantilever extension on the affected side .


1. Lateral cephalogram 4. Intra oral radiographs 3.Radiographic Examination The radiographic examination of the resorbed frontal alveolar bone f the upper jaw is recommended. Panoramic image 2. Tomography or CT Scan .

Presurgical Prosthetic Consideration Presurgical prosthetic examination and evaluation should include: ◦ ◦ ◦ ◦ ◦ ◦ Facial profile and contours Parafunctional habits Horizontal and vertical jaw relations Occlusal plane orientation Occlusal relationships Status of the oppsing dentition .

and the administratin of a local anesthetic agent is carried out.  Vestibular infiltratin and greater palatine block are administered  Also bilateral IAN Block is important  .Surgical procedures Px is premedicated with 2 gms of amoxicillin 1 hr prior to the surgery  The px is sedated and draped.

Surgical procedures Using a small-gauge needle. to obtain coverage of the implant by the periosteum and a wide wound area to minimize the risk of dehiscence during healing  . bilateral transcutaneous infiltration of the temporal areas over the zygomatic body and zygomatic notch is also administered  Incision is standard Le-fort I incision.


due to its length and design. If the drilling unit stalls several turns before it reaches the implant's final seating position when set at 45 Ncm. Ensure that the implant is guided along the correct path of insertion through the sinus. 3.Implant installation  There are three special concerns when installing the Zygoma implant. it indicates that the bone site has not been prepared to its full depth with the twist drills. back out the implant and prepare the bone site again to match the chosen implant length. In such an event. Applying excessive torque can distort the implant head or fracture the implant mount or implant mount screw.    1. Rotate the implant to such a position that the angulated hexagonal top is directed towards an ideal occlusal plane. 2. This can easily be verified by observing the position of the implant mount screw which corresponds to the position of the abutment screw. .


Place simple sutures between the mattress sutures. These sutures assure a liquid-tight closure of the wound. Do not suture them as deeply into the submucosa as the mattress sutures. using a resorbable suture material. This technique will minimize the risk of postsurgical dehiscence formation. Use non-resorbable vertical mattress sutures in the submucosa and mucosa.     . do the following: Start with submucosal sutures.Suturing  To minimize post-surgical bleeding and to ensure complete closure of the wound.

.Healing Phase The maintenance of the zygoma implant patient is an ongoing process from the completion of stage I surgery through the entire healing phase.

.As noted earlier.  Important to relieve the intaglio surface of the labial flange to prevent unnecessary apical pressure in the vestibular area. the existing or provisional upper denture can be modified for immediate use. giving the patient a continuous esthetic presentation.

. at which time it will have a viscous consistency.  The material is carefully applied to the borders of the modified denture and is then placed in the mouth and allowed to set while border molding. Denture conditioning material is mixed and allowed to set for approximately 8 to 10 minutes.

 Any excess material is removed from the chamber so that no pressure is placed on the areas immediately over the implant sites. the conditioning material is physiologically formed to create a peripheral seal. With border molding movements intraorally. .

 At the time of stage II surgery the patient should present with well-healed maxillary mucosal surfaces and may occasionally exhibit a proliferative reaction into the denture base chamber space as seen here.  This excess tissue is not detrimental. .

or exposure of all implants with abutment connections. . Immediately following stage II surgery.Protective Splinting Strength they provide when used with splinting and cross-arch stabilization. it is recommended that some protective measures be used to prevent independent stress transfer from the denture base to the implants individually.

Clinical validation of successful osseointegration is completed once the implants have been exposed and abutments have been connected.  .ZYGOMA IMPLANT  Radiographic analysis at approximately 5 months of healing shows the implants in both arches appear to be osseointegrated.

  Abutments are selected at stage II surgery with as low a profile as possible in order to minimize extension of the provisional splint into the denture base area. . both of which terminate at the gingival tissue. In this case two 3 mm standard abutments have been selected for the right side.

. This is accomplished by making an impression immediately after the abutments are delivered and sending it to the dental laboratory for rapid turnaround.

A gold bar of approximately 2 mm in diameter is bent to contour so that it touches a set of gold cylinders attached to the abutment analogs on the cast. .

and the denture is hollow ground to allow complete seating without bar interference . usually the next day.With a microwelding device the bar and cylinders can be soldered together and within a short time period a passive protective splint can be fabricated. The bar splint is delivered.

a complete soft liner can be applied to the upper prosthesis to enhance comfort and retention . At this time.

 Final Prosthesis Construction Final impressions can be made following an adequate healing period. usually 3 to 4 weeks .

The final impression is made using a custom tray. to control material thickness. . which allows the individual copings to be picked up rather than transferred into the impression material. and an open top technique.

 The master cast should be an absolute replica of the patient’s presentation intraorally. .

 Jaw relation records are obtained using implant-stabilized record bases and wax rims. .

and patient approval of the esthetic presentation is confirmed. . The mounted casts should be an articulated representation of the patient’s jaw relationships. The try-in with teeth follows the trial set-up done in the laboratory.

. The teeth are waxed to contour in positions dictated by the record base procedure and are sent to the clinic for try-in and patient approval.

 Final

approval for esthetic display, occlusion, and vertical dimension are all obtained at this clinical visit.

Silicone putty indexes are made of the approved wax-up and are used to provide a matrix for creation of a metal bar structure

The cast framework design is based on available space and tooth position as dictated by the wax set-up from the trial denture base. These dimensions are captured using a buccal index that keys to the master cast.

 For

greatest accuracy, the casting technique for these long-span restorations usually requires a runner bar and multiple sprue attachments to minimize distortion.

 Following a second try-in appointment for evaluation of passive fit and esthetics. the prosthesis is processed with heat polymerizing resin .

. Delivery is accomplished using appropriate screws and screw torques to provide even and complete seating.

. The bar structures are generally waxed and cast in precious metals but can also be milled from solid blocks of titanium with excellent passive fit properties.


ZYGOMA IMPLANT In select situations.  The procedure for constructing these prostheses is essentially the same up to the point of the patient-approved wax-up. The metal substructure will be designed to provide architecture from the hybrid denture tooth design. it may be beneficial to use a porcelain-fusedto-metal restoration. such as minimal interocclusal distance or high load forces.  .

 It may be especially advantageous to use the milled titanium technology for these restorations. . since they do not tend to distort through the thermocycling phases of veneering to the same degree as the precious metal alloy cast substructures.

the screws are re-tightened  . phonetics. esthetics is made  The stability of bridge retaining screws are also tested and if necessary.Post Insertion Visit The px should be seen one to two weeks after delivery for a check up  The stability of the restoration is checked  A general evaluation of function.

extensive bone grafting is usually needed before implant insertion and usually includes sinus lifts and onlay grafts with large amounts of donor bone required. lower implant success rates.costs.  The inconvenience. prolonged treatment.  If conventional implants are to be used exclusively in this setting.SUMMARY  The placement of implants and restoration of the extremely atrophic maxilla is a challenge to both the surgeon and prosthodontist. potential complications. and donor site morbidity are important considerations. .

bone grafts often may be avoided. treatment time is shortened.  With the zygoma implant. stable. donor sites are unnecessary. and the patient may continue to wear a transitional prosthesis.  .  This results in greater patient acceptance while providing the patient with a well-tolerated. and esthetic fixed or removable prosthesis at completion of treatment.This is further compounded by the patient’s inability to wear a prosthesis for extended periods of time—a factor that keeps many patients from pursuing treatment.

The total number of implants to support a prosthesis is reduced. 3. Bone graft survival and consolidation are not considerations. 4. . Donor site morbidity is reduced or eliminated entirely.The advantages of considering the zygoma implant include the following: 1. Treatment time is markedly reduced or eliminated entirely. 2. The treatment is more affordable and less invasive than alternative treatments. 5.

Technically demanding surgery— should only be performed by well. more difficult to retreat 5. Risk of injury to adjacent structures— that is. infraorbital nerve 3.The disadvantages of the zygoma implant include the following: 1.trained surgeons capable of dealing with any surgical situation or complications that might arise 2. facial nerve. Fixture failure—although rare. Surgical access difficult—deep sedation or general anesthetic required . orbit. although less than with sinus lift procedures 4. orbital contents. lacrimal apparatus. Risk of postoperative sinusitis.

the surgeon should become familiar with the prosthetic needs and techniques involved with fixture positioning and restoration.   As with all properly planned and executed implant prosthetic procedures. should include the need for meticulous hygiene and maintenance. Similarly. ◦ Patient understanding. the prosthodontist should be available at surgery. patient education. before treatment is initiated. The zygoma implant. when understood and appropriately used. preparation. Ideally. extensive coordination between the surgeon and the prosthodontist is necessary before initiating treatment. Finally. and informed consent are major parts of the procedure and its ultimate success. evaluation. . provides a treatment alternative for many patients with atrophic edentulous maxillae.

com/pubmed/medoralv13_i6_p363.odo..pdf http://www.br/Biblioteca/Implantes%20Zigomaticos/Meas urement%20of%20the%20Maxilla%20and%20Zygoma%20%20Uchida%20et%20al. pg.References:      Miloro.pdf .pdf http://jiads. Peterson’s Principle of Oral and Maxillofacial Surgery 2nd Ed.com/webcms/usuario/documentos/2011022 2134914_Inmediate_function. 235-259. http://www. BC Decker Inc. 2004.net/Archives/2011/7.pdf http://coimplante.institutodavo.medicinaoral. M et al.

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