FULL MOUTH REHABILITATION WITH

ZYGOMATIC IMPLANTS IN PATIENTS WITH

GENERALIZED AGGRESSIVE PERIODONTITIS: 2
YEAR FOLLOW-UP OF TWO CASES
GUNASEELAN RAJAN, GOWRI NATARAJARATHINAM, SARAVANA
KUMAR, HARINATH PARTHASARATHY
JOURNAL OF INDIAN SOCIETY OF PERIODONTOLOGY - VOL 18, ISSUE 1, JAN-
FEB 2014

PRESENTED BY-
SAPNA YADAV
MDS 2ND YEAR
DEPARTMENT OF PROSTHODONTICS
 AGGRESSIVE PERIODONTITIS
• Periodontitis is the “pathologic manifestation of the
host response against bacterial challenge that stems
from a polymicrobial biofilm at the biofilm–gingival
interface.” -Carranza

• Aggressive periodontitis is defined as “a multifactorial,

severe and rapidly progressive form of periodontitis,
which primarily but not exclusively affects young
individuals.” -1999 international workshop
 HISTORY
1923 Gottlieb “diffuse atrophy of the alveolar bone”

1938 Wannenmacher “parodontitis marginalis progressiva”

1967 Chaput “juvenile periodontitis”

1989 the World Workshop “localized juvenile periodontitis (LJP)

in Clinical Periodontics early-onset periodontitis (EOP)”
THE 1999 INTERNATIONAL CLASSIFICATION
WORKSHOP DEFINED THE ENTITY OF AGGRESSIVE
PERIODONTITIS TO BE CHARACTERIZED BY THREE PRIMARY
FEATURES:

• Rapid loss of attachment and tooth-supporting bone

• Subject is otherwise healthy (i.e., not suffering from any
systemic disease or condition that could be responsible for
the present periodontitis)
• Familiar aggregation
IN ADDITION, THE WORKSHOP DEFINED SEVERAL
SECONDARY FEATURES::

• Inconsistence etiologic factors and pronounced tissue

destruction
• Strong colonization by Aggregatibacter
actinomycetemcomitans and (in some populations)
Porphyromonas gingivalis
• Hyperresponsive macrophages
• Abnormalities of neutrophil function
• Self-limiting disease
 MICROBIOLOGICAL

ENVIRONMENTAL ETIOLOGY IMMUNOLOGICAL

GENETIC
 SUBGROUPS

LOCALIZED

Circumpubertal

Localized attachment loss at

incisors and first molars —
interproximal attachment loss
at ≥ 2 permanent teeth, one of
which is a first molar, and
involvement of ≤ 2 teeth,
other than first molars and
incisors
 GENERALIZED

Most often <30 years

of age, but can occur
in older individuals too
Generalized
interproximal
attachment loss at ≥3
permanent teeth other
than first molars and
incisors
THERAPEUTIC CONSIDERATIONS

Oral
Rehabilitation

Surgical
Therapy

Anti-
infective
Therapy

Periodontal
Therapy
Schou et al concluded that the “survival rate of
implants and suprastructures of individuals with
periodontitis was not significantly different than
individuals who did not have periodontitis prior to
tooth loss.”

“Outcome of implant therapy in patients with pervious tooth loss due to

periodontitis” in which human studies carried out from 1986 to 2006 were
reviewed.
 CASE REPORT

• Pt’s age - 33 & 44

• C/c – loose teeth
• M/H – No systemic disease reported.
• P/H – Habits like smoking or tobacco use not
reported.
• F/H - family history of early tooth loss reported by
both patients.
I/O –
• Case 1: 18, 17, 16, 15, 14, 13, 23, 24, 25, 26, 27, 28,
33, 34, 35, 36, 37, 38, 42, 43, 44, 45, 46, 47.
• Case 2: 11, 12, 13, 14, 17, 18, 21, 22, 23, 28, 41, 42,
43, 44, 45, 48, 31, 32, 33, 34, 35, 38.

Three permanent teeth other than molars and incisors

were involved
• R/E - severe bone loss of all existing teeth up to
middle third of the root.
 SEVERE FAMILY HISTORY
ATTACHMENT AND NO SYSTEMIC
BONE LOSS DISEASE

3 PERMANENT
TEETH OTHER THAN
MOLARS AND
INCISORS

Generalized Aggressive
Periodontitis
 TREATMENT OPTIONS

• Deep scaling or antibiotic therapy- no improvement.

Complete • Poor prognosis
extraction

• Conventional complete dentures

• Bone grafting with delayed loading of conventional implants
Treatment • 4 conventional implants in the anterior maxilla followed by bar retained
options over denture

• Fully fixed implant prosthesis

• Maxilla – 4 conventional and 2 zygomatic implants with immediate
Patient’s loading principle
desire • Mandible – 4 implant supported fixed partial denture
 ZYGOMATIC IMPLANTS

INDICATIONS CONTRAINDICATIONS
• Atrophic edentulous • Acute sinus
maxilla, sinus COMPLICATIONS infection
pneumatization • Maxillary or
• Maxillectomy • Sinusitis zygoma pathology
defects • Paresthesia • Uncontrolled or
• Fistula malignant systemic
disease.
 STEPS INVOLVED IN TREATMENT

Under GA, 2% of lignocaine with adrenaline was infiltrated

into the right and left vestibules

Remaining maxillary teeth were extracted

Incision and mucoperiosteal flap elevated to expose

alveolar crest, lateral wall of maxillary sinus and inferior
rim of zygomatic arch

Surgical guide was placed to identify prosthetically

favorable position for the conventional and zygomatic
implants.
 Maxillary bone was prepared to gain access to the inferior edge of
zygoma.

Two zygomatic implants (Branemark System Zygoma TiUnite Implants;

Nobel Biocare AB) were placed .[45Ncm]

Subsequently, four 4.3 × 13 implants (Nobel replace Tapered RP; Nobel

Biocare AB) were placed in the right and left maxillary canine region
 Multi-unit abutments were connected

Implants were showing adequate primary stability (above

40 Ncm) so immediate loading done
 FOLLOW UP EVALUATIION
• Modified bleeding index
• Clinical mobility
• Suppuration
• Mucosal seal efficacy evaluation
• Panoramic radiographs

Peri-implant Oral hygiene

soft-tissue aids and
inflammation maintenance
 CONCLUSION
• Two cases with 2-year follow-up, no implant failures occurred.
• Most common clinical observation in these patients during recall
visits was peri-implant soft-tissue inflammation which was,
considered as a biological complication.
• Treating these patients with zygomatic implants essentially
helped patients to avoid extensive sinus grafting and reduced
the treatment completion time.
• Within the limitations of this study, it can be stated that it can
definitely be considered as a viable treatment option treating
patients with GAP.
 Garima et al concluded that “GAP can be rehabilitated
successfully with osseointegrated implants. However more
bone and attachment loss at the implants have reported
than in periodontally healthy subjects. The case report
described successful management of AgP patient,
rehabilitated with endosseous dental implants.”

Management of aggressive periodontitis patient with implant supported prosthesis

Garima Jain, Rajesh KUMAR, Shrikant Vishnu, Gagan Jaiswal
Medical Journal of D Y patil University - vol8, Issue5, 2015.
 Ramesh, et al concluded that “implant-supported prosthesis can
be a definitive and viable treatment option for young GAP
patients where esthetics and functional aspects have to be
catered where a positive interplay of factors such as patient
cooperation and a strict maintenance regimen is utilized.

Comprehensive rehabilitation using dental implants in generalized aggressive

periodontitis Asha Ramesh, Sheethalan Ravi, Gurumoorthy Kaarthikeyan
Journal of Indian Society of Periodontology - Volume 21, Issue 2, March-April
2017
THANK
YOU