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A case report of a fractured zygoma implant. Using scanning electron microscopy (SEM) it was demonstrated that the cause was fatigue fracture. Next the retreatment of the patient is documented.
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Example of a retreatment after fracture of zygoma implant
Situation• Patient desires:
– Initial treatment dates back to 1990– solution for fractured zygomatic implant
• Diagnosis– Fatigue fracture of right zygoma implant
• Treatment plan– Placing two additional zygoma implants with
navigation│delayed loading │overdenture
Chronology
• Lower jaw:– 17/07/1998: 4 implants │Delayed loading
│implant supported bridge• Upper jaw:
– Before 1998: reconstruction bone graft │failed– 2000:placement long implants with zygomatic
anchorage and 2 implants with pterygoid anchorage
#
• #zygoma• #Pterygoid• #Overdenture_4
17/07/1998: failed reconstruction upper jaw
Placement implants lower jaw
01/01/1990 status after Lfeort I osteotomy with bone (hip) graft interposition
Follow-up 10 years
Fracture of right zygomatic implant
23/12/2010: Fracture right zygomatic implant + fracture prosthetic screw in right pterygoid implant
23/12/2010: Fracture right zygomatic implant + fracture prosthetic screw in right pterygoid implant
23/12/2010: Fracture right zygomatic implant + fracture prosthetic screw in right pterygoid implant
23/12/2010: Fracture right zygomatic implant + fracture prosthetic screw in right pterygoid implant
23/12/2010
Right pterygoid Right zygoma Left zygoma Left pterygoid
23/12/2010
23/12/2010
23/12/2010
Fractured zygoma implant
Remnant of overdenture bar on the left side
23/12/2010
23/12/2010
23/12/2010
23/12/2010
Head of the zygoma implant still engaged in overdenture bar
23/12/2010
23/12/2010
Head of the zygoma implant still engaged in overdenture bar
23/12/2010
11 12 13 14 15Height 4.25 2.11 3.81 - -
Thickn. 4.0 1.2 2.82 4 4
Preoperative bone analysis: Largely insufficient bone volumes in all locations
Retreatment
• Treatment plan– Removal of fractured zygoma implant right– Placement of 2 new zygoma implants
Planning for 2 zygoma implants on the right side in Brainlab software
This implant is very close to the orbital floor with
possible perforation during surgery
Planning for 2 zygoma implants on the right side in Brainlab software
Planning for 2 zygoma implants on the right side in Brainlab software
Planning for 2 zygoma implants on the right side in Brainlab software
Planning for 2 zygoma implants on the right side in Brainlab software
Planning for 2 zygoma implants on the right side in Brainlab software
Planning for 2 zygoma implants on the right side in Brainlab software
Surgery
• Planning of the 2 zygoma implants– 1 implant cranial of the failed implant
• Since it was close to the orbital floor an additional visual access would be prepared using an infraorbital incision and exposion of the oribita floor
– 1 implant in the neighbourhood of the failed implant provided that it could be removed
Determination entry point distal implant
Determination exit point distal implant
Determination exit point anterior implant
09/02/2011: operative view of fractured zygoma implant (right)
09/02/2011: operative view of left zygoma implants
Fully functional after 10 y
09/02/2011: view of fractured implant of extramaxillary implant with 10y follow-up
09/02/2011: view of fractured implant of extramaxillary implant with 10y follow-up
Extramaxillary implant placed in 2000
09/02/2011: cutting through the implant
Extramaxillary implant placed in 2000
09/02/2011: cutting through the implant
09/02/2011: cutting through the implant
09/02/2011: cutting through the implant
09/02/2011: cutting through the implant
09/02/2011: cutting through the implant: removal coronal part
The extramaxillary portion was not osseointegrated on the contact surface with the bone
09/02/2011: cutting through the implant: removal coronal part
The extramaxillary portion was not osseointegrated on the contact surface with the bone
09/02/2011: remaing apical part of the implant
Bone surface which was covered by the extramaxillary portion of the zygoma implant
09/02/2011: remaing apical part of the implant
09/02/2011: removal of the apical portion of the zygoma implant with a heavy forceps and rotation
Clinically the apical portion was very stable but apparantly non-osseointegrated
peroperatief: 09/02/2011
Clinically the apical portion was very stable but apparantly non-osseointegrated
09/02/2011: removal of the apical portion of the zygoma implant with a heavy forceps and rotation
peroperatief: 09/02/2011
Visualisation orbital floo
Placed implant
Just below orbital floor
09/02/2011: Intraoral view of new placed implants
09/02/2011: Bio-Oss
The Extended sinus lifting techniqueMarc Hinze, Wolfgang Bolz, Luc Vrielinck, submitted for pub, 2011
09/02/2011: Biogide
09/02/2011: primary wound closure
09/02/2011
Postoperative radiography
10/02/2011
10/02/2011: Postoperative radiography
10/02/2011: Postoperative radiography
10/02/2011: Postoperative radiography
SEM
Demonstrated that implant fracture was caused by fatigue
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