Fractures of long zygomatic implants

Two case reportsLuc@Vrielinck.be

• Case 1: Fixed bridge UJ on 4 standard and two long implants (pterygoid anSurgeonorage). Fracture of both long implants

• Case 2: Quad zygoma implant with unilateral fracture of both long implants

Case 118081941

Situation• Patient whishes: Fixed prosthesis in upper and lower jaw• Team:

– Dentist: Marc Pauwels– Surgeon: LV

• Bevindingen:– UJ: Dorsal bone atrophy– LJ: Sufficient bone volume

• Treatment plan:– LJ: 6 implants, delayed loading, implant supported bridge– UJ: 4 implants, 2 long implants with pterygoid anchorage,

delayed loading, implant supported bridge

Surgeonronology

• 03/01/2002: Implant placement UJ and LJ

• 09/07/2002: Second stage• 17/11/2008: Follow up 6 years• 22/11/2010: Follow up 8 years

27/03/2001: Intake

27/03/2001: Scanning template

27/03/2001: Implant planning

Scanning template planned implants drill guide

27/03/2001: Implant planning

Scanning template planned implants drill guide

27/03/2001: Implant planning

Scanning template planned implants drill guide

27/03/2001: Implant planning

Scanning template planned implants drill guide

27/03/2001: Implant planning

Scanning template planned implants drill guide

27/03/2001: Implant planning

Scanning template planned implants drill guide

Upper jaw implant placement

4 standard implants2 long implants with pterygoid anchorage

UsingSurgiGuide™

03/01/2002: Implant placement UJ and LJ

Placing the surgical template … and guiding tubes

03/01/2002: Implant placement UJ and LJ

Placing the surgical template drilling of the long implant

03/01/2002: Implant placement UJ and LJ

Drilling right posterior long implant … and the left

03/01/2002: Implant placement UJ and LJ

After drill guide removal probing in the direction of the posterior long implant

Lower jaw implant placement

5 standard implantsUsing

SurgiGuide™

03/01/2002: Implant placement UJ and LJ

03/01/2002: Implant placement UJ and LJ

Fixation of the drill guide with initial drillingOsteosynthesis screws

03/01/2002: Implant placement UJ and LJ

3 mm width drilling after removal of drill guide

03/01/2002: Implant placement UJ and LJ

03/01/2002: Implant placement UJ and LJ

Implant placement (freehand) end of the procedure

09/07/2002: Second stage

27/08/2002: Try-in

27/08/2002: Try-in

27/08/2002: Try-in

Follow-up

17/11/2008 6 years follow-up after several teeth fractures and 1x bridge loosening

17/11/2008: follow up

Follow-up 8 years

22/11/2010Bridge lossening: fracture of 3

implants

22/11/2010: FU 8 years

22/11/2010: FU 8 years

22/11/2010: FU 8 years

22/11/2010: FU 8 years

22/11/2010: FU 8 years

22/11/2010: FU 8 years

22/11/2010: FU 8 years

22/11/2010: FU 8 years

22/11/2010: FU 8 years

22/11/2010: FU 8 years

22/11/2010: FU 8 years

For zygoma implant, the

fracture occurs along the

prosthetic screw !

For standard implant the fracture occurs just below the apical part of the

prosthetic screw

Case 210/06/1937

Situation• Patient whishes: Fixed prosthesis in upper jaw and lower

jaw• Team:

– Dentist: Lieven Barbier– Surgeon: LV

• Bevindingen:– UJ: Dorsal bone atrophy– LJ: Sufficient bone volume

• Treatment plan:– LJ: 4 implants, delayed loading, implant supported bridge– UJ: Quad zygoma, implant supported bridge (2piece)

Surgeonronology

• 29/11/2000: Placement Quad zygoma• … intermittent data missing because

patient moved out of the region …• 06/10/2008: Fracture of the

suprastructure (implants were intact)• 20/12/2010: Fracture of the two

zygomatic implants on the right side

06/10/2008

20/12/2010

Heads of the 2 implants

are broken off

Discussion

• Similarities between the two cases:– Old type zygoma implant (with longer

perforating prosthetic screws)– Both cases about 7 -8 year in function– Antagonistic jaw has implant supported bridge– Both patients are bruxists– Both patients had a 2-unit suprastructure in

the UJ attaSurgeoned by a central connection