Fractures of long zygomatic implants
Two case [email protected]
• 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