Treatment of the Severely Atrophic Arch with Zygomatic, Pterygoid, and Vomer Dental Implants

Dan Holtzclaw, DDS, MS
Diplomate, American Board of Periodontology
Diplomate, International Congress of Oral Implantologists

Clinical case

A 64 year old male presented to the author’s practice with hopes of getting rid of his maxillary denture. He had been wearing this denture for approximately 5 years and had been told by other dentists that he had too much bone loss for dental implants in the maxillary arch. Using a variety of dental implants from Noris Medical, the author was able to provide the patient with an immediately loaded fixed prosthetic solution that required no bone grafting. Noris Medical Pteryfit™ implants were bilaterally placed into the pterygomaxillary complex for terminal prosthetic support while a pair of Noris Medical Zygomatic Implants were placed for mid-arch support. Anteriorly, support was achieved with a Noris Medical Tuff implant engaging the Vomer. The mandible was restored in the standard full arch fashion using Noris Medical Tuff implants. This case was immediately loaded and a final restoration was delivered six months after the initial surgery.

 

KEY TAKEAWAYS

Noris Medical Pteryfit™ implants are specifically designed to engage to the pterygomaxillary complex and allow for immediately loading protocols.

Noris Medical Zygomatic implants have a unique design especially suited for extra-sinus surgical approaches. The aggressive rough surfaced end cutting tip and smooth mid-coronal shaft make this implant an ideal fixture for treating cases with severe maxillary bone loss.

The Noris Medical line of dental implants are particularly suited for treatment of cases with severe bone loss. Furthermore, with 0, 17, 30, 45, 52, and 60 degree abutments, Noris Medical has one of the widest selection of prosthetic platforms in the industry.

1.Patient before treatment. The patient had been wearing an upper denture and bone atrophy was significant. The mandible had many missing, ailing, and failing teeth. 2. Patient after treatment with zygomatic, pterygoid, vomer, and standard dental implants.

1. Patient before treatment. The patient had been wearing an upper denture and bone atrophy was significant. The mandible had many missing, ailing, and failing teeth.
2. Patient after treatment with zygomatic, pterygoid, vomer, and standard dental implants.

 

3.Pre-treatment panoramic radiograph showing pneumatized maxillary sinuses, failing mandibular teeth, etc.

3. Pre-treatment panoramic radiograph showing pneumatized maxillary sinuses, failing mandibular teeth, etc.

 

4.Intraoral condition of maxilla before surgery.

4. Intraoral condition of maxilla before surgery.

 

5.Extra-sinus drilling technique for the placement of Noris Medical™ zygomatic implants.

5. Extra-sinus drilling technique for the placement of Noris Medical® zygomatic implants.

 

6.Noris Medical™ zygomatic implant. (45mm).

6. Noris Medical® zygomatic implant. (45mm).

 

7.Placement of Noris Medical™ zygomatic implant using the extra-sinus approach. 8. Noris Medical™ Tuff™ implants, zygomatic implants, and Pteryfit™ implants with 17º, 30º, and 45º abutments in place. Note the parallelism achieved due to the wide abutment selection.

7. Placement of Noris Medical® zygomatic implant using the extra-sinus approach. 8. Noris Medical® Tuff™ implants, zygomatic implants, and Pteryfit™ implants with 17º, 30º, and 45º abutments in place. Note the parallelism achieved due to the wide abutment selection.

 

9.Maxilla sutured after surgery using Dr. Holtzclaw’s famous “Texas 2-Step” suture protocol.

9. Maxilla sutured after surgery using Dr. Holtzclaw’s famous “Texas 2-Step” suture protocol.

 

10.Final radiograph after treatment. Maxilla was restored with Noris Medical™ Tuff™ implants, zygomatic implants, and Pteryfit™ implants while the mandible was restored with Noris Medical™ Tuff™ implants. 11. CBCT scan (cranial view )of restored case with zygomatic, pterygoid, vomer, and standard dental implants.

10. Final radiograph after treatment. Maxilla was restored with Noris Medical® Tuff™ implants, zygomatic implants, and Pteryfit™ implants while the mandible was restored with Noris Medical® Tuff™ implants.
11. CBCT scan (cranial view )of restored case with zygomatic, pterygoid, vomer, and standard dental implants.

 

12.Lateral CBCT scan of restored case with zygomatic, pterygoid, vomer, and standard dental implants. 13. CBCT scan of Noris Medical™ Pteryfit™ implant engaging the pterygomaxillary complex.

12. Lateral CBCT scan of restored case with zygomatic, pterygoid, vomer, and standard dental implants.
13. CBCT scan of Noris Medical® Pteryfit™ implant engaging the pterygomaxillary complex.

 

14.CBCT scan of Noris Medical™ zygomatic implant engaging the zygoma.

14. CBCT scan of Noris Medical® zygomatic implant engaging the zygoma.

 

 

 

 

 

 

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