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Utilization of the Z-Point with trans-nasal implants as an alternative to the Quad Zygomatic configuration

clinical case
Performed by Dr. Simon Oh DDS, FICOI
This patient presented with a chief complaint of loose teeth. Upon examination, there were generalized mobility grades 2 and 3. Radiographically, generalized bone loss was noted, along with pneumatized sinuses with poor medial sinus anatomy. A discussion took place regarding the need for Extramaxillary implants and a treatment plan was agreed upon.

Day of surgery, the patient was nasally intubated, the skin was prepped, and a local anesthetic was administered. Full mouth extraction and alveoloplasty were performed. The mucosa was reflected along the lateral nasal walls and up to the zygomatic-frontal notch. Nasal mucosa was reflected off the lateral nasal wall internally, and the inferior concha (Z-Point) was exposed and identified. Placement of a 3.75x25mm implant was placed in both inferior conchas (Z-Point), engaging both the maxillary alveoli and the Z-Points. Torque >80NCm was observed in both Z-Point fixtures. From here, bilateral zygomatic implants were placed in an inferior fashion, as well as bilateral pterygoids. A Noris Tuff implant was then placed into the Nasopalatine canal. Augma was placed around the Z-point fixtures, as well as the zygomatic implants. Primary closure via 3-0 chromic gut was achieved, and an immediately loaded prosthesis was picked up and fabricated.

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