Hybrid zygoma surgery with the new NobelZygoma™ TiUltra™ implants, using the sinus slot surgical technique
Dr. Raphael Bonnet
France
“The new NobelZygoma TiUltra implants have been perfected to enable the most efficient and precise surgery possible, in any situation. They are designed for simple and easy handling. The improved surface conditions promise to enhance our long-term results by preventing mucosal and sinus complications. We now have an extremely efficient tool to care for our patients under optimal conditions.”
Patient: 56 years, male.
Clinical situation: The patient presented with maxillary edentulism and was using a removable prosthesis. He complained of discomfort with his removable prosthesis and desired a fixed prosthesis. The patient also has facial asymmetry and a retrusive maxilla but does not wish to undergo orthognathic surgery to correct this condition.
Surgical solution: Radiographic analysis revealed complete resorption of bone in the posterior region, suggesting zygoma implants as the treatment option. The surgery was performed using the sinus slot technique, with the bone window preserved and maintained on the sinus mucosa. There was no Schneiderian membrane perforation during the surgery.
Restorative solution: Under general anesthesia, two anterior NobelParallel™ CC implants, measuring 11.5mm on the right and 10mm on the left, were placed. And two NobelZygoma TiUltra 45° 32.5mm implants were placed in the first molar region.
Surgery date: November 18, 2024
Total treatment time: The provisional prosthesis was delivered the same day of the surgery.
Pre-op situation frontal view with removable prosthesis (left).
Pre-op situation lateral view with removable prosthesis (right).
Pre-op maxillary removable prosthesis (left).
Pre-op mandibular removable prosthesis (right).
Pre-op intraoral view old prosthesis (left).
Pre-op intraoral view maxillary arch (right).
Pre-op OPG.
Note: Completely resorbed maxilla.
Treatment planning: Two 45° NobelZygoma TiUltra implants in the posterior region and two NobelParallel CC implants in the anterior region.
Tooth 12: NobelParallel CC TiUltra NP 11.5 mm (left).
Tooth 22: NobelParallel CC TiUltra RP 10 mm (right).
Tooth number 16: 45° NobelZygoma TiUltra 45° 32.5 mm.
Tooth number 26: 45° NobelZygoma TiUltra 45° 32.5 mm.
Flap raised to expose the premaxillary region (left).
Drilling for the anterior implants (right).
Placement of NobelParallel CC implant measuring 11.5 mm (left).
Placement of NobelParallel CC implant measuring 10 mm (right).
Placement of the Multi-unit Abutment (left).
Intraoral view of the left maxillary region (right).
After performing a lateral osteotomy to push the sinus membrane, drilling was done with a long precision drill (left).
Drilling with 2.9 mm NobelZygoma drill.
Placement of 45° NobelZygoma TiUltra 32.5mm implant on the left maxillary region (left).
Crestal view of the left NobelZygoma TiUltra. Note: the neck of the implant is on the crest (right).
Placement of Multi-unit Abutment (left).
Placement of the 45° NobelZygoma TiUltra 32.5 mm implant on the right maxillary region (right).
Guided bone regeneration around the implants to improve the bone volume. Material used: creos xenoprotect 20 x 30 mm.
Why GBR? “Over time, gingival recession and soft tissue dehiscence are inevitable. While efforts are often made to thicken the mucosa, these measures are insufficient without adequate underlying bone support. Therefore, Guided Bone Regeneration (GBR) is essential.” – Dr. Bonnet
Suturing of the flap around the Multi-Unit Abutments (left).
Surgical guide used for the impression at the end of the surgery (right).
Provisional prosthesis.
One-month post-op intraoral view: Aspect of the mucosa around the Multi-unit Abutments (left).
Provisional prosthesis in place (right).
One-month post-op CT scan.
Post-op CBCT: Classical GBR on the anterior implants, with thickening of the sinus wall by grafting in the sinus and along the slot in the maxilla.
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NobelZygoma®Immediate, graftless, fixed solutions for patients with severe maxillary atrophy.
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NobelParallel™ Conical ConnectionA simply straightforward implant system.
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Multi-unit AbutmentKey to the original All-on-4® treatment concept.
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