Quad zygoma surgery using the NobelZygoma™ TiUltra™ implants.
Dr. Dennis Rohner
Switzerland
Patient: A 69-year-old female with no systemic conditions, presented with removable prosthesis in the maxilla and a fixed removable prosthesis on mandible. Patient complained of reduced oral function.
Clinical situation: Fibroma in maxillary anterior region due to ill-fitting prosthesis.
Proposed surgical treatment: Removal of fibroma followed by rehabilitation of the maxilla using the quad zygoma technique and immediate provisionalization.
Temporization: Immediate loading of the implants with a fixed provisional prosthesis, secured on the Multi-unit Abutments.
Surgery date: November 28, 2024
Total treatment time: 4 months including the definitive prosthesis. The provisional prosthesis was delivered the same day of the surgery.
Initial clinical situation
Pre-op situation without prosthesis. Fibroma in the anterior (left).
Pre-op situation with prosthesis. Fibroma in the anterior (right).
Pre-op situation frontal view with prosthesis (left).
Pre-op situation lateral view with prosthesis (right).
Data collection
Coronal view (left). Sagittal view (center). 3D image (right).
Treatment planning
Planned implant in tooth position 15: 3.9 x 37.5 mm – NobelZygoma 45° TiUltra implant (left).
Planned implant in tooth position 13: 3.9 x 47.5 mm – NobelZygoma 45° TiUltra implant (right).
Planned implant in tooth position 23: 3.9 x 45 mm – NobelZygoma 45° TiUltra implant (left).
Planned implant in tooth position 25: 3.9 x 35 mm – NobelZygoma 45° TiUltra implant (right).
3D planning showing the NobelZygoma 45° TiUltra implants.
Surgical procedure
Maxillary arch prepared for surgery (left). Incision marking (right).
Incision and buccal flap reflection (left).
Knife edge observed after complete mucoperiosteal flap reflection (right).
Placement of NobelGuide® surgical guide and occlusion check (left).
Surgical guide placed in the maxilla (right).
Tooth position 15, 13: Position locator for implant parallelism verification with surgical marking. The sinus slot is also visible in the image (left).
Tooth position 25, 23: Position locator for implant parallelism verification with surgical marking. The sinus slot is also visible in the image (right).
Orientation of the position of the implant neck (left).
Occlusal orientation of the screwdriver for correct position of the 45° neck (right).
Orientation of the position of the posterior implant neck (left).
Occlusal orientation of the neck of the posterior implant (right).
NobelZygoma 45° implants in place with Multi-unit Abutment (left).
Temporary abutments in place for provisional prosthesis (right).
Post-surgical record and immediate provisional
Impression and bite record for provisional prosthesis (left).
Temporary abutments in place for provisional prosthesis (right).
Immediate provisional
Provisional prosthesis in place – frontal view (left).
Provisional prosthesis in place – occlusal view (right).
Phase 1 check-up
CT: Frontal view, post-surgery (left).
CT: Occipitomental view, post-surgery (right).
-
NobelZygoma™Immediate, graftless, fixed solutions for patients with severe maxillary atrophy.
-
Multi-unit AbutmentKey to the original All-on-4® treatment concept.
Share this clinical case
Sign up for our blog update
Get the latest clinical cases, industry news, product information and more.
© Nobel Biocare Services AG, 2025. All rights reserved. Distributed by: Nobel Biocare. Nobel Biocare, the Nobel Biocare logotype and all other trademarks are, if nothing else is stated or is evident from the context in a certain case, trademarks of Nobel Biocare. Please refer to nobelbiocare.com/trademarks for more information. Product images are not necessarily to scale. All product images are for illustration purposes only and may not be an exact representation of the product. Please contact the local Nobel Biocare sales office for current product assortment and availability. Disclaimer: For prescription use only. Caution: Federal (United States) law or the law in your jurisdiction may restrict this device to sale by or on the order of a licensed clinician, medical professional or physician. See Instructions For Use for full prescribing information, including indications, contraindications, warnings and precautions. Nobel Biocare does not take any liability for any injury or damage to any person or property arising from the use of this clinical case. This clinical case is not intended to recommend any measures, techniques, procedures or products, or give advice, and is not a substitute for medical training or your own clinical judgement as a healthcare professional. Viewers should never disregard professional medical advice or delay seeking medical treatment because of something they have seen in this clinical case. Full procedure is not shown. Certain sequences have been cut. Please refer to applicable IFUs for full instruction.