Quad zygoma surgery with the new NobelZygoma™ TiUltra™ implants
Dr. Rubén Davó
Spain
Patient:A 66-year-old female with no systemic conditions presented with implant-supported fixed prosthesis rehabilitation in both the maxilla and mandible, placed 25 years ago.
Clinical situation: In the maxilla, she had already lost four implants and currently has six implants with terminal peri-implantitis, supporting an unstable fixed implant bridge.
Proposed surgical treatment Extraction of the remaining maxillary implants was followed by the placement of four 45° NobelZygoma TiUltra implants: one in 15 measuring 4.0 x 50 mm, one in 13 measuring 4.0 x 50 mm, one in 22 measuring 4.0 x 50 mm, and one in 25 measuring 4.0 x 37.5 mm, using the sinus slot technique. The plan includes immediate loading with a printed provisional polymethyl methacrylate (PMMA) prosthesis.
Temporization: Immediate loading of the implants with a 3D-printed provisional prosthesis, secured on Multi-unit Abutments during the initial healing phase.
Surgery date: November 18, 2024
Total treatment time: 4 months including the definitive prosthesis. The provisional prosthesis was delivered the same day of the surgery.
Pre-op situation frontal with old prosthesis (left).
Pre-op situation lateral with old prosthesis (right).
Pre-op situation frontal without prosthesis (left).
Pre-op situation lateral without old prosthesis (right).
Intraoral pre-op maxillary arch with old prosthesis (left).
Intraoral pre-op maxillary arch with old implants (right).
OPG showing existing implants in the maxillary and mandibular arch (left).
CT scan showing existing implants in the maxillary arch (right).
STL scan with the old denture (left).
STL soft tissue scan of maxillary arch (right).
Planning of four zygoma implants using sinus slot technique.
Note: High bone resorption except around 6-7 mm in canine region left side.
Preparation of slot and osteotomy on zygoma bone using round bur (anterior left implant) (left).
Subsequent drilling using the 2.9 mm drill (right).
First drill using round bur for the posterior left implant (left).
Second drill using 2.9 mm (right).
Depth indicator using NobelZygoma depth indicator in anterior implant and drilling with 3.5 mm bur for the posterior (left).
Depth indicator using NobelZygoma depth indicator in anterior implant. The groove for the posterior implant has been prepared (right).
NobelZygoma TiUltra implant insertion through the maxillary slot (left).
NobelZygoma TiUltra implant insertion (right).
Four 45° NobelZygoma TiUltra implants: one in 15 measuring 4.0 x 50 mm, one in 13 measuring 4.0 x 50 mm, one in 22 measuring 4.0 x 50 mm, and one in 25 measuring 4.0 x 37.5 mm.
Provisional prosthesis matching and designing in CAD software with the exact implant position.
Post-op situation frontal view with provisional prosthesis (left).
Post-op situation lateral view with provisional prosthesis. (right).
Provisional prosthesis occlusion.
Post-op frontal view CT scan showing NobelZygoma TiUltra implants (left).
Post-op occipitomental view CT scan showing NobelZygoma TiUltra implants (right).
Implant maintenance and post-treatment care:
Zygomatic implants, which anchor in the zygomatic bone, provide a reliable solution in cases of severe maxillary bone loss or poor bone quality due to their dense and highly vascularized nature. This patient experienced failure of conventional implants, along with significant bone loss surrounding them, approximately 25 years after their initial placement. These implants were not placed Dr. Davó’s clinic, and the specific circumstances surrounding their failure remain unclear.
The patient presented in a Cawood and Howel VI situation, leaving with two potential treatment options:
1. A graft for total reconstruction of the maxilla, or
2. The quad zygoma protocol.
The patient was prescribed antibiotics to address any residual infection and provided with oral hygiene instructions to ensure optimal healing and implant maintenance. Regular follow-up appointments were scheduled to monitor progress and ensure long-term success of the treatment.
-
NobelZygoma™Immediate, graftless, fixed solutions for patients with severe maxillary atrophy.
-
Multi-unit AbutmentKey to the original All-on-4® treatment concept.
-
Xeal™ and TiUltra™Welcome to the Mucointegration™ era.
Surface chemistry cells can't resist.
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. Dr. Davó is a paid consultant for Nobel Biocare. The opinions expressed are those of the doctor. Nobel Biocare is a medical device manufacturer and does not dispense medical advice. Clinicians should use their own professional judgment in treating their patients. Individual patient results may vary.