Quad zygoma case with Navigation

Dr Luc Vrielinck, MD DDSOral and Maxillofacial Surgery

Comments at: Luc@Vrielinck.beGenk Belgium

Treatment plan• Total extraction upper jaw, healing• Upper jaw: Quad zygoma implant• Lower jaw: prosthetic reconstruction on short Bicon

implants• Navigation upper jaw for placement of zygoma implants• Drill guide lower jaw Aporis guide

Materials and devices• Implants upper jaw: Zygoma Tiunite (NobelBiocare.com)• Lower jaw: prosthetic reconstruction on short Bicon

implants (4.5 x 8 mm; 3 mm well) bicon.com• Navigation upper jaw: Brainlab.com (experimental set-

up)• Drill guide lower jaw Aporis guide (aporis.be)• Bio-oss and Biogide

06/02/2010: Intake

X X X X X X

XX

06/02/2010: Intake

06/02/2010: Intake

06/02/2010: Intake

06/02/2010: Intake

06/02/2010: Intake

05/08/2010: Healing after extractions

05/08/2010: Healing after extractions

05/08/2010: Healing after extractions

05/08/2010: Planning Quad zygoma upper jaw (all extramaxillary)

05/08/2010: Planning lower jaw (short implants needed on the left)

05/08/2010: Planning lower jaw (short implants needed on the left)

05/08/2010: Planning lower jaw (short implants needed on the left)

05/08/2010: Planning lower jaw (short implants needed on the left)

The drill guide in

the lower jaw is

dental supported,

thanks to optical

scanning of the

plaster cast and

fusion with the

conebeam scan

images

Aporis Drill guide design for the lower jaw

15/09/2010: Implant placement sheet for upper and lower jaw

15/09/2010: Implant placement

Placement of 3 fiducial screws preoperatively

15/09/2010: Implant placement

15/09/2010: Implant placement

15/09/2010: Implant placement

Working order Navigation• Antrotomy or sinus wall infracture• Registration (select best 4 points out of 6)

– Infraorbital formen left and right– Spina nasalis anterior– 3 fiducial screws

• Selection of entry point in the zygoma• Selection entry point in the maxilla• Drilling• Implant placement• External sinus lifting procedure

15/09/2010: Implant placement

Registration right fiducial screw

Registration midline fiducial screw

Registration left fiducial screw

Entry point zygoma implant 1 left

Entry point zygoma implant 2 left

Entry point zygoma implant 3 right

Entry point zygoma implant 4 right

15/09/2010: Implant placement

Antrotomy anterior maxillary wall and distal infracture of bony wall

Zygoma intraoral Zygoma intraoral

15/09/2010: Implant placement

Right side Left side

4 x extramaxillary

implants

15/09/2010: Implant placement

External sinus lifting with Bio-Oss and Biogide

15/09/2010: Implant placement

Bicon implants in the lower jaw

15/09/2010: Postoperative radiography

15/09/2010: Postoperative radiography

15/09/2010: Postoperative radiography