#Immediacy 01. Apr 2021

Full Mouth Implant Reconstruction Using Straumann Zygomatic Implants ZAGA Round together with BLX Implants. From planning to immediate loading.

A clinical case report by James Chow, Hong Kong

Immediate implant insertion is indicated when treating patients with terminal dentition. In the case of full-arch implant reconstruction, clinicians usually couple immediate implant placement with immediate loading if the primary stability of these implants is adequate. If the residual bone volume is limited in the posterior maxilla, a zygomatic implant is often employed by experienced surgeons to minimize the extent of grafting and to support immediate loading. This article describes the dental implant treatment of an elderly lady who was suffering from terminal dentition. This patient had undergone full mouth clearance followed by double-arch immediate implant reconstruction using Straumann® Zygomatic Implants, ZAGA™ and BLX implants.

Initial situation

A 76-year-old lady who complained of gum swelling and tooth mobility was a known case of hypertension and hyperlipidemia (Fig. 1). She was taking antihypertensives regularly (amlodipine 5 mg at night; losartan 50 mg QD). In addition, this patient had undergone a left hemithyroidectomy in 2018, as well as a spinal fusion many years ago. The patient was fit and ambulatory without any acute distress. Preoperative blood tests showed that she had mild vitamin D deficiency. Clinically, this patient suffered from multiple missing posterior teeth in her upper and lower jaws. The remaining teeth were diagnosed with secondary caries, chronic periodontal disease with clinical attachment loss, defective fillings and failing crown and bridgework (Fig. 2). Radiological examination further revealed that the three anterior mandibular implants had extensive peri-implant bone loss, which was consistent with a clinical diagnosis of severe peri-implantitis.

Treatment planning

After undergoing a CBCT scan, the patient’s DICOM files were exported for computer-aided implant planning (Figs. 3a,3b). Third-party software was used for segmentation and simulation. To respect the biology and biomechanics for optimal functional and esthetic outcomes, the treatment plan was formulated according to the principles of prosthetically driven implant planning (Figs. 4a,4b). Important planning considerations included the distribution of the dental implants in a wider arc, the placement of dental implants according to the future tooth position, and the elimination of a distal cantilever on the prosthesis.

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