Maxillary full-arch rehabilitation using the new NobelZygoma™ TiUltra™ implants
Prof. Enrico Agliardi
Italy
"The NobelZygoma TiUltra 0° is a great leap forward from the previous generation of zygomatic implants. The small diameter and conical connection offer advantages both surgically and prosthetically. Furthermore, the TiUltra surface ensures minimal tissue trauma making them more stable over time. In addition to all this, the new drill system offers optimal implant site preparation in every anatomical situation and greatly simplifies every single step. The entire system for treating patients with severe maxillary atrophy using zygomatic implants now has a new gold-standard thanks to Nobel Biocare."
Patient: A 72-year-old female with no systemic conditions and a history of failing implants and grafts in the left upper side.
Clinical situation: The patient presents failing residual teeth in the upper jaw and a failing implant in region 23. She has recurrent sinusitis due to an oral antral communication in region 24-25.
Proposed surgical solution: Extraction of the remaining maxillary teeth with immediate implant placement, consisting of two anterior NobelSpeedy® Groovy implants, one tilted NobelSpeedy® Groovy in region 13 of dimension 4mm and a 37.5mm NobelZygoma 0° TiUltra implants in region 25. The plan includes immediate loading with a pre-fabricated provisional PMMA prosthesis.
Temporization: Immediate loading of the implants with a PMMA provisional prosthesis, secured on temporary Mult-unit Abutments during the initial healing phase.
Surgery date: September 18, 2024
Total treatment time: 6 months including the definitive prosthesis. The provisional prosthesis was delivered the same day of the surgery.
Patient initial situation.
Patient initial situation.
Patient initial situation.
Patient initial situation.
Provisional prosthesis planned before the surgery (left).
Provisional prosthesis planned before the surgery (right).
Right side view (left).
Planning frontal view (center).
Left side view (right).
Cross sectional view of planned zygomatic implant.
Extraction of the pre-existing teeth and incision (left).
Flap elevation (right).
Initial osteotomy drill (left).
Direction indicator (center).
NobelSpeedy® implant of 11.5mm * 4 mm (right).
Design of the window – Extra sinus (left).
Lower border of zygomatic bone identification (right).
Complete zygomatic bone visualization (left).
Round bur to mark the entry point (right).
Lateral bur engages at the mark and creates the implant path (left).
Precision drill (right).
2.9 mm twist drill (left).
3.5 mm pilot drill (right).
Depth indicator angled to identify correct implant length (left).
37.5mm NobelZygoma 0° TiUltra implants in region 25 (right).
Zygoma implant final position (left).
Mounting of MUA (right).
Final implant position with MUA (left).
Occlusal view post implant and MUA placement (right).
Nasal and sinus communication Double closure thanks to buccal fat (BICHAT) Pad and soft tissue (left).
Suture (right).
Occlusal view of provisional prosthesis (left).
Frontal view of provisional prosthesis (right).
Pre-op smile (left).
Post-op smile (right).
Follow-up X-ray post implant placement (left).
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NobelZygomaImmediate, graftless, fixed solutions for patients with severe maxillary atrophy.
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Multi-unit AbutmentKey to the original All-on-4® treatment concept.
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