Hybrid-zygoma surgery with the new NobelZygoma™ TiUltra™ implants
Dr. Rubén Davó
Spain
Patient: A 65-year-old female with no systemic conditions and a history of a previously failed sinus lift on the right side.
Clinical situation: The patient presents with four mobile, terminal teeth in the maxilla supporting a fixed bridge. She has a fixed prosthesis supported by six implants in the mandible.
Proposed surgical treatment: Extraction of the remaining maxillary teeth with immediate implant placement, consisting of two anterior NobelParallel™ implants and two 40mm NobelZygoma™ TiUltra™ implants. The plan includes immediate loading with a pre-fabricated provisional PMMA prosthesis.
Temporization: Immediate loading of the implants with a 3D-printed provisional prosthesis, secured on Multi-Unit Temporary Abutments during the initial healing phase.
Surgery date: February 9, 2024
Total treatment time: 4 months including the definitive prosthesis. The provisional prosthesis was delivered the same day of the surgery.
Initial occlusion (left).
Initial patient’s X-ray (right).
Initial situation without the prosthesis (left).
Initial situation with the prosthesis (right).
Intraoral pre-op maxillary arch (left).
Intraoral pre-op mandibular arch (right).
IOS of preexisting prosthesis (left).
IOS of bite in preexisting prosthesis (right).
Virtual wax-up of the provisionals (left).
Virtual wax-up trial of the future prosthesis (right).
Upper left picture: Central bone.
Lower left picture: Bone in premolar/molar region (left side of the patient).
Upper right picture: Available bone from premolar area to posterior (right side).
Lower right picture: Available bone at the level of the canine (left side).
Printed model of part of the skull of the patient.
Extraction of the pre-existing teeth and incision (left).
Flap elevation (right).
Surgical splint position (left).
Design of the window and sinus slot (right).
Window and slot (left).
Reflecting sinus membrane (right).
First drill (left).
Drilling (right).
Zygoma implant insertion through the slot (left).
Positioning the implant head (right).
Surgical splint position (left).
Drilling right side (right).
Zygoma implant insertion through the maxillary slot (left).
Zygoma implant insertion (right).
Implants in place.
Provisional printed (left).
Provisional printed (right).
Occipitomental view, post-surgery (left).
Panoramic X-ray, post–surgery (right).
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NobelZygomaImmediate, graftless, fixed solutions for patients with severe maxillary atrophy.
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NobelParallel™ Conical ConnectionProven performance, enhanced esthetics.
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Multi-unit AbutmentKey to the original All-on-4® treatment concept.
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