Retreatment of a fractured zygoma implant

$Page 1: Retreatment of a fractured zygoma implant$
Example of a retreatment after fracture of zygoma implant

Situation• Patient desires:

– Initial treatment dates back to 1990– solution for fractured zygomatic implant

• Diagnosis– Fatigue fracture of right zygoma implant

• Treatment plan– Placing two additional zygoma implants with

navigation│delayed loading │overdenture

Chronology

• Lower jaw:– 17/07/1998: 4 implants │Delayed loading

│implant supported bridge• Upper jaw:

– Before 1998: reconstruction bone graft │failed– 2000:placement long implants with zygomatic

anchorage and 2 implants with pterygoid anchorage

#

• #zygoma• #Pterygoid• #Overdenture_4

17/07/1998: failed reconstruction upper jaw

Placement implants lower jaw

01/01/1990 status after Lfeort I osteotomy with bone (hip) graft interposition

Follow-up 10 years

Fracture of right zygomatic implant

23/12/2010: Fracture right zygomatic implant + fracture prosthetic screw in right pterygoid implant




23/12/2010

Right pterygoid Right zygoma Left zygoma Left pterygoid

23/12/2010

23/12/2010

23/12/2010

Fractured zygoma implant

Remnant of overdenture bar on the left side

23/12/2010

23/12/2010

23/12/2010

23/12/2010

Head of the zygoma implant still engaged in overdenture bar

23/12/2010

23/12/2010

Head of the zygoma implant still engaged in overdenture bar

23/12/2010

11 12 13 14 15Height 4.25 2.11 3.81 - -

Thickn. 4.0 1.2 2.82 4 4

Preoperative bone analysis: Largely insufficient bone volumes in all locations

Retreatment

• Treatment plan– Removal of fractured zygoma implant right– Placement of 2 new zygoma implants

Planning for 2 zygoma implants on the right side in Brainlab software

This implant is very close to the orbital floor with

possible perforation during surgery







Surgery

• Planning of the 2 zygoma implants– 1 implant cranial of the failed implant

• Since it was close to the orbital floor an additional visual access would be prepared using an infraorbital incision and exposion of the oribita floor

– 1 implant in the neighbourhood of the failed implant provided that it could be removed

Determination entry point distal implant

Determination exit point distal implant

Determination exit point anterior implant

09/02/2011: operative view of fractured zygoma implant (right)

09/02/2011: operative view of left zygoma implants

Fully functional after 10 y

09/02/2011: view of fractured implant of extramaxillary implant with 10y follow-up

09/02/2011: view of fractured implant of extramaxillary implant with 10y follow-up

Extramaxillary implant placed in 2000

09/02/2011: cutting through the implant

Extramaxillary implant placed in 2000





09/02/2011: cutting through the implant: removal coronal part

The extramaxillary portion was not osseointegrated on the contact surface with the bone

09/02/2011: cutting through the implant: removal coronal part

The extramaxillary portion was not osseointegrated on the contact surface with the bone

09/02/2011: remaing apical part of the implant

Bone surface which was covered by the extramaxillary portion of the zygoma implant

09/02/2011: remaing apical part of the implant

09/02/2011: removal of the apical portion of the zygoma implant with a heavy forceps and rotation

Clinically the apical portion was very stable but apparantly non-osseointegrated

peroperatief: 09/02/2011

Clinically the apical portion was very stable but apparantly non-osseointegrated

09/02/2011: removal of the apical portion of the zygoma implant with a heavy forceps and rotation

peroperatief: 09/02/2011

Visualisation orbital floo

Placed implant

Just below orbital floor

09/02/2011: Intraoral view of new placed implants

09/02/2011: Bio-Oss

The Extended sinus lifting techniqueMarc Hinze, Wolfgang Bolz, Luc Vrielinck, submitted for pub, 2011

09/02/2011: Biogide

09/02/2011: primary wound closure

09/02/2011

Postoperative radiography

10/02/2011

10/02/2011: Postoperative radiography



SEM

Demonstrated that implant fracture was caused by fatigue













Retreatment of a fractured zygoma implant

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