Post on 14-Mar-2016
description
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