Case Overview

A 58-year-old female patient presented with severe maxillary atrophy following years of complete

denture wear. Traditional implant placement was not possible due to insufficient bone volume, making

zygomatic implants the treatment of choice.

Initial Assessment

CBCT analysis revealed:

- Residual ridge height: 2-4mm in premolar regions

  • Complete pneumatization of maxillary sinuses
  • Good zygomatic bone quality (Type 2)
  • Adequate anterior maxillary bone for 2 conventional implants

Treatment Plan

After careful analysis, we planned a Quad-Zygoma approach with 4 zygomatic implants and 2 anterior

conventional implants for a total of 6 implant-supported prosthesis.

> Clinical Pearl: Zygomatic implants require extensive 3D planning due to their proximity to vital structures

including the orbit and the complex trajectory through the sinus.

Digital Planning Steps

1. Prosthetic wax-up: Digital design of ideal tooth positions

2. Zygomatic bone segmentation: 3D visualization of available bone

3. Trajectory planning: Each implant planned avoiding sinus membrane perforation

4. Emergence optimization: Ensuring palatal emergence for prosthetic access

5. Guide design: Bone-supported guide with multiple fixation points

Surgical Guide Design

Given the complexity, we designed a stackable guide system:

- Primary guide: For initial osteotomy and trajectory verification

  • Secondary guide: For final drilling and implant insertion
  • Multiple fixation pins for absolute stability

Outcome

The surgery was completed successfully with all implants achieving primary stability. The patient

received her provisional prosthesis the same day. At 6-month follow-up, all implants showed

excellent osseointegration.

Key Takeaways

- Complex cases require meticulous 3D planning

  • Stackable guides provide better control for multi-step procedures
  • Collaboration between surgeon and planning specialist is essential
  • Proper guide fixation is critical for zygomatic procedures

Zygomatic Implants

Complex Case

Bone Atrophy

Case Study