Analog-digital workflow for complex rehabilitation of severe maxillary atrophy with zygomatic implants: a clinical case

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Abstract

Patients with a complete lack of teeth, severe maxillary atrophy and midface deformity create the most unfavorable conditions for their rehabilitation according to traditional protocols, including bone grafting, sinus lifting and implantation, which forms a complex clinical challenge. Today, zygomatic implants are successfully used as an alternative option for rehabilitation of patients with severe upper jaw atrophy, allowing to reduce the volume of surgical interventions, as well as to shorten the rehabilitation period. Until now, the question of finding an optimal treatment protocol with the use of zygomatic implants remains relevant.

We proposed an integrated protocol of rehabilitation of patients with severe maxillary atrophy, based on the use of analog-digital diagnostic tools and treatment outcome planning, as well as including the stages of surgical and prosthetic treatment using the developed technology of zygomatic implant placement and immediate loading with prosthetic jaw prosthesis constructions.

This work presents a clinical case of the patient (62 years old), whose rehabilitation was performed in accordance with her own protocol: preoperative digital planning according to computer tomography data (Blue Sky Bio Plan, USA), virtual modeling and manufacturing of surgical template for positioning four zygomatic implants (Nobel Biocare, USA), installation of zygomatic implants and immediate fixation of temporary dental prosthesis. Based on the results of follow-up examinations, including X-ray assessment of the zygomatic bones over a period of 6 years, no complications were detected.

About the authors

Timur M. Dibirov

Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

Email: rumit.05@mail.ru
ORCID iD: 0000-0003-0876-928X

md, cand. sci. (med.)

Russian Federation, 20/1 Delegatskaya street, 127473 Moscow

Aleksey Yu. Drobyshev

Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

Email: Dr.Drobyshev@gmail.com
ORCID iD: 0000-0002-1710-6923

md, dr. sci. (med.), professor

Russian Federation, 20/1 Delegatskaya street, 127473 Moscow

Ramaz Sh. Gvetadze

Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

Email: gvetadze-rs@msmsu.ru
ORCID iD: 0000-0003-0508-7072

md, dr. sci. (med.), professor

Russian Federation, 20/1 Delegatskaya street, 127473 Moscow

Edvard A. Kharazyan

Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

Email: edwardkharazian@hotmail.com
ORCID iD: 0009-0008-6750-7080
Russian Federation, 20/1 Delegatskaya street, 127473 Moscow

Sergey D. Arutyunov

Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

Author for correspondence.
Email: sd.arutyunov@mail.ru
ORCID iD: 0000-0001-6512-8724

md, dr. sci. (med.), professor

Russian Federation, 20/1 Delegatskaya street, 127473 Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. Photographs of the patient’s face: a — the front view; b — side view.

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3. Fig. 2. Intraoral photos: a — upper jaw; b — lower jaw.

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4. Fig. 3. View of three-dimensional digital visualization of the computed tomography result: a — direct projection; b — lateral projection.

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5. Fig. 4. Preoperative computer planning of zygomatic implant position and size: a — anterior projection; b — axial projection.

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6. Fig. 5. Intraoperative photo of zygomatic bone access.

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7. Fig. 6. Intraoperative photo of a fixed navigational template for pilot dissection.

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8. Fig. 7. The process of inserting a zygomatic implant into the prepared area.

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9. Fig. 8. Positioning of the implant platform.

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10. Fig. 9. The process of replacing implant guides with gum shapers (a), followed by wound closure and formation of a mucosal-periosteal flap (b).

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11. Fig. 10. Control X-ray examinations of the patient immediately after the completion of surgical interventions: a — orthopantomogram; b — anterior cephalogram.

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12. Fig. 11. View of fixed immediate dentures: a — maxillary; b — mandibular.

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13. Fig. 12. Photographs of the patient’s face: a — the front view; b — side view.

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14. Fig. 13. Control X-ray examination of the patient (orthopantomography) 6 years after the completion of comprehensive rehabilitation.

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15. Fig. 14. Measurement of bone density in the zygomatic region: a — before treatment; b — after 6 years.

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