Treatment of the Severely Atrophic Arch With Zygomatic, Pterygoid, and Vomer Dental Implants

Dan Holtzclaw, DDS, MS

A 64-year-old man presented to the author's practice with hopes of replacing his maxillary denture. He had been wearing the denture for approximately 5 years and was told by other dentists that he had too much bone loss in the maxillary arch to accommodate implants. Using a variety of dental implants from Noris Medical (norismedical.com), the author was able to provide the patient with an immediately loaded fixed prosthetic solution that required no bone grafting. Noris Medical Pteryfit^™ implants were bilaterally placed into the pterygomaxillary complex for terminal prosthetic support while a pair of Noris Medical Zygomatic implants were placed for mid-arch support. Anteriorly, support was achieved with a Noris Medical Tuff^™ implant engaging the vomer. Noris Medical Tuff implants were also used to restore the mandible in a standard full-arch fashion. This case was immediately loaded and a final restoration was delivered 6 months after the initial surgery.

Noris Medical Pteryfit^™ implants are specifically designed to engage the pterygomaxillary complex
and allow for immediate loading protocols.

Noris Medical Zygomatic implants have a unique design especially suited for extra-sinus surgical approaches.
The aggressive rough surfaced end cutting tip and smooth mid-coronal shaft make the implant an ideal fixture for treating cases with severe maxillary bone loss.

The Noris Medical line of dental implants is particularly suited for treatment of cases with severe bone loss. Also, with 0-, 17-, 30-, 45-, 52-, and 60-degree abutments, Noris Medical offers a wide selection of prosthetic platforms.

Dan Holtzclaw, DDS, MS
Diplomate, American Board of Periodontology; Diplomate, International Congress of Oral Implantologists; Private Practice, Austin, Texas

Figures and Images

BEFORE

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BEFORE

BEFORE. Pretreatment photograph. The patient had been wearing an upper denture, and bone atrophy was significant. The mandible had many missing, ailing, and failing teeth.

Figure 1

Fig 1. Pretreatment panoramic radiograph. Note pneumatized maxillary sinuses and failing mandibular teeth.

Figure 2

Fig 2. Intraoral condition of maxilla before surgery.

Figure 3

Fig 3. Extra-sinus drilling technique for placement of zygomatic implants.

Figure 4

Fig 4. Placement of zygomatic implant using the extra-sinus approach.

Figure 5

Fig 5. Tuff implant, zygomatic implant, and Pteryfit implant with 17-, 45-, and 30-degree abutments, respectively, in place. Note the parallelism achieved due to the wide range of abutment selection.

Figure 6

Fig 6. Maxilla sutured after surgery using the author’s Texas 2-Step™ suture protocol.

Figure 7

Fig 7. Final radiograph after treatment. The maxilla was restored with Tuff, zygomatic, and Pteryfit implants, while the mandible was restored with Tuff implants.

Figure 8

Fig 8. CBCT scan (cranial view) of restored case with zygomatic, pterygoid, vomer, and standard dental implants.

Figure 9

Fig 9. CBCT scan (lateral view) of restored case.

Figure 10

Fig 10. CBCT scan of Pteryfit implant engaging the pterygomaxillary complex.

Figure 11

Fig 11. CBCT scan of zygomatic implant engaging the zygoma.

Figure 12

Fig 12. Patient after treatment.