Nuevas técnicas de planificación y tratamiento para la rehabilitación maxilar con implantes cigomáticos . A propósito de un caso.

  1. Gutiérrez Jiménez, Alejandro 1
  2. Arnaiz González, Francisco Javier 1
  3. Urcelay Moreno, Nerea 1
  1. 1 Sanitas Dental
Journal:
Científica Dental. Revista científica de formación continuada.

Year of publication: 2022

Volume: 19

Issue: 1

Pages: 33-41

Type: Article

DIALNET GOOGLE SCHOLAR lock_openOpen access editor

Abstract

In this case report we present a 76-yearold female patient with an intraoralsquamous cell carcinoma history (2003),who after the surgery and a subsequentradiotherapy presented an edentulismand a severe maxillary atrophy. After aclinical and radiological examination by anorthopantomography and a computerizedaxial tomography (CT, it was decided torehabilitate the upper jaw with zygomaticimplants and a complete screw-retainedrestauration in immediately loadedprosthesis.By means of the DICOM export ofthe maxillary CT scan to the Mimicssoftware (Materialise, Belgium), a virtualsurgical planning is performed taking asa reference a digital prosthetic proposal(DentalCAD, Exocad, USA). In the 3-Maticenvironment (Materialise, Belgium), twobone-supported surgical guides weredesigned for the optimal placement of fourzygomatic implants, combining the ZAGA(Zigomatic anatomy-guided approach)and “Quad approach” techniques.Prosthetically, a prototype is designed toserve as a traditional wax tooth try-in andas a pre-surgical barite splint. The aim isto simplify the working system/procedurewith a new combined digital method,which is possible thanks to the digitizationof the Multi-Unit® Healing Cap.Within this clinical case, a workingprotocol has been developed to simplifythe recordings, reduce costs, andshorten the surgical and the office time to produce an immediate loaded prosthesis in polymethylmethacrylate (PMMA). In addition, a post-surgical CT scanwas used to compare and analyse the precision providedby the guidelines used in the implant placement procedurein relation to those designed for the initial virtual planning;thus, confirming the simplicity, accuracy, and safety ofthe entire surgical procedure. The coronal and apicalend of each zygomatic implant and the angle resultingfrom the discrepancy between the real implant positionand the digital implant one was taken as a reference forcomparison. The results obtained and compared with theliterature, show a deviation without repercussion in therehabilitation process.

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