CHAPTER 15 Case Presentations
Management of Complications
A 64-year-old woman presented with no restorable mandibular dentition and an ill-fitting maxillary full denture. The clinical and radiographic studies demonstrated multiple periodontally involved and nonrestorable teeth. The panoramic study demonstrated advanced resorption of the maxillary alveolar bone and residual alveolar bone in zone I only. The patient’s priority was treatment of the mandibular arch. After fabrication of a full mandibular denture, the mandibular teeth were removed; mandibular implants were placed immediately and the mandibular denture was converted into an immediate-load mandibular provisional, implant-supported bridge. After 3 months of osseointegration, the mandibular implants were checked for the presence of osseointegration and the final profile prosthesis was fabricated and delivered (Figures 15-1 to 15-3).
Five years after treatment of the mandible, the patient requested treatment of her maxillary arch with an implant-supported fixed bridge. Because of the presence of zone I bone and an inadequate volume of zones II and III bone, the zygomatic treatment method was used. Using the protocol for the zygomatic method, two premaxillary implants and two zygomatic implants were placed and the patient’s full maxillary denture was converted to a provisional, immediate-load prosthesis (Figures 15-4 to 15-7).
Six months after the maxillary procedure, the patient presented for phase II with stable occlusion and without any complaints. Osseointegration was confirmed and fabrication of the final profile prosthesis was planned. After removal of the provisional prosthesis, osseointegration was checked by applying the torque driver to each implant. The right zygomatic implant rotated on its axis, demonstrating a lack of osseointegration. The remaining premaxillary and left zygomatic implants were stable without any rotation or symptoms during torquing of their abutment screws. The decision to replace the right zygomatic implant was made.
In preparation for replacement of the failed zygoma implant, reformatted views of the patient’s cone beam radiographic study demonstrate the availability of bone above the existing implant. The intention of the procedure was to remove the failed implant, with immediate placement of a new zygoma implant with the apex in the os zygomaticus and above the failed implant apex (Figures 15-8 to 15-16).
To reconnect the immediate-load provisional prosthesis to the new implant, the existing right posterior maxillary titanium cylinder was removed. The provisional prosthesis was connected to the existing three implants by their retention screws and the new implant was “salt and peppered” to the new titanium cylinder. The patient was discharged with the corrected prosthesis. An additional 6 months of osseointegration was allowed prior to checking the right maxillary implant for osseointegration. After osseointegration of all four implants was confirmed, the final metal-based profile prosthesis was fabricated (Figures 15-17 to 15-22).