Sinus Lift or Zygoma Implants?

Havingseen many Zygomatic cases it would be harder to sell the idea to the patient due to the cleansing issues and the route of the implants passing from the palatal aspect. With 6 or preferably 8 implants with bilateral sinus augmentation you can return the patient to a more reasonable retored state with cross arch screw retained or passive fit cemented prosthesis. Sure maybe not immediate load but better in the long run in my eyes...

I agree with the comment above. If immediate temporization is desired by the patient it could be implemented with strategically placed mini implants keeping the occlusal load of of the immediately placed regular diameter implants while they heal.

Why not take the teeth out first, fit immediate replacement dentures and reassess when the sockets have healed. It looks as though there will be sufficient bone from UR5 to UL5 to take sufficient implants to carry a bridge extending from UR6 to UL6 without the need for any over-involved solutions. There will also be heaps of bone in the lower arch.

Restoring with Zygomatic implant is a great option for failed sinus lift case .So sinus lift should be attempted first then six or eight implants depending on the prosthesis.Hopefully patient' systemic health is supportive for this treatment plan.

Extract...No need for alveoloplasty...All-on-4...Immediate Load...Out the door...No problem!

extract teeth, preserve anterior sockets at implant sites if needed, insert CUD and allow healing, then bilateral sinus augmentation followed by 8 implants for a nicely rehabilitated complete upper dentition. Forget immediate load or immediate anything, no reason to rush a big case like this.

I agree with above comment, why not consider this a great case for All on 4. The screwholes of distal abutments would extend nicely into the first molar areas. The spread of the implants is favorable. You might consider full extraction and then waiting to make a surgical guide, or use the Malo surgical guide. Good luck!

hello dear Dr.B, in some cases it seems better to use zygoma implants instead of sinus lifting,i had such a case in 1986 and used 2 fixtures of 45mm long inserted in cnine areas and fixed in zygoma,the patient is alive and the full rehab.(joining 2 fixtures and 2 molars)is working properly after 24 years.but the case shoulb be selected very carefully,why dont extract all uppers and then decide?if you like i can send you the xrays of befor treatment -10 years after-and 24 years after rehab.please let me know if interested.

Hello Restore with all on 4 or all on 6 technique

I think that even for a OS zygomatic implants are "scarey" Put in more impants and make a lab temp to the second premolars sinus lift place posterior impans and let them cook.

this is a slam dunk case for all on 4/6 with immediate load. happy to see many comments promoting the technique. I've been doing it for over three years with wonderful results. somewhere on osseo news website I've posted several cases. this case does not seem to need zygoma implants a ct is needed

Sirs, I have been totally shocked by one of the comments in this post.Our colleague claims that he has placed a zygomatic implant on a patient (who is still alive) in 1986, while the original idea of placing implants in the zygomatic bone actually goes back to 1992, and these types of fixtures were not supplied overtly to the market until 1999.I don't see any possibility unless he has been doing some clandestine experimentations with these type of implants even before their advent.Here we go again!!!!!

Dear Dr.jafari, i was sure that there may be such critics to what i,ve done in1986 so a wrote (the patient is still alive) and the implanta are working properly. my dear colleague, as far as i know,you are Iranian and living in Iran,why not contact with m by phone and see all the evidences i have and also visit the patient and ask if there is any question abiut the procedure and specially the date of operation? i will be pleased by hearing your voice on 0912-1247874. thanks againg for your attention

Hi, firstly should we going straight to immediate all on 4/fixed definitive prosthesis in a patient who has active perio disease?? nope Immediate implants shown to have more complications, Cardapoli, after 5 years the volume of bone around immediate implants can reduce by 56%. I would extract immediate denture; unfortunately immediate full upper (fixative needed) currete sockets and collagen block. Then assess soft tissue situation , defo likely to be a FP-3 if so should we be doing this in a patient with who has had active perio as FP-3 v difficult to clean. I feel longterm options: -locator retained denture -galvano denture -fixed solutions but major hard tissue grafting and soft tissue grafting needed.

No need for such a type of procedures.Immediate loading on 4-6 implants or a tripod provisional fixed bridge and implants after healing of the bony sockets.

Hey, seriously google cardarpoli and immediate sockets. All on 4 as a mechanical concept works, but i dont believe in immediate implants long term they are not as successful: you can NEVER fill the bony defect between the socket and the implant effectively, and also soft tissue closre?! And yes there is a need how can you possibly predict the volume of keratinized tissue after immediate implants tell me how please? Healed bony sites are best, i practice in England and i am very academically focussed on the subject and all the leading clinicians and institutions are going away from immediates. Also how can you possibly clean completely effectively around something that has a huge flange and is fixed, you can't. Keep it simple locators or galavano's, Google galvano implant retained denture far superior to all on 4. Cheers

Dear Dr. Before deciding for implant-supported rehab, should the patient be evaluted by means of periodontal measures even full-mouth extraction will be the plan, I believe. Age, gender, chief complaint, history of medical/dental visits&treatment should be questioned paralel to careful intraoral/periodontal exam, especially on a patient with such generalized/severe bone loss. A patient sensitive to periodontal disease or unable to perform oral hygiene measures adequately should not be considered as an implant candidate. Ä°mplant is not a must. Good luck with the patient.

Hey, this is a perfect all on 4 cases, all u need to do is to make sure the smile line cover the edge of the prosthesis. I am sure Cardaropoli would be happy to be quoted but the bundle bone here is already gone ( is the more coronal part of the socket), so it does not make anysense to graft. What is scaring here is the risck of perimplantatis. Good luck.

I feel the reluctance of some of the posters, on this thread, to do an all on four in this situation. I too used to be that reluctant. The literature is clear on placing implants on periodontally compromised patients, and on the fact that immediate implants do have a high rate of long term survival. Where it is still a little cloudy is on the all on four technique, but w the research is getting more and more clear on this technique. I delved into this technique slowly and now have become a believer. It works and it works well. You should base what to do on this patient depending on what THEY want as their final prosthesis. Solely based on the PAN this would be a perfect case for the All on 4.

This is a really interesting procedure.

The severity of periodontitis in this patient suggests that an implant rehabilitation is at high risk as well. I would suggest anterior socket conservation post extractionem. Full denture rehab for a year. Clearance of systemic illnesses. Then All on 4 solution in solid bone.

IF totale extraction is the only solution I would go for it. Then observe a healing period and then evaluate residual bone volume (height and thickness) and only then decide what to do further. AO4, zygomas etc are all an option but what really matters is the prosthetic whishes of the patient. Taking these 2 parameters into account (bone volume and patient whishes), the desired implant treatment option will become evident. Thank you for the interesting discussion on this topic.

Easy case for all-on-4 (on opg view). I´ve done a lot of similar cases and it work great.

If you are actually considering zygoma implants, have a sinus lift done, but make sure you have a CT scan available. So far from what I can see in the panoramic image, you may be able to pull this off with 6 implants with two of them tilted. I have personally observed Zygoma implants. They are not fun nor easy. So if the tilted concept without the sinus lifts does not work for you, then do the sinus lifts and do traditional implant dentistry. Good luck