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Initial opening into the sinus.

Pre op. Panoramic X-ray.

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Extra Maxillary Technique,Noris Medical Zygomatic implants

Patient73 y.o. female with failing dentition.

Medical historySignificant for history of stroke, deep vein thrombosis, pulmonary embolism, hypertension, anxiety, Status post IVC filter placement, Status post bariatric surgery, Status post craniotomy, back surgery. On multiple medications, including Coumadin.

Clinical examinationSevere Gagging reflex. Unable to wear dentures.

Radiograph examinationSinus floor extending to alveolar ridge. Risk of oral - antral communication as Zygomatic implant would be in contact with the sinus at the level of the ridge.

Carlos H. Letelier, MD, DMD, DDS Las Vegas, NV, USA

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Initial channel preparation with coarse grit cylindrical drill.

Fine grit cylindrical drill use in contact with the sinus membrane.

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Sinus membrane elevatedIntact sinus membrane. 7

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Coronal portion of sinus grafted. 8

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Implant placed over grafted site. 9

At the end of the procedure the buccal aspect of the Zygomatic implant was also grafted, to create a buccal seal. The Pterygoid implants and mid-maxillary implants had low torque. They will be uncovered for the final restoration. The left Pterygoid implant was placed rather horizontally due to lack of more superior bone to engage the implant.

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The Zygomatic and anterior implants were used to secure the maxillary prosthesis. Tuff implants were used for the Pterygoid and posterior mandibular implants. On the mandible, the posterior implants had to engage the inferior border of the mandible to obtain sufficient torque for immediate loading. Maxillary and mandibular prosthesis were immediately loaded.

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12 Immediate post operative radiograph.

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