Patient
73 y.o. female with failing dentition.
Medical history
Significant 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 examination
Severe Gagging reflex. Unable to wear dentures.
Radiograph examination
Sinus floor extending to the alveolar ridge. Risk of oral – antral communication as Zygomatic implant would be in contact with the sinus at the level of the ridge.
Pre op. Panoramic X-ray.
Initial opening into the sinus.
Initial channel preparation with a coarse-grit cylindrical drill. / Fine grit cylindrical drill use in contact with the sinus membrane.
Intact sinus membrane. / Sinus membrane elevated.
Coronal portion of sinus grafting. / Implant placed over the grafted site.
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 a lack of more superior bone to engage the implant.
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 prostheses were immediately loaded.
Immediate postoperative radiograph.
