Region Jnkpings ln Odontologiska Institutionen
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Oral rehabilitation with zygomatic implants in a patient with maxillary subperiosteal implant failure

Göthberg C*, Bergendal B, Nilsson P
 

Aim

The aim of this case presentation is to describe the oral rehabilitation with bilateral zygomatic implants of an elderly woman who had a fixed partial denture and a subperiosteal implant in the upper jaw that needed to be removed.

Clinical Report: The patient, after having been edentulous in the upper jaw and worn a full denture for many years, underwent installation of a subperiosteal implant and a fixed partial denture (FPD) at the age of 68 at another clinic in 1986. She was referred to the Institute for Postgraduate Dental Education in Jnköping in 1987.

At the time, her mouth opening was reduced and the tissue around the abutments of the implant was infected. There was a flow of pus to the nasal cavity. She wished to retain the subperiosteal implant and the FPD as long as possible. She was given palliative treatment comprising regular visits to a dental hygienist, repeated periods of antibiotic therapy, and regular checkups by a specialist in internal medicine. The patient was informed at this time that when the subperiosteal implant was to be removed, she would have to return to wearing a removable denture. The progression of bone resorption was followed by radiographs and was rather slow between 1988 and 1996.

In 1996, the subperiosteal implant was removed after 10 years of use. One month later, a full upper denture and a new FPD in the lower jaw were made. The patient was far from comfortable with the upper denture and was prepared to undergo extensive therapy to have fixed teeth in the upper jaw. After a thorough radiographic and clinical examination, two implants (Zygoma Fixture, Brånemark System®) were placed bilaterally in the zygomatic bone and bone from the iliac crest was augmented to the frontal maxillae while the 82-year-old patient was under general anesthesia. Four months later, four 10-mm oral implants (Brånemark System®) were placed in the frontal part of the upper jaw. Abutment connection was per-formed 4 months later and an FPD was made. Because of the extreme bone resorption and to achieve a normal occlusion and meet the esthetic demands of the patient, the buccal extension of the FPD was great. Before the FPD was placed, the dental hygienist was present so as to be able to understand the special hygienic demands.

At follow-ups 6 months after placement of the FPD, the patient was very satisfied with the treatment outcome from a functional as well as an esthetic aspect. She also managed to perform the hygienic measures in the upper jaw very well. She could talk and eat without problems and experienced a better quality of life and increased social security.

Conculusion

Use of the treatment modality Zygoma implants made it possible to install a fixed partial denture in an 82-year-old woman with extensive bone resorption in the upper jaw.

Uppdaterad: 2013-04-03
Anna Thofelt, Avdelningen för odontologisk radiologi Jönköping, Folktandvården