A Novel Prosthetically Driven Workflow Using Zygomatic Implants: The Restoratively Aimed Zygomatic Implant Routine.

PURPOSE: Zygomatic implants present a unique treatment option for patients with severe resorption of the maxilla; however, palatally positioned zygomatic implant platforms will result in a significant buccopalatal cantilever, speech disturbances, and unhygienic prosthesis contours. The purpose of the present study was to introduce a novel preoperative workflow to help attain predictable surgical and prosthetic outcomes with zygomatic implants. METHODS: To minimize prosthetic complications, an appropriate preoperative workup is imperative. A restoratively driven approach commonly used in traditional intra-alveolar implant dentistry has been adapted for zygomatic implant rehabilitation and described in the present report. RESULTS: With zygomatic implants, applying a prosthetically driven approach is possible. However, it involves a unique application of traditional biomechanical and soft tissue principles of implant dentistry and digital integration of the prosthetic and surgical treatment plans. CONCLUSIONS: Striving to attain zygomatic implant platforms as close as possible to the central fossae and cingulum of prosthetic teeth should be the goal when placing zygomatic implants. The restoratively aimed zygomatic implant routine introduced in the present report is a progressive and modern approach to prosthetically driven implant rehabilitation.

"Monoblock" Occlusal Model to Enhance Occlusal Verification During Orthognathic Surgery.

Intraoperative verification of the planned occlusion is critical in ensuring the accuracy of orthognathic surgery. This step is limited to visual inspection, which can be especially challenging when the planned occlusal setup is less-than-stable. The authors introduce a cost-effective method of an accurate reproduction of the planned occlusion using additive manufacturing which can aid in intraoperative verification of positionally unstable occlusal setups. The authors present a case example, and discuss various technical considerations.

A Systematic Approach to Restoring Full Arch Length with Maxillary Fixed Implant Reconstruction: The PATZi Protocol.

The traditional configuration of four maxillary implants to restore full-arch maxillary fixed implant prostheses is not without pitfalls. Intraoperative variability, such as bone quality and quantity, may lead to unexpected intraoperative challenges that may not allow for execution of the original treatment plan. Additionally, extensive maxillary sinus pneumatization may inhibit posterior spread and lead to a shortened dental arch or excessive cantilever forces. The PATZi protocol is a systematized algorithm for maxillary full-arch implant treatment planning that addresses such intraoperative surprises and achieves full arch length in the planned prosthesis. PATZi also assigns a numbering classification to each implant configuration, which leads to uniform communication and grading of surgical difficulty, as well as predictable planning for developing future salvage plans. By using the PATZi protocol as a guideline, the surgeon may improve composite torque value and anteroposterior (AP) spread, eliminate distal cantilever forces, and ultimately improve the predictability of the prosthetic treatment plan.