Vol. 20, No. 2
 Page 3
December 2007

Against All Odds A “No Bone Solution™” continues:

Initial Clinical and Radiographic Assessment:
After a thorough oral examination, which included evaluation of the existing prosthetics, articulated diagnostic casts, panorex radiograph (Fig 2A), lateral cephalometric radiograph (Fig 2B) and preoperative clinical photographs, the following treatment plan was developed using the “No Bone Solutions™” protocol.

Treatment Plan:

  1. Removal of the non-integrated “mini” implants in the area of teeth 14 and 15.
  2. Fabrication of a new maxillary denture (Figs 3A-C) that incorporated radiographic markers to be used in conjunction with an i-Cat cone beam scan.
  3. Teeth In An Hour™ guided surgery for placement of five traditional Brånemark implants and freehand placement of four zygomatic implants to support an interim all-acrylic screw-retained fixed prosthesis.
  4. After 12 weeks of healing and osseointegration, the fixed screw retained titanium and ceramic prosthesis was fabricated.

Computer Plan:
A virtual plan of the intended surgery was completed using the Nobel Biocare Procera software (Fig 4 A-C ). Computer data was transmitted to a rapid prototyper machine for production of the surgical template. Using this template, a master cast was constructed and articulated. The screw retained provisional prosthesis was then constructed prior to dental implant surgery.

Preop dentures and radiographs Preop dentures and radiographs Preop dentures and radiographs
Figs 3A: Preoperative dentures and radiographic guide
Figs 3B: Preoperative dentures and radiographic guide
Figs 3C: Preoperative dentures
and radiographic guide


Surgical Protocol:
Blood was drawn prior to surgery, transferred to the Harvest cell separator unit and Platelet Rich Plasma was prepared. General anesthesia was then administered and the patient was fully draped using the standard sterile protocol. Local anesthesia was also used for hemostasis.
Following the guided portion of the surgery, which assisted in the placement of 5 Brånemark implants, the surgical template was removed. A crestal incision and vertical releasing incisions were made bilaterally and full thickness flaps were elevated to the level of the superior aspect of the zygomatic bone. The transantral osteotomies, using graduated diameter drills, were completed to permit the apex of the implants to penetrate through the lateral surface of the zygoma. A total of four Brånemark System® Zygoma implants were installed—two in each zygoma. Finally, using the Teeth In A Day® conversion protocol, the previously constructed prosthesis was installed on the standard Brånemark implants and then connected intraorally to the zygomatic implants. The prosthesis was then removed, adjusted, polished and reinstalled.

Implant locations and sizes visible in software
Fig 4A: Nobel Biocare NobelGuide Procera®
software illustrates implant locations and sizes
in maxillary bone

Preoperative Ceph Xray
Fig 4B: Nobel Biocare NobelGuide Procera®
software depicts upper prosthesis with implants

Nobel Biocare Software Shows Implants
Fig 4C: Nobel Biocare NobelGuide Procera®
software shows implants only

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