Abstract
In cases when the residual maxillary bone is not appropriate for insertion of standard implants, the treatment of full dental arch rehabilitation can be performed with zygomatic (ZIs) and pterygoid implants (PI). Although, ZI/PI rehabilitations are well established treatment modalities, these kinds of surgeries are difficult to perform and need a highly experienced operator. One of the major operational challenge is to perform accurate presurgical diagnostics to plan ZI/PI receptor sites. Further research on guided ZI/PI surgery is highly encouraged, in order to reduce errors and complications in free hand surgeries.The purpose of this study is to introduce a novel protocol for the placement of ZI/PI utilizing presurgical planning with 3-D (3-dimensional) CB-CT (cone beam- computed tomography) diagnostic technologies and 3-D printing through the development of a custom made surgical guide. For this purpose, CBCT-derived surgical guides and an exact replica of the entire maxilla and zygomatic bone were fabricated in actual scale model size using 3D printing technology. A total of 4 zygomatic and 2 pterygoid implants were inserted. According to the results, the novel surgical guide design afforded the surgeon direct visual control and support. Positioning the guide in close proximity to the entry point of the zygomatic body aided the control of drills up to the vicinity of the exit point, significantly limiting problems associated with angular deviation. There was no damage to adjacent vital anatomical structures. Provisional prosthesis was delivered a week after the surgery and clinical follow-ups of 3 months showed good healing with no complications. As a conclusion, the use of “inverted supports guided technique” for ZI/PI placement is a safe protocol with successful results.
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