This patient was intubated without complications, and local anesthesia was administered. A crestal incision was made, a full-thickness flap up to the Fronto-zygomatic notch, and a Balshi Retractor was placed. From here, we placed 2 zygomatic implants on each side, along with a Vomer implant in a trans-nasal fashion. Bilateral pterygoids were also placed. The fixation of 3 non-zygomatic implants helps stabilize the prosthesis to avoid the springboard sensation of a quad zygomatic configuration. Composite torque exceeded 700 NCM in this case. Bilateral buccal fat pads were dragged to the maxillary midline and closed with 3-0 chromic gut sutures. The mandible was performed in a typical tilting AOX configuration. There were no complications. Immediate loading of the maxilla and mandible took place.
