Vomer, Quad Zygomatic, Pterygoid case in a ZAGA-0 patient

clinical case
Performed by Dr. Simon Oh DDS, FICOI
This patient is a 55-year-old male with no contributory past medical history. His chief complaint was not being able to tolerate his denture anymore due to having a significant gag reflex. Upon examination, a significant concave ridge was noted, due to the decades of wearing a horseshoe complete denture.

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.



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