“QuadZygoma” and “SixZygoma”

Full zygoma surgery – the full, immediate and fixed rehabilitation of the total edentulous upper jaw, with dramatic bone atrophy, using only zygomatic implants.

QuadZygoma” – the “last resort” treatment consisting of 4 simultaneously inserted zygomatic implants, that allows the immediate and fixed rehabilitation of a totally edentulous upper jaw, with dramatic bone atrophy (there is hardly any maxillary bone left), the sinuses being excessively pneumatized.

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SixZygoma” – the “last resort” treatment consisting of 6 simultaneously inserted zygomatic implants, that allows the immediate and fixed rehabilitation of a totally edentulous upper jaw, with dramatic bone atrophy (there is hardly any maxillary bone left), the sinuses being excessively pneumatized.

Concept: original of the US Nobel Biocare manufacturer.

Alternative names: „Zigoma4” (Noris Israeli producer);

National premiere: the concept was introduced in Romania by Dr. Taner Chemal and his surgical team in 2012. From then until now, dozens of our patients have benefited from indisputable advantages of this concept.

Implantodent premiers:

  • 2012 – Implantodent specialists conduct nationally for the first time „QuadZygoma” to a 76-year-old female patient, giving her what nobody in the country and in Europe could have given her, considering the dramatic maxillary atrophy: immediate and fixed teeth! Since then the team successfully performed dozens of such interventions.
  • 2013 – Implantodent specialists perform for the first time in Romania and the third time globally the „SixZygoma” procedure.
  • 2014 –Implantodent specialists perform for the first time globally „LaserQuadZygoma”, inserting simultaneously the 4 zygomatic implants and exclusively using the Waterlase surgical laser.

To whom is this concept addressed?

The patient’s upper maxilla without any teeth:

  • Totally edentulous (toothless);
  • Wears for a long time a total mobile denture that caused dramatic bone reabsorptions, thus being thick and unstable (due to the repeated rebasing);
  • With excessively pneumatized maxillary sinuses;
  • With a reduced face, wrinkled, prematurely old looking due to the strong jaw atrophy;
  • That is unwilling or cannot be subjected to massive bone additions from grafts harvested from extra oral areas (hip, leg, ribs, etc.);
  • …but that wants a fixed, immediate, aesthetic and functional rehabilitation;

The patient’s upper jaw with terminal dentition:

  • Existing teeth are severely affected by periodontal disease in advanced form;
  • In anterior region of upper jaw bone found large cystic lesions that have destroyed big portions of it;
  • Bearing partial denture, repeatedly refill adapted until it became so heavy and unstable;
  • Maxillary sinuses are too inflated (very large volume);
  • Who does not want or cannot be subjected to massive bone surgeries, with grafts harvested from extra-oral areas (hip, foot, ribs, etc.);
  • Who wants a graftless fixed, immediate, aesthetic and functional maxillary rehabilitation

Terminal dentition rehabilitated immediately and fixed through the “QuadZygoma” method

Anatomic conditions:

  1. Maxilla (upper) – the entire jaw bone suffers from dramatic atrophy, under the maxillary sinuses there is less than 4-6 mm of bone; bone exists only in the IV region (zygomatic) and there is none in I, II and III (incisive, canine, premolar and molar).
  2. Excessively pneumatized maxillary sinuses (enlarged) both towards the inferior pole (crest) and anterior, in the canine teeth region (up to C or D positions).

NOTE: No matter how severe the maxillary atrophy is, the zygomatic bones (cheek bones) keep their volume and most of the time their density. This is why, when the patient cannot be rehabilitated using conventional implants (there is no bone left in the I, II or III area), the best alternative for a fixed denture remains the special implants (named zygomatic) that are inserted in IV area.

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What does the treatment offer?

The unique opportunity to come to the clinic without any teeth combined with dramatic maxillary atrophy and after only 24 hours you can leave the clinic with implants and fixed teeth!

Even if your immediately teeth are provisional, they are fixed, aesthetic and functional.

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Alternative treatment:

Insertion of axial implants after restoring the deficit bone volume through complex and massive bone augmentations with autologous bone blocks harvested extra orally (iliac crest, tibia, rib, calvarial, etc.) – treatment duration of approximately 20-24 months, invasive method, high risk of graft loss.

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How many implants does the treatment require?

  • 4 simultaneously inserted zygomatic implants, two on each side; the implants start from the upper jaw, go through or beyond the maxillary sinuses (depending on the clinical situation) and are anchored in the zygomatic bones;
    4-implanturi-zigomatice
  • 4 simultaneously inserted zygomatic implants, two on each side and 1, 2 conventional implants inserted in the anterior area of the central incisors; the completion with conventional implants decision is taken by the medical team, depending on the clinical status, the type and strength of occlusion (bite);
    4-implanturi-zigomatice-si-1-sau-2-conventionale
  • In exceptional cases, when the biodynamic and the occlusion (bite) demand it, but there is sufficient zygomatic bone volume, 6 zygomatic implants are simultaneously inserted, 3 on each side and the concept is called „SixZygoma”;

How are the dental implants inserted?

  • 2 zygomatic implants that start in the anterior area of the maxilla (the lateral incisors), go through or beyond the sinuses and are anchored in the zygomatic bones (cheek bones), i.e. in the bone area IV;
  • 2 zygomatic implants that start in the posterior area of the maxilla (second premolar or first molar region), go through or beyond the sinuses and are anchored in the zygomatic bones (cheek bones), i.e. in bone area IV;

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Do the dental implants have anything special?

Yes, they differ primarily in size and design: lengths from 35 to 55mm and the body of the implant, depending on the sinus approach can be fully or partially covered with coils. Let’s not forget that they will be anchored in the upper area, in the zygomatic bones.

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What other components are there beside the implants?

Special screw, components and abutments named “multi-unit” and the denture.
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Necessary investigations:

Each clinical case is unique! Each treatment plan is customized and requires advanced consultation. A correct treatment requires an accurate diagnosis! Precise diagnosis is supported by advanced investigations: clinical, laboratory and radiological.

  1. Advanced consultation (performed in the clinic);
    consultatie-de-specialitate
  2. Blood tests;
  3. Panoramic (2D) radiography (digitally performed in the clinic);
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  4. Large FOV (field of view) dental tomography (performed in the clinic);
    tomografie-a-intregului-masiv-facial
  5. Diagnostic special pictures (digitally performed in the clinic);
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  6. Digital (CAM) or classical (cast) maxillary impressions (performed in the clinic)
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  7. Static and dynamic recording of the occlusion (bite)/jaw movement – (digitally performed in the clinic);inregistrarea-ocluziei
  8. Surgical guide (digitally performed in the clinic);
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  9. The approval of the ENT specialist (when the approach is through the sinuses and there are radiology signs of sinus pathology);
  10. The approval of the cardio specialist;
  11. Chest radiography;

What does the immediate denture require? Is it temporary?

The role of the temporary denture, besides the rehabilitation of aesthetics and the partial rehabilitation of functions, is to stick firmly but passive (no lateral tensions) the implants (a prerequisite in such rehabilitation works).

Yes, this immediate bridge is temporary, but fixed. Incorporates 12 or 14 teeth (from the first or second molar to its counterpart on the opposite side) covering the entire “aesthetic area”, because the posterior extensions are prohibited in this stage! For resistance increasing, denture it can be thickened on the inside or reinforced with metal. It has a very important role in rebalancing the wrong or lost bite (occlusion) in many situations and therefore will be monitored through regular checks by our specialists. It requires careful maintenance and sanitation, as prescribed by the doctor.

In some situations, this denture is performed before surgery, is balanced through periodic meetings until the time of surgery (the decision to perform the task before or immediately after surgery is taken by the medical team, depending on the clinical situation identified during advanced consultation).

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What does the permanent denture entail?

Permanent denture is fixed and not covers the roof of mouth (palate)!

Permanent denture is made of 12 (common) or 14 teeth. The denture is fixed by screwing and is locked by prosthodontist (prosthesis specialist) according a special algorithm, using a special torque wrench (this is why these demanding and expensive dentures should not be handled and cleaned by inexperienced doctors). It will be easily removed by unscrewing whenever needed or for regular professional cleaning.

The permanent denture has 2 components:

  1. A structural strength (supporting structure):
    • Metallic that can be manufactured by casting (chrome-cobalt) or cad-cam milling (titanium);
    • Made of high-performance polymers that behave similar to human bone and is creamy white (aesthetic);
    • Zirconium (robotic milling);
  2. An over structure (teeth):
    • acrylic/composite;
    • full ceramic (porcelain without metal);
    • zirconium or zirconium-ceramic;

Price of permanent denture may be fixed only after dental implant osseointegration (about 6 months), depending on the clinical situation at the time, the complexity and the material it is made. (check the price list)

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Do the temporary or permanent denture cover the palate (roof of the mouth)?

No, neither the temporary nor the permanent dental implant dentures cover the palate!

Does the dental denture include the artificial “pink” gum at the base of the teeth?

In general, because we are talking about vertical bone atrophy, they do require compensation.

This can be done as follows:

– either through vertical bone additions (which besides involving inherent risks they considerably extend the treatment duration and dramatically increase costs) or

– using the artificial gum, which is not seen when the patient is talking or laughing, but only if the lips are retracted willful.

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Do the sutures remain under the denture?

Yes, the sutures are generally non-absorbable and the visible parts will be removed after approximately 2-3 weeks. The temporary denture can be removed only after the first month, by the prosthodontist (prosthesis specialist) who unscrews the denture, inspects the healing and removes the rest of the sutures

Where is the treatment conducted?

In conditions of maximum safety and comfort, in one of the implantology rooms, which are designed and function like an operating room. We will never insert the dental implants in the common treatment rooms, where microbial load can be too high, and the conditions are not conducive to a safe treatment for full mouth rehabilitation (extensive surgery).

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Who performs the treatment?

  • The surgical stage will be performed by one of the 4 specialised doctors that are experienced in such advanced treatments: Dr Chemal Taner, Dr Dumitru Ovidiu, Dr Vasileios Panagopoulos or Dr. Chemal Olgun. The IV (intra-venous) medicine sedation (sleeping anesthesia), completing the loco-regional anesthesia and the monitoring of the patient during surgery will be performed by our ICU (intensive care) specialist, Dr. Fono Adrian.
  • The prosthetics stage falls under the responsibility of the experienced prosthetics specialists: Dr Curt-Nazar Varol, Dr Rusu Mihaela, Dr Popescu Dragos.
  • The technical execution: depending on the complexity and type of the work, the technicians Zoltan Elekes (Brasov), Milos Miladnov (Timisoara) or the technicians in the Euroteknika laboratories (France) or the Nobel Biocare laboratories (Nobel Procera).

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What does the Implantodent treatment include?

  • Stage 1: free shuttle from the airport to hotel, panoramic radiography (2D), dental tomography (3D), diagnosis pictures, diagnostic and treatment plan, professional cleaning of the oral cavity, (possible) preoperational diagnostic models and dentures, pro implant surgeries, dental implants, blood concentrates-platelet reached fibrin (PRF), surgery aftercare in special rooms, free shuttle from the clinic to hotel and back, prescription, immediate and fixed temporary denture, the special oral hygiene package, checking X-rays (tomography and panoramic), laser physiotherapy sessions, regular sessions for the occlusal balancing of the immediate denture.
  • Stage 2: permanent fixed denture, digital occlusal (bite) recordings, diagnostic models and dentures, the permanent denture, protection mouth guards, oral irrigator (shower).
  • Additional: invoice, medical services contract, implant passport and international guarantee, conformity certificate both for the temporary but also for the permanent prosthetic systems.

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What prices (costs) are entailed by the Implantodent treatment?

  • Stage 1: „QuadZygoma – 12.000 eur and „QuadZygoma+” – 14000 eur; „SixZygoma” – 18000 eur. (check the price list)
  • Stage 2: based on the complexity and the materials used in the permanent work, its price varies from 2500 to 8000 eur/maxillary arch.

What costs are not included in the treatment?

The cost of the IV sedation-analgesia (sleeping anesthesia) and of the sometimes necessary biomaterials (bone substitute and barrier membranes) for possible bone repairs (post extraction alveoli, remaining cavities in the bone, bone dehiscence, etc.) that are required simultaneously with the implant insertion.

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We remind you that the initial price does not include the cost of permanent prosthetic work. The fees for this work varies between 2500 to 8000 euro / maxillary arch and is established with the prosthesis specialist depending on the clinical situation when changing the work, and of course depending on the material recommended by the specialist and agreed by the patient.