Full-arch re-treatment involving prolonged peri-implantitis is always a tedious challenge due to the limitation of bone proposition following its resorption. Most often the resulting solution lies in remote anchorage techniques, such as Zygomatic, Pterygoid and Trans-Nasal implants. In the following case we present one of the more common solutions for such situations — the Quad-Zygoma Technique.
While performing re-treatment due to peri-implantitis it is important to analyse and assess the following factors: Etiology, Patient motivation, Restorative prognosis, Hygienic factors and others. The most common and controversial opinion in the periodontic community is that peri-implantitis is a iatrogenic disease, caused mainly due to poor prosthodontic and mucogingival factors leading to the inability of the patient to perform proper daily hygienic management of the restoration thus leading to increased plaque accumulation and subsequently implant failure. Taking these factors into account, it is important to not just explant the failing implants and place new ones, but rather manage the perio-prostho factors to prevent re-occurring infection.
The result is often more functional, rather than aesthetic, such as in this case, where we created a “hygienic zone” in the restorations by moving the base of the titanium bar further from the soft tissues coronaly , thus allowing the patient to better clean the area of contact on a daily basis.
Case by Dr. Prytula (Ukraine)
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