Zygoma Implant-Supported Prosthetic Rehabilitation of a Patient After Bilateral Maxillectomy

Objectives: This article describes the prosthetic rehabilitation of a patient with a severe intraoral defect resulting from a maxillectomy resection, using two zygoma implants connected by CAD/CAM-fabricated milled bar (infrastructure framework) and a maxillary obturator prosthesis.
Methods: A 52-year-old male Prosthodontic Diagnostic Index (PDI) Class IV patient that had a history of a bilateral maxillectomy for resection of a squamous oral cell carcinoma of the hard palate was referred to our department for oral rehabilitation by Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University. Intraoral examination revealed two zygoma implants (Zygoma Fixture, NobelBiocare) that 1 on the right side and 1 contralaterally. Multiunit abutments were connected to the implant body and a transfer impression (Impregum Penta, 3M ESPE) over the implants was made. A free shape milled bar were designed without following a particular manufacturing shape and customized according to the the denture tooth arrangement and the soft tissues. Before the manufacturing of infrastructure framework, acrylate polymer blocks (Tizian Blank PMMA, Schütz Dental GmbH) were initially used for the fabrication of replica bar using CAD/CAM to control intraoral compatibility. Maxillary obturator prosthesis and mandibular complete denture was completed and placed in the oral cavity in 2014. Turkish version of the 14-item questionnaire¹ was given to patient before (temporary obturator prosthesis) and after oral rehabilitation for self-completion to evaluate functional, esthetic, and psychologic satisfaction (Table 1). Each item was scored by a number, with the final score (range: 0-29).
Results: Following delivery of the prosthesis, the patient’s response was favorable in relation to esthetics, speech, swallowing and mastication while the patient’s oral and facial appearance improved. A significant decrease in the total questionnaire score between the temporary obturator prosthesis (score = 18) and the zygoma implant-supported definitive obturator prosthesis (score = 2), suggesting an improvement in the patients quality of life and self-esteem.
Conclusions: Zygoma implant-supported obturator prosthesis have excellent retention and stability, and there is no displacement of the denture during speech and mastication.