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Clinical Case Report

Treatment of the Atrophic Maxilla Using Two Standard Implants and Two Zygomatic Implants Immediately Loaded with a Fixed Restoration

Paolo Casentini, Matteo Chiapasco

A 65-year-old woman was referred to our clinic by another dentist she had recently visited and who had diagnosed a compromised and complex clinical and anatomical situation. She complained of pain and difficulty when chewing, instability of her maxillary prosthesis, and unsatisfactory esthetics. She had received maxillary implants restored with partial fixed dental prostheses, but no stable clinical solution had been achieved. She expressed a preference for a fixed maxillary rehabilitation.


Surgical classification
Complex
Prosthodontic classification
Complex
Source
Treatment Guide 15
Purchase price
10 Academy Coins
CPD/CME
25 hours

Recommended content

General Risk Assessment

Patient-related Factors
Oral hygiene Fair
Compliance Adequate
Patient-medical Factors
Medical Fitness Healthy, able to undergo planned anesthesia and surgical procedure (ASA I)
Medications No medications that would negatively affect the surgical procedure and outcomes.
Radiation Treatment None
Growth Status Complete
Site-related Factors
Access Adequate
Pathology near the implant site None
Previous surgeries in planned implant site Previous procedures resulting in significant bone and soft tissue changes.

Surgical Classification

Surgical Complexity
Timing of placement Immediate Placement (extraction sockets) (Type I)
Simultaneous or Staged grafting procedures Implant placement without adjunctive procedures
Number of implants > Three
Anatomy
Keratinized Tissue Sufficient (>4 mm)
Soft Tissue Quality Presence of scars and inflammation
Proximity to vital anatomic structures High risk of involvement
Extractions
Radicular morphology Uniradicular
Available apical bone to achieve primary stability Sufficient height ( ≥ 4 mm) and width (> 2 mm around apex of planned implant)
Socket walls Intact
Thickness of buccal wall 2mm or greater
Anticipated residual defect after implant placement 2 mm or less

Prosthodontic Classification

Complicating Factors
Biological Framework/Bar with appropriate contours and accessible maintenance procedures
Mechanical/Technical Presence of non-critical contributing factors
Planned contour of tissue-fitting surfaces Appropriate contours (hygienic - accessible for maintenance)
Prosthesis Factors
Prosthetic volume Adequate. Space available for ideal anatomy of the restoration
Inter-occlusal space Adequate. Capable to create an anatomically & functionally correct planned restoration
Volume and characteristics of the edentulous ridge (fixed) Inadequate. Adjunctive therapy or prosthetic materials may be necessary to achieve optimal result
Occlusal Factors
Occlusal scheme User-defined occlusal scheme achievable
Involvement in occlusion Involvement
Occlusal parafunction Absent
Complexity
Loading Protocol Immediate
Implant-supported provisional restoration Required, elevated esthetic and/or functional demands
Number of implants >2 (non-splinted) or ≥ 2 (splinted)
Timing of placement Immediate Placement (extraction sockets) (Type I)

Esthetic Risk Assessment

Edentulous Esthetic Risk Assessment (fixed)
Facial Support Minimal changes in facial support tolerated by patient
Labial Support Minimal changes in lip support tolerated by patient
Upper Lip Length Long upper lip (>20mm)
Buccal Corridor Wide Corridor
Smile Line No display of the Maxillary ridge at full smile
Maxillomandibular Relationship Class I
Publication date: Dec 9, 2025 Last review date: Dec 2, 2025 Next review date: Dec 2, 2028

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