Gap Magazine Implant Dentistry Today No 17

Implant Dentistry Today 26 was evaluated. Once the channel showed the desired depth and the floor surface became even, the round bur tail slid up and down gently. The grinding with the round bur becomes more precise by gently touching the bone during the slide down movement and by a “grinding- back” movement the round bur is able to eliminate the channel floor irregularities (Figs. 8 & 9). Once a zygomatic notch was prepared; the channel was evaluated in order to ensure a homogeneous floor, desired inclination and depth. For the final drill Fig.11. Channel left twist drill.2 Using profuse irrigation, the twist drill slides up and down, using short pressure periods of about 4 seconds, allowing the saline to clean and cool the drill. Fig.12. Left osteotomy Detail of the left ZAGA channel osteotomy prepared accordingly to the virtual planning. Minimal destruction of the alveolar bone and maxillary wall has been performed. Note the enlarged but protective maxillary bone able to integrate with the implant. Note also the achieved sinus lining integrity. The antrostomy site was moved to an apical position on the zygomatic process of the maxillary bone. Fig.13. Measuring left osteotomy Implant length is estimated with a 2,9mm diameter gauge. Fig.14. Left flat implant.1 A flat tapered implant design (Straumann Zygomatic Implant ZAGA®-Flat) is presented and its body compared to the osteotomy size. Note that the tapered apical part of the implant is provided with cutting flutes. The self-tapping flutes are helping the flat implant design (Straumann ZAGA®-Flat) to smoothly penetrate the external cortical of the zygomatic process with enhanced primary stability. Fig.15. Left flat implant.2 The clinical picture is pointing out (Straumann Zygomatic Implant ZAGA®-Flat) implant tip features (see implant picture). The benefit in adapting implant and implant-bed dimension and shape corresponds to a final drill -implant diameter difference of 1 mm. That unique tapered design feature on a zygomatic implant together with the use of a ZAGA conservative osteotomy, allows for an increased implant primary stability. Fig.16. Left flat implant.3 The clinical picture is showing an implant transport holder having the same diameter as the implant itself. That feature helps the surgeon to easily manage implant insertion in situations where the implant is inserted close to another implant or into hard bone. Fig.17. Left flat implant.4 The implant in place is partially outside the bone envelope. To diminish eventual vascular compression of the soft tissues, the implant (Straumann Zygomatic Implant ZAGA®-Flat) has a flat section. To reduce eventual bacterial contamination, the implant body is made of non-threaded turned grade 4 titanium. Fig.18. Left flat implant lateral.1 Clinical lateral view of the flat implant (Straumann ZAGA®-Flat) design. Note the difference with the classic round designs in both the amount and the type of surface facing the soft tissue. Fig.19. Left flat implant lateral.2 Straumann Zygomatic Implant ZAGA®-Flat implant in place from a lateral view. Note that its flat profile is not protruding out the remaining alveolar bone. Figure 11 Figure 14 Figure 17 Figure 12 Figure 15 Figure 18 Figure 13 Figure 16 Figure 19 diameter, a Ø2.9mm twist drill was used with profuse irrigation and with up and down movements, using short pressure periods of about 4 seconds, allowing the saline to clean and cool the drill (Figs. 10 & 11). Following the drilling protocol, the ZAGA channel osteotomy prepared according to the virtual planning was appreciated with a minimal destruction of the alveolar bone maxillary wall and zygomatic bone. A precisely congruent to the implant shape maxillary groove was created while maintaining sinus lining integrity (Figs. 12 & 13). After it was ensured that the implant site was free of soft tissue remnants, the torque control was set at 50Ncm and 15 rpm, and a flat tapered implant design (Straumann Zygomatic Implant ZAGA®-Flat) was inserted at increased torque using the hand piece with the final aid of the manual implant holder. The self-tapping flutes helped this implant design to smoothly penetrate the external cortical of the zygomatic process. Enhanced primary stability was achieved by the implant tapered design and by a