Dr. Caesar Butura - "Combined immediate loading of zygomatic and mandibular implants: a preliminary 2-year report of 19 patients"
Key takeaways
- Dr. Caesar Butura's 2014 study followed 19 patients treated with combined immediately loaded zygomatic and mandibular implants over a two-year period.
- The study placed 40 zygomatic implants and 112 conventional implants, with mandibles restored using an All-on-4 approach.
- Zygomatic implant survival was 100% at an average of two years, with no failures among the conventional implants and no early sinus issues.
- Implants were loaded within three to four hours of surgery at an insertion torque between 32 and 45 Ncm; the 45 Ncm ceiling protected the external connection of the Nobel Speedy fixtures from distortion.
- Zygomatic implants in extramaxillary positions can show micromotion up to 100 micrometers, unlike anterior conventional implants, so controlling occlusion across a roughly 40 mm arch spares the anterior implants from torsional forces.
- The implants were placed following the original Branemark protocol updated with the Stella slot technique, as the ZAGA concept was not yet fully established at the time.
- One patient, a former F-4 Vietnam fighter pilot in his late 70s, had a failed 1980s subperiosteal implant removed before placement of two zygomatic fixtures and anterior conventional implants.
What you'll learn
- Combining immediately loaded zygomatic implants with mandibular All-on-4 in one surgical intervention
- Insertion torque window of 32-45 Ncm to load implants without distorting external-connection fixtures
- Managing dissimilar implant behavior by controlling occlusion to spare anterior conventional implants from torsional forces
- Removing failed subperiosteal implants and placing zygomatic fixtures in the atrophic maxilla
- Setting occlusion de novo when both arches are restored simultaneously in mixed dentate/edentulous cases
About the guest
Dr. Caesar Butura
Dr. Caesar Butura is a board-certified oral and maxillofacial surgeon practicing in Phoenix, Arizona, where he founded Butura Oral and Maxillofacial Surgery. He has focused on immediately loaded full-arch reconstruction of the maxilla and mandible since his first immediate-load case in August 2008. His practice is the ZAGA Center Phoenix, and he trained at Columbia University College of Dental Medicine and the University of Illinois Chicago.
