1. Be prepared for the worst scenario From Bicon to Zygoma MKA Genk

2. Overview ♂ 49 year old Severe periodontitis UJ and LJ Smoker ± 6 cigarettes / day Medically uncompromised Treatment plan: –Upper jaw; total extraction and implant treatment –Lower jaw: extraction 47 and periodontal treatment

3. 13/12/2012

4. 20/02/2013

6. Location 14

7. Location 12

8. Location 22

9. Location 24

10. Treatment plan 1 Moderate/severe bone atrophy 4 x Bicon (4,5 x 6 mm) Delayed loading Fixed bridge (e.g. Trinia)

11. 02/05/2013

12. 24/10/2013: failure all 4 implants At second stage failure of all implants

13. Complicating factors Postoperative infection region implant 22 (R/ Clindamycin 3 * 300 mg/day) Denture wearer, inadequate prothesis releive 4 x mucosal perforation of healing plug smoker

14. X Treatment plan 2

15. CBCT Before retreatment 14 12 22 24

16. Treatment plan 2 severe bone atrophy Quad zygoma Immediate loading Temporary bridge After 12 months definitive bridge

17. Buccal fenestration of implant at 14

18. Placing 4 zygoma implants (Stella technique)

19. Showing the buccal bone defect after failure of the Bicon implants

21. 09/01/2014: Radiographic check postoperatively