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\title{Zygomatic and Conventional Implants for Management of Severe Alveolar Atrophy in Partial Edentulous Maxilla and Completely Edentulous Mandible}
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             \author[1]{Dr. Anshuman  Dwivedi}

             \author[2]{Dr. Manmeet  Kour}

             \author[3]{Dr. Amit  Sarkar}

             \affil[1]{  maxillofacial surgery}

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\date{\small \em Received: 9 December 2018 Accepted: 2 January 2019 Published: 15 January 2019}

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\begin{abstract}
        


The geriatric population, atrophic maxilla is a common condition.1. Severely resorbed maxilla is challenging for the installation of conventional osseointegrated implants.2. To reduce the complications associated with bone grafting procedures and to simplify the rehabilitation of atrophic maxilla, zygomatic implants play an essential role.3. With the use of zygomatic implants the wait for osseous graft maturation is eliminated saving the treatment time and money.4. In this case report, nasal floor lift for anterior implants was performed with placement of bilateral zygomatic implants and conventional implants.

\end{abstract}


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\let\tabcellsep& 	 	 		 
\section[{Introduction}]{Introduction}\par
O rehabilitate the atrophic maxilla is very challenging for the oral and maxillofacial surgeons. Restoration is not possible in majority of patients of atropic maxilla with conventional implants due to lack of alveolar bone caused by pneumatization of the maxillary sinus. From the past few years, these cases had been treated with cortical-medullar bone grafts from the iliac crest performed under general anesthesia. \hyperref[b1]{2}. Zygomatic implants offer a satisfactory function, improves aesthetic results, costs low, execute time and also provide low morbidity for patients as it is less invasive surgery as compared to other treatment options for atrophic maxilla such as reconstructions with autologous grafts. For the very first time, zygomatic implants were used in cancer patients who underwent maxillectomies or tumor resections, trauma and congenital defects by Professor P-I Branemark in 1987. An excellent alternative in the rehabilitation of the atropic maxilla was proposed by Aparicio, et al in 1993 that Zygomaticmalar bone can be used as an anchorage for oral implants \hyperref[b4]{5} . Zygomatic implants are immediately loaded as their length is enough to provide anchorage as there is a larger contact between the surface of the implant and the bone; therefore, the stability is also greater \hyperref[b4]{5} .\par
T towards piriform aperture then the nasal floor was lifted carefully then after osteotomy was performed from the anterior maxillary crest and implants placed simultaneously and bovine bone graft was used to graft the deficit site. (Figure  {\ref 9}). Interrupted 3-0 silk sutures were placed on the incision line and post-operatively a prescription of Xylometazoline nasal spray (to reduce swelling and congestion), and antibiotics was made. The patient was instructed to strictly follow the oral hygiene, and regular follow-ups. A placement of Eleven freehand implants were done in both the arches in which six ADIN Implants were placed in mandibular arch and five implants were placed in the maxillary arch out of which two were Zygomatic, and three were conventional of NORRIS MEDICAL ITALY. Delivery of the provisional prosthesis was made possible on the same day of surgery, and the final prosthesis was given 12 weeks post-operatively. CBCT scans were performed post-operatively, which showed excellent integrated implants with new bone formation at the region of nasal floor lift. (Figure  {\ref 9}). The patient was followed up for two years; on CBCT all implants were osseointegrated with no marginal bone loss.\par
IV. 
\section[{Discussion}]{Discussion}\par
The latest scientific technology had provided a huge benefit for recuperation of maxilla in patients. Various possibilities like traditional implants, bone reconstruction, or zygomatic implants were used for the rehabilitation of totally edentulous patients with severe atrophy of the maxilla. \hyperref[b1]{2} Out of various treatments, zygomatic implants have been in clinical use for 20 years and is an excellent treatment plan for patients with severely resorbed fully or partially edentulous maxillary arches. \hyperref[b8]{9} When direct alveolar support for conventional implants is lacking; Zygomatic implants offer a relatively measured approach to restore missing upper dentition. Parel et al developed the concept of remote implant anchorage from which the zygomatic implant is derived. In many studies, the zygomatic implant has been demonstrated a high survival rate of 97\% after more than 12 years of follow-up. Malevezand Bedrossian reported a 100\% survival rate using 2 stage protocols. \hyperref[b2]{3} In our case report, the patient was partially edentulous with the severely atrophic maxilla. Besides placing the zygomatic implants, the nasal floor of the patient was also lifted, and placement of conventional implants in the maxillary anterior and mandibular region was also done. According to El-Ghareeb et al. Nasal Floor Lift is the most reliable method for reconstruction of the anterior atrophic maxilla when the residual height is less than 10 mm for implant-supported overdentures. The use of osteoconductive bone graft substitutes with simultaneous implant placement is a predictable approach for augmentation of up to 5 mm in height, and eliminates the need for more invasive procedures such as Le Fort I osteotomy, as well as donor-site morbidity associated with autogenous bone graft harvest. \hyperref[b5]{6} Using a fixed prosthesis to connect all implants with adequate anteroposterior spread provides crossarch stabilization and allows the transmission of masticatory forces on the zygoma bone. Thus crossarch stabilization from the prosthesis, just after placement of the implants, could alleviate the load on the anterior implants and could be one of the reasons to explain the loss of only three implants in such atrophied sites. This loss of implants may be related to the fact that they were placed in an area with an extensive bony defect since immediate loading itself does not seem to preclude osseointegration \hyperref[b6]{7} .\par
With the use of zygomatic implants either in combination with or without conventional implants in anterior atrophic fully or partial edentulous maxilla may be considered as the replacement to osseous grafting for providing bone formation for conventional implants. It has been reported that the success and survival rates of the zygomatic and conventional implants are equally same. Zygomatic implants provide short treatment time which would be normally required for osseous graft maturation and until maturation occurs it also subsequently delays the implant placement. Therefore, the treatment costs are also lowered as the complex grafting procedures are eliminated. As the use of CBCT, virtual planning, and surgical guides' progresses, it is anticipated that these implants may be utilized more readily and would result in the reduction of potential complications associated with prior placement techniques. 4          \begin{figure}[htbp]
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\caption{\label{fig_2}Figure 3 :}\end{figure}
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\caption{\label{fig_3}Figure 4 :}\end{figure}
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\caption{\label{fig_4}Figure 5 :Figure 6 :}\end{figure}
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\noindent\textbf{7}\includegraphics[]{image-7.png}
\caption{\label{fig_5}Figure 7 :}\end{figure}
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\noindent\textbf{8}\includegraphics[]{image-8.png}
\caption{\label{fig_6}Figure 8 :}\end{figure}
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\noindent\textbf{910}\includegraphics[]{image-9.png}
\caption{\label{fig_7}Figure 9 :Figure 10 :}\end{figure}
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\caption{\label{fig_8}Figure 11 :}\end{figure}
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\noindent\textbf{1213}\includegraphics[]{image-11.png}
\caption{\label{fig_9}Figure 12 :Figure 13 :}\end{figure}
 			\footnote{© 2019 Global Journals} 			\footnote{( )J} 		 		\backmatter  			  				\begin{bibitemlist}{1}
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