Zygoma Plus Questions Answered - All On 4 Clinic
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Zygoma Plus Questions Answered

Following my roadshows in India and China I received numerous requests from my peers regarding the thought process in the treatment planning of complex dental implants cases, and the dilemmas regarding whether to preserve existing implants in failing cases. I posted a link on Dental Product Review where I previously blogged about “Dental Implants Re-treatment & Zygoma Plus“. One of the peer replies was as follows: Thank you for sharing this link. Do you expect that Zygoma plus will become the gold standard for zygomatic implants in the future? & How long should the patient avoid flying after this procedure? These were relevant questions, and common, so I decided to post my response in this professional section of the All-On-4 Clinic blog. ZYGOMA PLUS, the GOLD STANDARD? After seeing the improved results in the many cases that I treated, especially in respect of cleanability, durability and patient comfort, and the lower complications with Zygoma Plus I would never go back to the conventional technique. I have showcased the Zygoma Plus technique around the world, and the concept was very well received.
However, as the vast majority of the clinicians who do Zygomas are experienced and specially trained OMFS’s, it is unnatural for them to place emphasis on the restorative specifications, and perhaps not their place, whereas at the same time the restorative clinicians typically leave the entire Zygoma planning to the OMFS because of the perceived complexity of those cases, and for the same reason accept what comes back. So there end up being little or no restorative planning/consideration. And yet, it is not the surgeon who has to deal with the issues of comfort, speech, cleanability and increased breakages. In fact the surgeon may not even be aware that these issues exist as they do not see the patient following the surgical review. But dealing with those issues can often become a burden on the practice of the restorative dentist. For the above reasons, until the surgeon spends time in the restorative arena to appreciate the significance and burden of those issues, they are more inclined to continue doing what they have been, especially since Zygoma Plus is far more technique sensitive. I certainly hope with time this becomes the Gold Standard. It already is at my practice and all the All-On-4 Clinics around Australia. WHEN CAN PATIENTS FLY AFTER ZYGOMA OR SINUS SURGERY? When patients ask me after a procedure “can I drink wine?” I often say “well, that depends on what kind of wine!”. So here that would depend on where they are flying to, right? Jokes aside, the question on when to fly really depends on when there is healthy drainage of the sinuses. After surgery there is edema/inflamation and thickening of the schneiderian membrane in the sinus. This can often results in partial obliteration of the osteomeatal complex and interrupts normal drainage. Once the facial swelling goes down, after about 7-10 days, there is also reduced swelling in the sinus and it resumes normal function. However, there can also be blood clots or a haematoma which may take more time to be expelled or naturally dissolve, and then the mucous. As a result of a potential physical obstruction, there is also a heightened risk of infection in the first 3 weeks. For the above reasons, the minimum delay to flying should be 7-10 week. However 3 weeks is more typical of what I recommend. To help improve sinus drainage I use the following protocol:
  • Administration of Dexamethasone + Cefazolin + Metronidazole during the operation;
  • Augmentin Duo Forte 875/125 q12d (or Clindamycin) starting the day prior and taken for a continuous period of 2 weeks;
  • Decongestants (Pseudoephedrine during the day, antihistamines at night, nasal spray) post operatively;
  • NSAID’s such as Anaprox 550mg for 3 days post operatively
Depending on the pre-existing sinus thickening and/or symptoms I might also prescribe Prednisolone to be taken 7 days prior to the surgery (+/- nasal douche).

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