SRILANKA’S FIRST QUAD ZYGOMATIC IMPLANT SURGERY
A HISTORIC MILESTONE : SRI LANKA’S FIRST QUAD ZYGOMATIC IMPLANT SURGERY IN FEBRUARY 2025, By Dr Hirantha Weragoda
In February 01st 2025 Dr Hirantha Weragoda pioneered a revolutionary full-mouth reconstruction by performing the first-ever quad zygomatic implant surgery in Sri Lanka, ushering in a new era of advanced dental implantology in the country.
Addressing a challenging case of complex dental rehabilitatation.
A 70 year old female presented with partially edentulous maxilla and mandible, presenting only three standing teeth per jay. Initial investigations, including photography, intraoral scans and CBCT confirmed lack of sufficient bone for conventional implants. Therefore a comprehensive treatment plan was
10devised to achieve full-mouth rehabilitation utilizing zygomatic implants for the upper jaw (encompassing the quad zygoma, pterygoids, and anterior central implants) and an all on four protocol for the lower.
Treatment Planning
| PHOTOGRAPHS | Cone Beam Computer Tomography (CBCT) | Intra Oral Scan (IOS) | PLASTER-MODELS |
| Pre-operative photographs | Analysis of the underlying bone | Actual Geometry of the upper and lower arch. | |
| Primary Reference | Analysis of the standing teeth | Precise and accurate. | Table-top reference for diagnosis and treatment planning, until the printed digital 3D models are ready. |
| Visual Analysis | Surgically important structures, Sinuses, Nerves, etc | Primary reference for the upper and lower arches. | In-case of instant diagnostic changes are need |
| Best material for smile design | Assessment of the underlying pathologies, Granulomas, Cysts, Septic roots, Old Implants, Bone Fractures, Repaired Fractures, plates, screws and wires, ets | For bite relationship assessment and mounting purpose in the articulator | |
| Comparison with the treatment procedures and with the end of the treatment. | Main Canvas for Implant planning | Printing models for treatment planning. | Patient education. |
| Patient education | Surgical guide design |
Upper jaw severe bone loss. Lowe anterior/ mental region hopeful bone for conventional implants for all on 4 lower implants.
Treatment Planning Tools
Computer softwares used for Treatment planning
| CBCT Viewer | Digital Smile Design Software | Implant planning and surgical guide design software. | 3D Print Design Software. | Dental-CAD Soft ware. |
| Primary visual analysis of the upper and lower jaw hard tissues. | Virtual design of patient’s future smile | Implant planning | Helpful for the surgical guide fabrication | Prostheses Design |
| Tentative treatment planning | Patient education | Surgical guide design | Model design | Prosthesis Manipulation |
| Patient education | Prosthetic planning | Study models and working model design | Customized surgical jigs design | Laboratory communication. |
| Axial Data conversion in to DICOM format for the use of advanced treatment planning softwares. | Helpful for the implant planning software. | Patient education. | ||
| Communication with the Laboratory technician. | Laboratory communication. | |||
| Bone segmentation and Make STL format for the hard tissues |
Full arch implant placement. Blue sky bio implant surgical guide planning software. Implants in the upper arch. Four zygomatic implants (Quad-zygoma) Two Pterygoids and one implant in the incisive canal. Segmented maxilla for the planning. All-on-X implant full mouth reconstruction.
Mandibular implant planning. All-on-four implant full mouth reconstruction.
Bone reduction planning to gain the required prosthetic versicle height
Bone reduction surgical guide.
Surgical planning incorporated digital smile design and CBCT data, utilizing specialized implant planning software to design custom surgical guides for the placement of both the quad zygomatic and other implants. The prosthetic phase was initiated with a delayed loading protocol, with the first temporary prosthesis being delivered one to two weeks following the implant placement surgery.
GETTING READY FOR THE SURGERY
Pre-operatively, detailed surgical jigs, stencils and guides were fabricated, meticulously cross checked with the printed maxillary and mandibular models, and kept ready for the case which has thoroughly studied to assess the complexity and seriousness of the procedure. Comprehensive patient counseling ensured informed consent, and through medical assessments were completed while mandatory prostheses within two weeks following surgery boosting confidence and supporting psychological well being.
"Dr. Hirantha Weragoda, BDS (Hons), is a specialized Dental Surgeon with expertise in Implants, Oral Surgery, Zygomatic implants, and Full mouth reconstruction in Sri Lanka. Graduating with Honors, Dr. Weragoda is committed to clinical excellence and advanced dental solutions."
View All Articles