25/05/2026
Four years follow-up of a highly challenging case with Grade 3 mobility, chronic periodontitis, and a horizontally impacted upper left canine. The impacted canine had to be surgically removed, which inevitably created significant bone deficiency in the anterior maxilla. Despite the compromised situation, we carefully managed the case and successfully placed the implants to restore function and esthetics.
Bilateral zygomatic and pterygoid implants were placed with immediate loading protocol. The mandibular bone density was also very poor, which made primary stability challenging. To achieve adequate cumulative torque for immediate loading, the maximum possible number of implants were strategically placed.
After four years, the patient remains extremely happy with the smile, function, and overall outcome, with stable and well-maintained bone levels.