Rehabilitation of the atrophic maxilla: Guided Le Fort I maxillary advancement and zygomatic implants with and immediate loading

The full-arch rehabilitation of the atrophic maxilla using four zygomatic implants (ZI) has become a widespread solution, allowing us to bypass bone grafting procedures. However, the palatal prosthetic emergences inherent to the skeletal discrepancy cause significant discomfort for patients due to prosthetic compensations volume. A 60-year-old patient, completely edentulous at the maxillary with severe atrophy and a skeletal Class III, was referred to us for full rehabilitation. We use an innovant surgical guide to perform the Le Fort I osteotomy, placement of four zygomatic implants, and immediate loading of a screw-retained Zirconia bridge without prosthetic compensation in one single surgery virtually planned. Zygomatic implant and orthognathic rehabilitation, using a custom surgical guide, offers an accurate solution to restore in a single surgery, the oral function with an immediate loading prothesis when the maxilla atrophy is severe in skeletal Class III. • Combining Le Fort I osteotomy with zygomatic implants restore both function and esthetics in severe maxillary atrophy with skeletal Class III. • Custom surgical zygomatic guides ensure accuracy and safety of the procedure. • Immediate loading of a zirconia prosthesis supports healing and improves outcomes.