Fully Digital Guided Single-Stage Maxillectomy and Zygomatic Implant Rehabilitation After Recurrent Oral Squamous Cell Carcinoma: A Case Report

Background: The rehabilitation of patients who have undergone extensive maxillectomy for neoplastic lesions is a significant clinical challenge. The resulting anatomical and functional defects severely impact quality of life, and traditional removable prostheses often lack stability. Zygomatic implants offer a viable solution by providing stable anchorage in the zygomatic bone, bypassing the need for bone reconstruction. Methods: This case report details the rehabilitation of a 62-year-old female patient with a history of recurrent oral squamous cell carcinoma. A fully digital workflow, including CBCT and CAD/CAM technology, was used for meticulous surgical and prosthetic planning. The surgical procedure involved a guided maxillectomy, a free forearm flap reconstruction, and the simultaneous placement of two zygomatic implants and one conventional implant. The procedure was done with EZGOMA guided surgery, which, starting from the EZPLAN software design of zygomatic and traditional implants, allowed us to determine the implant’s position in the three-dimensional axes and also the position of the internal hexagon. This allowed us to design the implant beneath the diagnostic wax-up in the three axes, and also to calculate the degrees of inclination of the multi-unit abutment. Results: All implants achieved primary stability with a torque exceeding 45 Ncm. The patient received an immediate provisional prosthesis, which allowed for the rapid restoration of phonetic and esthetic function. The post-operative course was uneventful, with no complications. Follow-up imaging confirmed the successful integration of the implants and the absence of any prosthetic or surgical issues at 24-month successful follow-up. Conclusions: This case suggests that implant-supported rehabilitation with zygomatic implants can be a highly effective treatment for patients with severe maxillary defects following cancer surgery. By using an integrated surgical and prosthetic strategy, along with advanced digital technology, we can achieve fast, safe, and predictable results. This approach successfully restores both function and esthetics, even in challenging anatomical situations. The auxilium of guided plates is a helpful aid for both implant placement and managing bone resection during cancer surgery.