Treatment of the Atrophic Maxilla Using Two Standard Implants and Two Zygomatic Implants Immediately Loaded with a Fixed Restoration

General Risk Assessment

Patient-related Factors

Oral hygiene	Fair
Compliance	Adequate

Patient-medical Factors

Medical Fitness	Healthy, able to undergo planned anesthesia and surgical procedure (ASA I)
Medications	No medications that would negatively affect the surgical procedure and outcomes.
Radiation Treatment	None
Growth Status	Complete

Site-related Factors

Access	Adequate
Pathology near the implant site	None
Previous surgeries in planned implant site	Previous procedures resulting in significant bone and soft tissue changes.

Surgical Classification

Surgical Complexity

Timing of placement	Immediate Placement (extraction sockets) (Type I)
Simultaneous or Staged grafting procedures	Implant placement without adjunctive procedures
Number of implants	> Three

Anatomy

Keratinized Tissue	Sufficient (>4 mm)
Soft Tissue Quality	Presence of scars and inflammation
Proximity to vital anatomic structures	High risk of involvement

Extractions

Radicular morphology	Uniradicular
Available apical bone to achieve primary stability	Sufficient height ( ≥ 4 mm) and width (> 2 mm around apex of planned implant)
Socket walls	Intact
Thickness of buccal wall	2mm or greater
Anticipated residual defect after implant placement	2 mm or less

Prosthodontic Classification

Complicating Factors

Biological	Framework/Bar with appropriate contours and accessible maintenance procedures
Mechanical/Technical	Presence of non-critical contributing factors
Planned contour of tissue-fitting surfaces	Appropriate contours (hygienic - accessible for maintenance)

Prosthesis Factors

Prosthetic volume	Adequate. Space available for ideal anatomy of the restoration
Inter-occlusal space	Adequate. Capable to create an anatomically & functionally correct planned restoration
Volume and characteristics of the edentulous ridge (fixed)	Inadequate. Adjunctive therapy or prosthetic materials may be necessary to achieve optimal result

Occlusal Factors

Occlusal scheme	User-defined occlusal scheme achievable
Involvement in occlusion	Involvement
Occlusal parafunction	Absent

Complexity

Loading Protocol	Immediate
Implant-supported provisional restoration	Required, elevated esthetic and/or functional demands
Number of implants	>2 (non-splinted) or ≥ 2 (splinted)
Timing of placement	Immediate Placement (extraction sockets) (Type I)

Esthetic Risk Assessment

Edentulous Esthetic Risk Assessment (fixed)

Facial Support	Minimal changes in facial support tolerated by patient
Labial Support	Minimal changes in lip support tolerated by patient
Upper Lip Length	Long upper lip (>20mm)
Buccal Corridor	Wide Corridor
Smile Line	No display of the Maxillary ridge at full smile
Maxillomandibular Relationship	Class I