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D'Amario M, Orsijena A, Franco R, Chiacchia M, Jahjah A, Capogreco M. Clinical achievements of implantology in the pterygoid region: A systematic review and meta-analysis of the literature. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101951. [PMID: 38906380 DOI: 10.1016/j.jormas.2024.101951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/21/2024] [Accepted: 06/18/2024] [Indexed: 06/23/2024]
Abstract
The purpose of the study is to evaluate the survival rate of pterygoid implants compared to implants placed in different maxilla area and to settle as an alternative solution for the rehabilitation of the posterior maxilla atrophy. Studies that were included for this systematic review were selected using different database of references: PubMed Medline, Lilacs and Cochrane Library. Other journal platforms were also used for the research. Five articles met the strict inclusion/exclusion criteria of the 180 articles founded. This systematic review was registered on Prospero (CRD42023409706) and followed PRISMA statement. A total of 768 implants placed presented 97.43 % with a peak of 100 % of survival rate. Follow-up period varies from a minimum of 1 year to a maximum of six years. Pterygoid implants could be a valid alternative in patients presenting a posterior maxilla atrophy, but results should be interpreted cautiously due to the difficulty of the surgical technique. Further studies in the future should be taken in consideration to confirm the success rate of pterygoid implants since there is only one prospective RCT, potentially incorporating modern technologies such as guided surgery or navigated surgery could be a solution for the success of pterygoid implants, minimizing the risk and less dependent on the operator.
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Affiliation(s)
- Maurizio D'Amario
- Department of Life, Health and Environmental Sciences, Dental Clinic, University of L'Aquila, Via Vetoio, Delta 6, Coppito, L'Aquila 67100, Italy.
| | - Alessandro Orsijena
- Department of Life, Health and Environmental Sciences, Dental Clinic, University of L'Aquila, Via Vetoio, Delta 6, Coppito, L'Aquila 67100, Italy
| | - Rocco Franco
- Department of Life, Health and Environmental Sciences, Dental Clinic, University of L'Aquila, Via Vetoio, Delta 6, Coppito, L'Aquila 67100, Italy
| | - Marianna Chiacchia
- Department of Life, Health and Environmental Sciences, Dental Clinic, University of L'Aquila, Via Vetoio, Delta 6, Coppito, L'Aquila 67100, Italy
| | - Ali Jahjah
- Department of Life, Health and Environmental Sciences, Dental Clinic, University of L'Aquila, Via Vetoio, Delta 6, Coppito, L'Aquila 67100, Italy
| | - Mario Capogreco
- Department of Life, Health and Environmental Sciences, Dental Clinic, University of L'Aquila, Via Vetoio, Delta 6, Coppito, L'Aquila 67100, Italy
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Sala YM, Lu H, Chrcanovic BR. Clinical Outcomes of Maxillary Sinus Floor Perforation by Dental Implants and Sinus Membrane Perforation during Sinus Augmentation: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1253. [PMID: 38592698 PMCID: PMC10932102 DOI: 10.3390/jcm13051253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
The aim of the present systematic review was to investigate the clinical outcomes after the perforation of the maxillary sinus by dental implants, or after maxillary sinus membrane perforation during sinus lift procedure. Twenty-nine publications were included. Failure rates of implants in cases where perforation of sinus floor had happened (11 studies) was generally low, and only one case of transient sinusitis was reported. The estimated failure rate of these implants was 2.1% (SE 1.0%, p = 0.035). There were 1817 implants (73 failures) placed in augmented sinuses in which the sinus membrane was perforated and 5043 implants (274 failures) placed in sinuses with no perforated membrane, from 18 studies. The odds of implant failure difference between the groups were not significant (OR 1.347, p = 0.197). log OR of implant failure between perforated and non-perforated membrane groups did not significantly change with the follow-up time (-0.004/month; p = 0.500). In conclusion, implant failure rate is generally low either for implants penetrating in the floor of the maxillary sinus or implants placed in augmented sinuses in which the sinus membrane was perforated. The prevalence of postoperative infection/sinusitis is low, and it may depend either on the dimensions of the perforation or on the anatomical predisposition.
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Affiliation(s)
- Yousef Mohamed Sala
- Faculty of Odontology, Malmö University, SE-214 21 Malmö, Sweden; (Y.M.S.); (H.L.)
| | - Hans Lu
- Faculty of Odontology, Malmö University, SE-214 21 Malmö, Sweden; (Y.M.S.); (H.L.)
| | - Bruno Ramos Chrcanovic
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, SE-214 21 Malmö, Sweden
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Sharaf MA, Wang S, Mashrah MA, Xu Y, Haider O, He F. Outcomes that may affect implant and prosthesis survival and complications in maxillary fixed prosthesis supported by four or six implants: A systematic review and meta-analysis. Heliyon 2024; 10:e24365. [PMID: 38317918 PMCID: PMC10839890 DOI: 10.1016/j.heliyon.2024.e24365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Objective To investigate whether the clinical and radiographical outcomes are affected when four or six implants support the maxillary fixed complete denture (FCD). Materials and methods This study was registered on PROSPERO (CRD42021226432) and followed the PRISMA guidelines. The focused PICO question was, "For an edentulous maxillary patient rehabilitated with an implant-supported fixed prosthesis, do the clinical and radiographical outcomes differ when four or six implants support the prosthesis ". A thorough search of the relevant studies was designed and performed electronically. The survival rate of implant and prosthesis, marginal bone loss, and complications (mechanical and biological) were the primary outcomes, whereas implant distribution and using the surgical guide, follow-up, and framework material were evaluated as secondary outcomes. Results Out of 1099 articles initially retrieved, 53 clearly stated the outcomes of interest and were included in this study. There were no significant differences in implant and prosthesis survival, technical/mechanical complications, and biological complications between the 4-implant group (4-IG) and the 6-implant group (6-IG). However, marginal bone loss (MBL) was significantly higher in the 4-IG (p < 0.01). The surgical guide and follow-up period did not significantly affect implant/prosthesis survival. Additionally, using the CAD/CAM milled framework and anteroposterior implant distribution were associated with significantly higher implant survival in the 6-IG (p < 0.01). Conclusion The findings of this study indicated that having a greater number of implants, as seen in the 6-implant group, can lead to a decrease in technical and biological complications and reduce marginal bone loss. It is worth noting that factors such as using CAD/CAM frameworks and the anteroposterior distribution of implants were recognized as important in improving implant survival rates when more implants are present.
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Affiliation(s)
- Mufeed Ahmed Sharaf
- Department of Prosthodontics, College of Dentistry, Ibb University, Ibb, Yemen
| | - Siyuan Wang
- Department of Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Mubarak Ahmed Mashrah
- Department of Implantology, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong 510182, China
| | - Yangbo Xu
- Department of Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Ohood Haider
- Department of Orthodontics, Medical Center of Stomatology, Second Xiangya Hospital, Central South University, Changsha, China
| | - Fuming He
- Department of Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang, China
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Sharaf MA, Jiang J, Wang S, Xiao P, Xu A, He F. Clinical and patient-centered outcomes following rehabilitation of atrophic edentulous maxilla using six implants placed simultaneously with bilateral maxillary sinus augmentation: A retrospective case series. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101480. [PMID: 37105492 DOI: 10.1016/j.jormas.2023.101480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/11/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES To evaluate treatment success, patient satisfaction, and oral health-related quality of life (OHRQoL) after rehabilitation of atrophic edentulous maxilla (AEM) with six implants placed simultaneously with bilateral maxillary sinus floor augmentation (MSFA). MATERIALS AND METHODS The selected patients were fully edentulous with atrophic maxillary posterior residual ridges and rehabilitated with six implants placed simultaneously with bilateral MSFA and immediate All-on-4 provisional fixed prosthesis (PFP). After 7-12 months of implant surgery, all patients have received an All-on-6 definitive fixed prosthesis (DFP). After at least one year of function with DFP, clinical and radiographic examinations were performed. Patient satisfaction was assessed through a visual analog scale (VAS). The OHRQoL before treatment (T0), during provisional (T1), and after definitive prosthesis (T2) was evaluated using OHI-14. RESULTS 20 maxillary edentulous patients were rehabilitated with 120 implants, 20 immediate All-on-4 PFP, and 20 All-on-6 DFP. Of those, 12 patients have passed at least a year follow-up after DFP insertion and were eligible to be included in the assessment of treatment success. After a mean of 20 (12-36) months follow-up, the implant and prosthesis survival rates were 100%. The success rate at the implant level was 98.6%. The mean marginal bone loss (MBL) was 0.09 ± 0.06 mm. No prosthetic or postoperative complications, and the mean general satisfaction was (91.75 ± 7.06). There was a significant improvement in all OHIP-14 domains during the final All-on-6 prosthesis (T2) (P < 0.01). CONCLUSIONS Rehabilitation of atrophic edentulous maxilla using six implants with simultaneous bilateral MSFA and immediate All-on-4 PFP is a successful treatment approach associated with minimal postoperative complications and significant improvement in OHRQoL.
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Affiliation(s)
- Mufeed Ahmed Sharaf
- Department of Oral Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang 310006, China; Department of Prosthodontics, Faculty of Dentistry, Ibb University, Ibb, Republic of Yemen
| | - Jimin Jiang
- Department of Oral Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang 310006, China
| | - Siyuan Wang
- Department of Oral Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang 310006, China
| | - Pei Xiao
- Department of Oral Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang 310006, China
| | - Antian Xu
- Department of Oral Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang 310006, China
| | - Fuming He
- Department of Oral Prosthodontics, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Clinical Research Center for Oral Disease of Zhejiang Province, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, Zhejiang 310006, China.
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Avila-Ortiz G, Vegh D, Mukaddam K, Galindo-Moreno P, Pjetursson B, Payer M. Treatment alternatives for the rehabilitation of the posterior edentulous maxilla. Periodontol 2000 2023; 93:183-204. [PMID: 37486029 DOI: 10.1111/prd.12507] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023]
Abstract
Rehabilitation of the edentulous maxilla with implant-supported fixed dental prostheses can represent a significant clinical challenge due to limited bone availability and surgical access, among other factors. This review addresses several treatment options to replace missing teeth in posterior maxillary segments, namely the placement of standard implants in conjunction with maxillary sinus floor augmentation, short implants, tilted implants, and distal cantilever extensions. Pertinent technical information and a concise summary of relevant evidence on the reported outcomes of these different therapeutic approaches are presented, along with a set of clinical guidelines to facilitate decision-making processes and optimize the outcomes of therapy.
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Affiliation(s)
- Gustavo Avila-Ortiz
- Private Practice, Gonzalez + Solano Atelier Dental, Madrid, Spain
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Dániel Vegh
- Department of Oral Surgery and Orthodontics, University Clinic of Dental Medicine & Oral Health, Medical University Graz, Graz, Austria
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
| | - Khaled Mukaddam
- Department of Oral Surgery and Orthodontics, University Clinic of Dental Medicine & Oral Health, Medical University Graz, Graz, Austria
- University Center of Dental Medicine, Department of Oral Surgery, University of Basel, Basel, Switzerland
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria (IBS), Granada, Spain
| | - Bjarni Pjetursson
- Department of Reconstructive Dentistry, University of Iceland, Reykjavik, Iceland
| | - Michael Payer
- Department of Oral Surgery and Orthodontics, University Clinic of Dental Medicine & Oral Health, Medical University Graz, Graz, Austria
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Konstantinović VS, Abd-Ul-Salam H, Jelovac D, Ivanjac F, Miličić B. Pterygoid and tuberosity implants in the atrophic posterior maxilla: A retrospective cohort study. J Prosthet Dent 2023; 130:219.e1-219.e10. [PMID: 37481400 DOI: 10.1016/j.prosdent.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 07/24/2023]
Abstract
STATEMENT OF PROBLEM Rehabilitation of the partially or completely edentulous posterior maxilla using dental implants is a clinical challenge because of the presence of the maxillary sinus, as well as the low quality and quantity of bone in that region. In addition to bone augmentation procedures, posterior maxillary rehabilitation using implants includes their anchoring in bones such as the zygoma, pterygoid, and maxillary tuberosity, as well as in short implants. However, the performance of pterygoid and tuberosity implants in the atrophic posterior maxilla is unclear. PURPOSE The purpose of this retrospective cohort study was to evaluate the survival of tuberosity and pterygoid implants in patients with posterior maxillary atrophy. MATERIAL AND METHODS A nonprobability convenient sample of patients who had received fixed prostheses on implants placed in the maxillary tuberosity or pterygoid regions was analyzed retrospectively. Demographic variables included sex (male, female) and age. Implant-related variables included surface characteristics, site of placement, implant design, length, diameter, and anteroposterior insertion angle. Prosthetic-related variables included the type of reconstruction for rehabilitation and loading protocols. Implant survival, complications, crestal bone loss, and follow-up intervals were also documented. Collected data were analyzed at both patient and implant levels. The demographics and implant characteristics of patients receiving pterygoid or tuberosity implants were analyzed with a statistical software program (α=.05). Survival analysis was estimated by using the nonparametric Kaplan-Meier curve. RESULTS A total of 119 patients had 183 pterygoid or tuberosity implants inserted. Most implants in the pterygoid region (71.5%) were Ø4.1 mm (87.4%) and 15 mm in length (60.1%). The most common prostheses were complete maxillary reconstructions (49.2%) with late loading (74.3%). The average implant anteroposterior insertion angle was 60.8 degrees. The cumulative survival rate was 97.3% (n=178) during the mean follow-up period of 57 months (range 1 to 168 months). Among all implants placed, 2.7% failed (n=5) within 2 months of their placement. The statistically significant differences noted between tuberosity and pterygoid implants were related to design, surface characteristics, and loading. The average crestal bone loss was 1.5 mm. CONCLUSIONS The survival of the implants placed in the maxillary tuberosity and pterygoid regions was high in patients with posterior maxillary atrophy.
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Affiliation(s)
- Vitomir S Konstantinović
- Professor, Clinic of Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Hani Abd-Ul-Salam
- Adjunct Professor, Department of Population Oral Health, Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada; and Professor, Department of Diagnostic and Oral Surgical Dental Sciences, Faculty of Dentistry, Gulf Medical University, College of Dentistry, Ajman, Ajman, United Arab Emirates.
| | - Drago Jelovac
- Associate Professor, Clinic of Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Filip Ivanjac
- Research Associate, Clinic of Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Biljana Miličić
- Professor, Department of Medical Statistics and Informatics, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
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Sun Y, Xu C, Wang N, Wu Y, Liu Y, Fan S, Wang F. Virtual pterygoid implant planning in maxillary atrophic patients: prosthetic-driven planning and evaluation. Int J Implant Dent 2023; 9:9. [PMID: 36971973 PMCID: PMC10043104 DOI: 10.1186/s40729-023-00472-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
PURPOSE The study aims to use cone beam computed tomography (CBCT) to (1) define the virtual valid length of pterygoid implants in maxillary atrophic patients from the prosthetic prioritized driven position and (2) measure the implant length engaged in the pterygoid process according to the HU difference of the pterygoid maxillary junction. MATERIALS AND METHODS Virtual pterygoid implants were planned with CBCT of maxillary atrophic patients in the software. The entry and angulation of the implant were planned according to the prosthetic prioritized driven position in the 3D reconstruction image. The planned implant length and the valid length defined as the implant between the pterygoid maxillary junction and pterygoid fossa were recorded. The relationship between the implant and sinus cavity was also evaluated. RESULTS A total of 120 CBCT samples were enrolled and virtually planned. The mean age of the patients was 56.2 ± 13.2 years. One hundred and sixteen samples could successfully place virtual implants according to the criterion. The mean implant length and mean implant length beyond the pterygoid maxillary junction were 16.3 ± 4.2 mm (range, 11.5-18 mm) and 7.1 ± 3.3 mm (range, 1.5-11.4 mm), respectively. Ninety percent of virtually planned implants had a close relationship with the sinus cavity, and implants exhibited longer lengths when they had no relation with the sinus. CONCLUSION From a prosthetic prioritized driven position with fixed entry and angulation, pterygoid implants achieve adequate bone anchorage length beyond the pterygoid maxillary junction. Due to the individual anatomy and the volume of the maxillary sinus, the implants presented a different positional relationship with the maxillary sinus.
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Affiliation(s)
- Yuanyuan Sun
- Department of Oral Cell Biology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 280, Mohe Road, Baoshan District, Shanghai, 201900, China
| | - Chunfeng Xu
- Department of Oral Cell Biology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ningtao Wang
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 280, Mohe Road, Baoshan District, Shanghai, 201900, China
| | - Yiqun Wu
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 280, Mohe Road, Baoshan District, Shanghai, 201900, China
| | - Yuelian Liu
- Department of Oral Cell Biology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shengchi Fan
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 280, Mohe Road, Baoshan District, Shanghai, 201900, China.
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes-Gutenberg University, Augustusplatz 2, 55131, Mainz, Germany.
| | - Feng Wang
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, No. 280, Mohe Road, Baoshan District, Shanghai, 201900, China.
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Corrêa-Silva M, de Vicq Normande Neto H, de Oliveira-Neto OB, Ostetto S, Sales PHDH, de Lima FJC. Effectiveness of palatally positioned implants in severely atrophic edentulous maxillae: a systematic review. Oral Maxillofac Surg 2023; 27:1-8. [PMID: 35301604 DOI: 10.1007/s10006-022-01055-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/06/2022] [Indexed: 11/24/2022]
Abstract
The purpose of this systematic review was to define the effectiveness of palatally positioned dental implants placed in atrophic maxillae. Searches were performed in five databases including the gray literature, up to August 2021, by 2 independent reviewers, in order to answer the following research question: Is the palatal approach technique effective in the rehabilitation of atrophic maxillae? In the initial search, 1948 articles were found and after applying the inclusion and exclusion criteria, five studies were selected, none of which was a randomized clinical trial. A total of 681 implants were placed, 549 of them with a palatal approach and 132 at the alveolar crest, with an effectiveness of 98.38% and 99.5%, respectively, with no statistically significant difference between the groups. In assessing the risk of bias, only one of the studies had a low risk of bias. Implants installed with the palatal approach technique showed high effectiveness for rehabilitation of atrophic maxilla; however, few studies in the literature report this technique, requiring more controlled studies, and with less risk of bias, to confirm the results obtained in this systematic review.
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Affiliation(s)
- Matheus Corrêa-Silva
- Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | - Pedro Henrique da Hora Sales
- Department of Prothesis and Oral and Maxillofacial Surgery, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, Pernambuco, 50670-901, Brazil.
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Korn P, Gellrich NC, Spalthoff S, Jehn P, Eckstein F, Lentge F, Zeller AN, Rahlf B. Managing the severely atrophic maxilla: Farewell to zygomatic implants and extensive augmentations? JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:562-565. [PMID: 34896647 DOI: 10.1016/j.jormas.2021.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Dental rehabilitation of severe atrophic upper jaws remains challenging. A new generation of subperiosteally placed and rigid multi-vector bone-anchored patient-specific implants proposes an innovative line extension in implant dentistry. This single-center retrospective study focused on treating severely atrophic maxillae using these implants. METHODS All patients who were treated with a patient-specific implant (IPS Implant® Preprosthetic, KLS-Martin, Tuttlingen, Germany) at Hannover Medical School due to severe atrophy of the maxilla who had no history of malignancy, cleft lip or palate, or trauma were evaluated regarding implant stability and prosthetic restoration, as well as complications. RESULTS Out of a total of 58 inserted implants, 13 implants in 10 patients, which were placed to treat a severely atrophic upper jaw, were identified. The mean follow-up period was 8.2 months (1-29 months). All implants were clinically stable over the entire period. All patients with an observation period of over 2 months received prosthetics for restoration. Minor complications, screw fractures, infection, and exposure of the framework were observed, but these did not lead to failure. CONCLUSION This initial follow-up suggests that this new generation of implants represents a valuable treatment alternative, especially for patients with a history of failed dental implant placement. Larger numbers of cases and longer observation periods are required to confirm our findings.
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Affiliation(s)
- Philippe Korn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Nils-Claudius Gellrich
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Simon Spalthoff
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Philipp Jehn
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Fabian Eckstein
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Fritjof Lentge
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Alexander-Nicolai Zeller
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Björn Rahlf
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Menini M, Pesce P, Delucchi F, Ambrogio G, Canepa C, Carossa M, Pera F. One-stage versus two-stage technique using two splinted extra-short implants: A multicentric split-mouth study with a one-year follow-up. Clin Implant Dent Relat Res 2022; 24:602-610. [PMID: 35700161 PMCID: PMC9796435 DOI: 10.1111/cid.13113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 05/05/2022] [Accepted: 05/21/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare the clinical outcomes of extra-short implants (≤6.5 mm) inserted with one-stage versus two-stage technique in adjacent sites of the upper or lower jaw. MATERIALS AND METHODS In this split-mouth multicenter study, implants were randomly divided into two groups according to the healing phase: two-stage and one-stage technique. Primary outcome measures were implant survival, implant success, and prosthodontic complications. Secondary outcome measurements were: implant stability quotient (ISQ) collected at surgery time (T0), and after 3 (T3) and 12 (T12) months, marginal bone level (MBL) evaluated at T0, T3, T6, and T12, marginal bone loss evaluated at T6 and T12, plaque index (PI), probing depth (PD), bleeding on probing (BoP) evaluated at T3, T6, and T12. Significances of differences between groups were tested by linear mixed model with random intercept. RESULTS Nineteen patients (8 males and 11 females) were included. A total of 38 implants were inserted. At T12 implant cumulative survival and implant success rate were 100% in both groups. No statistically significant differences were recorded for any of the analyzed parameters between the two groups at any time point. ISQ values were similar at T0 (two-stage: mean 67.53 ± SD 19.47; one-stage: mean 66.53 ± 19.07 p = 0.8738) and increased in both groups at the 12-month follow-up appointment (two-stage: 81.1 ± 7.04; one-stage: 81.39 ± 0.9266). MBL values were similar in the two groups at any time point. At T12 marginal bone loss was 0.46 ± 0.41 (two-stage) and 0.45 ± 0.38 (one-stage) mm (p = 0.9417), while mean PD was 2.7 ± 0.85 (two-stage) and 2.69 ± 0.89 (one-stage) mm. CONCLUSIONS Within the limits of the present short-term report, extra-short implants demonstrated optimal clinical outcomes using the one-stage technique, without statistically significant differences compared with the traditional two-stage approach.
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Affiliation(s)
- Maria Menini
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
| | - Paolo Pesce
- Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
| | - Francesca Delucchi
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
| | - Giulia Ambrogio
- CIR Dental School Department of Surgical SciencesUniversity of TurinTorinoItaly
| | - Camilla Canepa
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences and Integrated Diagnostics (DISC)University of GenoaGenoaItaly
| | - Massimo Carossa
- CIR Dental School Department of Surgical SciencesUniversity of TurinTorinoItaly
| | - Francesco Pera
- CIR Dental School Department of Surgical SciencesUniversity of TurinTorinoItaly
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Bhombe KR, Bajaj P, Mundada B, Dhadse P, Subhadarsanee C, Oza RR. Combined Effect of Platelet-Rich Fibrin Matrix (PRFM) and Demineralized Freeze-Dried Bone Allograft (DFDBA) in Immediate Implant Placement: A Single-Arm Clinical Trial. Cureus 2022; 14:e29728. [PMID: 36324343 PMCID: PMC9617181 DOI: 10.7759/cureus.29728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/23/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Placement of immediate implants in contrast to delayed implant placement may be favorable. The factors contributing to this are shortened overall treatment time, aid in ideal orientation and fixture placement, bone preservation following extraction, and achieving optimal aesthetics involving soft tissue. However, the gap distance between the surface of the implant and the buccal bony wall during implant placement is critical for subsequent bone healing in a fresh extraction socket. Considering that as the gap broadens, the amount of bone-to-implant contact (BIC) decreases, causing an apical shift of the highest bone-implant contact. Incorporating a bone substitute material (BSM) within the fixture-socket gap preserves alveolar ridge volume by minimizing socket remodeling and encouraging de-novo bone formation. Aim and objectives To evaluate the efficacy of platelet-rich fibrin matrix (PRFM) and demineralized freeze-dried bone allograft (DFDBA) in fresh extraction socket with simultaneous implant placement. Methods Implants were immediately placed in 12 patients following a two-stage submerged protocol. The combination of PRFM and DFDBA was used to fill the gap between the implant body and the surrounding socket wall. The final restoration was placed after 3 months following implant placement. The full mouth plaque, gingival bleeding index, and gingival esthetics scores were assessed at baseline, 3, and 6 months. The crestal changes were evaluated using intraoral periapical radiographs (IOPA) at baseline, 3, and 6 months. Cone beam computed tomography (CBCT) images were obtained at baseline and 6 months after implant loading to analyze the buccolingual changes. Results At 6 months follow-up, the coronal bone remodeling detected on CBCT revealed a minimal (0.1 mm) narrowing of the alveolar ridge in a buccolingual direction, with a mean bone loss of 0.10+0.09, which was statistically non-significant (p > 0.05). Implant success was 100% at 6 months after loading as determined by Akbrektsson’s criteria for implant success. Conclusions The adjunctive use of PRFM with DFDBA following immediate implant placement yielded a significant reduction in bone resorption and maintenance of buccolingual dimensions.
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Motiwala IA, Bathina T. A Radiographic Study on Pterygoid Implants with Hamulus as a Landmark for Engaging the Pterygoid Plate - A Retrospective Study. Ann Maxillofac Surg 2022; 12:190-196. [PMID: 36874784 PMCID: PMC9976848 DOI: 10.4103/ams.ams_132_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/17/2022] [Accepted: 10/13/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Rehabilitating the posterior maxilla with pterygoid implants can be quite challenging as the area entails many hindrances for implant placement. Although few studies have reported the three-dimensional angulations according to various planes (Frankfort horizontal (FH), sagittal plane, occlusal or maxillary planes), no anatomical landmarks have been identified to guide their placement. This study aimed at analysing the three-dimensional angulation of pterygoid implants using the hamulus as an intraoral guide. Methods Pre-operative cone-beam computed tomography scans (axial and parasagittal sections) of 150 patients rehabilitated with pterygoid implants were retrospectively analysed to determine the horizontal and vertical angulations in relation to the hamular line and FH plane, respectively. Results The results showed horizontal buccal and palatal safe angulations of 20.8° ± 7.6° and -20.7° ± 8.5° in relation to the hamular line. Maximum and minimum vertical angulations of 61.6° ± 7.0° and 37.2° ± 10.3° were observed, with a mean of 49.8 ± 8.1 in relation to FH plane. The post-operative scans showed that around 98% of the implants placed along the hamular line were successfully engaging the pterygoid plate. Discussion Comparing with the results of previous studies, this study concludes that when implants are placed along the hamular line, they are more likely to engage the centre of the pterygomaxillary junction resulting in an excellent prognosis of pterygoid implants.
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Affiliation(s)
- Irfan Ali Motiwala
- Department of Oral and Maxillofacial Surgery, Dr. Motiwala Dental Clinic and Implant Center, Hyderabad, Telangana, India
| | - Tejaswi Bathina
- Department of Oral and Maxillofacial Surgery, Dr. Motiwala Dental Clinic and Implant Center, Hyderabad, Telangana, India
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Abraha SM, Geng YM, Naujokat H, Terheyden H. Modified Le Fort I interpositional grafting of the severe atrophied maxilla - a retrospective study of 106 patients over 10 years. Clin Oral Implants Res 2022; 33:451-460. [PMID: 35175642 DOI: 10.1111/clr.13905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/14/2022] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate a modified Le Fort I interpositional grafting followed by dental implants for the rehabilitation of edentulous atrophied maxillae (Cawood classes IV and V). The surgical modification was a bilateral sinus floor augmentation prior to the osteotomy. This generated a closed recipient bed which allowed the use of particulated bone grafts (xenogenic bone mineral) and a reduced amount of autologous iliac bone grafts. MATERIALS AND METHODS 106 patients with maxillary interpositional bone grafts were included in this retrospective analysis between 2006 and 2020. The panoramic radiographs and lateral cephalograms were analysed to assess the gain and stability of the maxillary bone and the peri-implant bone loss. In addition, the observational period of up to 14 years implant survival and success was evaluated. RESULTS A stable vertical bone height with mean 0.63 ± 1.41mm resorption over 5 years after implant loading was observed. A mean of 0.20 ± 0.37mm marginal bone loss was noted after 5 years. The implant survival was 96.4% after 5 years and implant success can be rated 91.7% in a mean follow-up period of 93 months and 168 months maximal observation time. Perioperative complications included sinus membrane perforation (59.43%), wound healing disturbances (25.47%) and transient primary complications (13.78%). All receded apart from two subtotal graft losses (1.8%). CONCLUSIONS The modified Le Fort I osteotomy with interpositional bone grafts is a predictable procedure in terms of bone and implant stability. Patients with atrophic maxillae who are fit for surgery should be informed about risks and benefits of this treatment alternative.
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Affiliation(s)
- Sophia Mulugeta Abraha
- Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein - UKSH, Arnold-Heller-Straße 3, 24105, Kiel, Germany.,Private practice, Rosenkavalierplatz 18, 81925, München, Germany
| | - Yuan-Ming Geng
- Department of Stomatology, Zhujiang Hospital, Southern Medical University, Gongyedadaozhong Road 253, 510282, Guangzhou, China
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Medical Center Schleswig-Holstein -UKSH, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Hendrik Terheyden
- Department of Oral and Maxillofacial Surgery, Helios Hospital Kassel, Hansteinstraße 29, 34121, Kassel, Germany
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Rehabilitation of Atrophic Maxilla With Immediate Loading of Extrasinus Zygomatic Implant. J Craniofac Surg 2021; 33:e488-e491. [PMID: 34907950 DOI: 10.1097/scs.0000000000008411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022] Open
Abstract
ABSTRACT The aim of this case series was to evaluate the long-term success rate of immediate occlusal loading of extrasinus zygomatic dental implants after a 3-year follow-up. The sample consisted of 31 patients (mean age of 64 years) with atrophic maxillae rehabilitated with 1 to 4 extrasinus zygomatic implants, placed unilaterally or bilaterally. All the patients received complete implant-supported dental prostheses with immediate loading by associating zygomatic implants with conventional implants. None of the procedures were associated with bone grafts. During the 3-year period of follow-up in the present study, all the patients attended clinical sessions and underwent radiographic exams every 6 months. In total 55 zygomatic and 69 conventional implants were placed, where 1 zygomatic and 2 conventional implants were lost, representing success rates of 98.18% and 97.20%, respectively. None of the studied patients had signs of sinusitis or changes in the maxillary sinuses. All the patients showed occlusal contact on natural antagonist teeth or implant-supported dental prostheses. Therefore, it was concluded that the use of exteriorized zygomatic implants with immediate loading represented a feasible option with high success rates for the treatment of atrophic maxilla.
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Caramês JMM, Marques DNDS, Caramês GB, Francisco HCO, Vieira FA. Implant Survival in Immediately Loaded Full-Arch Rehabilitations Following an Anatomical Classification System-A Retrospective Study in 1200 Edentulous Jaws. J Clin Med 2021; 10:jcm10215167. [PMID: 34768687 PMCID: PMC8584991 DOI: 10.3390/jcm10215167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 11/16/2022] Open
Abstract
This retrospective study analyzed implant survival of immediate implant-supported fixed complete denture (IFCD) treatment options (TOs) based on the level of alveolar atrophy (CC). Records of 882 patients receiving a total of 6042 implants at one private referral clinic between 2004 and 2020 were considered. The mean follow-up period was 3.8 ± 2.7 years. Cumulative implant survival rates (CSRs) were analyzed as a function of CCs and TOs according to Mantel-Haenszel and Mantel-Cox. Hazard risk ratios for implant loss were compared using Cox regression. Confounding factors were identified using mixed Cox regression models. The 2- and 5-year CSRs were 98.2% and 97.9%, respectively. Maxillary 2- and 5-year CSRs were lower (97.7% and 97.3%) compared to mandibular CSRs (99.8% and 98.6%) (p = 0.030 and 0.0020, respectively). The CC did not influence CSRs of IFCDs in the mandible (p = 0.1483 and 0.3014, respectively) but only in the maxilla (p = 0.0147 and 0.0111), where CSRs decreased with increasing atrophy. TOs did not statistically differ in terms of survival rate for a given level of alveolar atrophy. The adaption of IFCD treatments to the level of atrophy and patient-specific risk factors can result in high CSRs, even at different levels of bone atrophy.
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Affiliation(s)
- João Manuel Mendez Caramês
- Instituto de Implantologia, Avenida Columbano Bordalo Pinheiro, 1070-064 Lisbon, Portugal; (D.N.d.S.M.); (G.B.C.); (H.C.O.F.); (F.A.V.)
- Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisbon, Portugal
- LIBPhys-FCT UID/FIS/04559/2013, Faculty of Dental Medicine, University of Lisbon, 1600-277 Lisbon, Portugal
- Correspondence: ; Tel.: +351-919727353; Fax: +351-217210989
| | - Duarte Nuno da Silva Marques
- Instituto de Implantologia, Avenida Columbano Bordalo Pinheiro, 1070-064 Lisbon, Portugal; (D.N.d.S.M.); (G.B.C.); (H.C.O.F.); (F.A.V.)
- Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisbon, Portugal
- LIBPhys-FCT UID/FIS/04559/2013, Faculty of Dental Medicine, University of Lisbon, 1600-277 Lisbon, Portugal
| | - Gonçalo Bartolo Caramês
- Instituto de Implantologia, Avenida Columbano Bordalo Pinheiro, 1070-064 Lisbon, Portugal; (D.N.d.S.M.); (G.B.C.); (H.C.O.F.); (F.A.V.)
| | - Helena Cristina Oliveira Francisco
- Instituto de Implantologia, Avenida Columbano Bordalo Pinheiro, 1070-064 Lisbon, Portugal; (D.N.d.S.M.); (G.B.C.); (H.C.O.F.); (F.A.V.)
- Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisbon, Portugal
| | - Filipe Araújo Vieira
- Instituto de Implantologia, Avenida Columbano Bordalo Pinheiro, 1070-064 Lisbon, Portugal; (D.N.d.S.M.); (G.B.C.); (H.C.O.F.); (F.A.V.)
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Wu J, Liu K, Li M, Zhu ZJ, Tang CB. Clinical assessment of pterygoid and anterior implants in the atrophic edentulous maxilla: a retrospective study. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2021; 39:286-292. [PMID: 34041877 DOI: 10.7518/hxkq.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study aims to evaluate the short-term clinical outcomes and patient satisfaction of anterior and pterygoid implants in the rehabilitation of edentulous maxilla with posterior atrophy. METHODS Given a minimum follow-up of 1 year, 25 patients with fixed maxillary rehabilitation over anterior and pterygoid implants were enrolled in this retrospective study. The implant survival rates, peri-implant soft tissue status (including probing depth, modified sulcus bleeding index, and plaque index), marginal bone loss, and patient satisfaction were measured. RESULTS The survival rates for anterior and pterygoid implants at 1-year follow-up were 96.5% and 97.8%, respectively (P>0.05). No statistically significant difference in probing depth, modified sulcus bleeding index, and plaque index was observed between the two types of implants (P>0.05). The marginal bone losses of anterior implants were 0.62 mm± 0.44 mm (mesial) and 0.61 mm± 0.40 mm (distal), and those of pterygoid implants were 0.64 mm± 0.46 mm (mesial) and 0.68 mm± 0.41 mm (distal) mm. These results showed no statistical difference in mesial and distal sites (P>0.05). Patients indicated a high degree of satisfaction with the full-arch prostheses supported by anterior and pterygoid implants. CONCLUSIONS For the edentulous maxilla with posterior atrophy, full-arch fixed prostheses supported by anterior and pterygoid implants has an acceptable short-term clinical outcome and excellent patient satisfaction. It may be considered as a predictable and feasible method for maxillary rehabilitation.
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Affiliation(s)
- Jin Wu
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University & Dept. of Dental Implantology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing 210029, China
| | - Kun Liu
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University & Dept. of Dental Implantology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing 210029, China.,Dept. of Dental Implantology, Hefei Stomatological Hospital, Hefei Stomatological Clinical College of Anhui Medical University, Hefei 230001, China
| | - Ming Li
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University & Dept. of Dental Implantology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing 210029, China
| | - Zhi-Jun Zhu
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University & Dept. of Dental Implantology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing 210029, China
| | - Chun-Bo Tang
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University & Dept. of Dental Implantology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing 210029, China
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Molina G, Mazzey G, Coronado C. “Surgical and prosthetic management of a severely atrophic maxilla, using nasal and sinus lifts along with incisive canal implants”.A case report. ORAL AND MAXILLOFACIAL SURGERY CASES 2021. [DOI: 10.1016/j.omsc.2021.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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18
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Implant placement in the pterygoid region with dynamically navigated surgery: A clinical report. J Prosthet Dent 2021; 128:125-129. [PMID: 33640090 DOI: 10.1016/j.prosdent.2020.12.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 02/05/2023]
Abstract
Implant placement in the pterygoid region is a reliable treatment for posterior maxillary tooth loss. However, the surgery is not widely applied because the implant placement region is hard to access and the direct visual access is limited. This clinical report describes the use of a dynamic navigation system to improve the pterygoid implant placement surgery. Real-time imaging of the surgery area and full-time guidance are provided by the system to alleviate the problem of lack of visibility and to reduce the complexity of placement.
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Rengo C, Fiorino A, Cucchi A, Nappo A, Randellini E, Calamai P, Ferrari M. Patient-reported outcomes and complication rates after lateral maxillary sinus floor elevation: a prospective study. Clin Oral Investig 2021; 25:4431-4444. [PMID: 33620600 PMCID: PMC8310489 DOI: 10.1007/s00784-020-03755-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/21/2020] [Indexed: 01/29/2023]
Abstract
Objectives Oral surgery morbidity is highly variable based on patients’ characteristics and kind of surgical intervention. However, poor data are available in the literature regarding patient outcomes after oral surgery. The aim of this retrospective study was to evaluate patient-reported outcome and complication rates after maxillary sinus floor elevation. Materials and methods Data from the records of patients undergoing maxillary sinus elevation have been collected from a private dental office. Patient-reported outcome has been assessed using a 100-mm visual analog scale to evaluate the post-operative pain (VASpain) experienced in the first week following surgery and visual rating scales to evaluate discomfort level (VRSdiscomfort: 0 to 4) and willingness to repeat the same surgical procedure (VRSwillingness: 0 to 3). Analgesics intake, swelling onset and duration, and ecchymosis have been also recorded. Results VASpain showed moderate values in the first 2 days (< 50) post-surgery, with a tendency to progressively decrease over the next 2 days. Average assumption of painkillers was 3.93 ± 3.03. Discomfort level (VRSdiscomfort) after surgery was low (median: 1; IR: 1–0), while willingness to undergo the same surgical procedure was very high (77.63% of patients). Swelling and ecchymosis were experienced by 97.36% and 51.32% of patients, respectively, with a mean duration of 4.09 ± 1.43 and 2.21 ± 2.31 days, respectively. Membrane perforation occurred in 4 cases. Other post-operative complications were not observed. Conclusions Maxillary sinus grafting is a safe procedure, with a low complication rate and moderate morbidity that is well tolerated by patients. Particular attention is needed in case selection, surgical planning and operator expertise. Clinical relevance The analysis of patient-reported outcomes can be of great help in surgical planning and in providing correct and adequate treatment.
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Affiliation(s)
- Carlo Rengo
- Department of Prosthodontics and Dental Materials, University of Siena, Viale Bracci, 53100, Siena, Italy.
| | - Antonino Fiorino
- Dentistry Unit, Catholic University of Sacred Heart, Rome, Italy
| | | | - Antonio Nappo
- Department of Prosthodontics and Dental Materials, University of Siena, Viale Bracci, 53100, Siena, Italy
| | | | | | - Marco Ferrari
- Department of Prosthodontics and Dental Materials, University of Siena, Viale Bracci, 53100, Siena, Italy
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Digital Approach for the Rehabilitation of the Edentulous Maxilla with Pterygoid and Standard Implants: The Static and Dynamic Computer-Aided Protocols. Methods Protoc 2020; 3:mps3040084. [PMID: 33371232 PMCID: PMC7768480 DOI: 10.3390/mps3040084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022] Open
Abstract
A full-arch rehabilitation of the edentulous upper jaw without grafting procedures exploits the residual alveolar or the basal bone, with the necessity of long implants placed with a particular orientation. The precision in planning and placing the fixtures is fundamental to avoid clinical problems and to allow an acceptable connection with the prosthesis. The computer-aided implantology resulted in more accuracy than the traditional one, with a high standard of correspondence between the virtual project and the real outcome. This paper reports about the two different digital protocols, static and dynamic, as support to implant-borne prosthetic rehabilitation of edentulous maxillae. Two pterygoid and two/four anterior standard implants were seated in both cases by two different operators, without flap raising, and immediately loaded. This approach avoided the posterior cantilever by-passing the maxillary sinus and was adequately planned and realized without any surgical or prosthetic error. The two digital flow-charts were described step by step, underlining each other’s advantages and drawbacks compared to a free-hand approach.
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Nunes de Sousa BL, Leitão de Almeida B. Pterygoid implants for the immediate rehabilitation of the atrophic maxilla: A case report of a full arch on 4 implants. ORAL AND MAXILLOFACIAL SURGERY CASES 2020. [DOI: 10.1016/j.omsc.2020.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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22
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Minimally invasive rehabilitation of a severely atrophic and fully edentulous maxilla using 4-mm-ultrashort implants: A case report with 1-year follow-up. ORAL AND MAXILLOFACIAL SURGERY CASES 2020. [DOI: 10.1016/j.omsc.2020.100176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Signorini L, Faustini F, Samarani R, Grandi T. Immediate fixed rehabilitation supported by pterygoid implants for participants with severe maxillary atrophy: 1-Year postloading results from a prospective cohort study. J Prosthet Dent 2020; 126:67-75. [PMID: 32631637 DOI: 10.1016/j.prosdent.2020.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 11/20/2022]
Abstract
STATEMENT OF PROBLEM Few investigations concerning the use of pterygoid implants have reported reproducible and consistent data, making survival data controversial. PURPOSE The purpose of this clinical study was to investigate the 1-year survival and success rates of pterygoid implants and prostheses in participants affected by severe atrophy of the posterior maxilla requiring a complete-arch immediate fixed prosthesis. MATERIAL AND METHODS Fifteen participants, either completely edentulous or with failing dentition in the maxillary arch and with severe atrophy of the posterior maxilla, were enrolled in the study. All participants underwent prosthodontic rehabilitation after implant placement in both the anterior maxilla areas and the pterygoid regions. The survival data of the implants were evaluated at the time of abutment connection by means of a mobility test for each implant. After placement of the prostheses, survival was assessed by means of marginal bone maintenance as assessed by panoramic radiographs and the absence of pain or symptoms of infection. The t test was used for evaluating the difference in age between men and women (α=.05). Correlations between categorical variables (Fisher exact test) were used to evaluate the possible association between the number of implants and both the age and presence of comorbidities (α=.05). RESULTS During the 1-year follow-up, high prosthesis stability and no implant loss were observed for all participants. In addition, participants did not report any pain or paresthesia. No peri-implant radiolucency was detected in the panoramic radiographs. Survival and success rates in the follow-up period were 100%. CONCLUSIONS The present study supports the conclusion that pterygoid implants have a high success rate with minimal or no complications.
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Affiliation(s)
- Luca Signorini
- Private practice, Rome, Italy; Professor, Saint Camillus University of Health Science, Rome, Italy.
| | - Fabio Faustini
- Private practice, Castelvetro Piacentino, Piacenza, Italy
| | - Rawad Samarani
- Professor, Department of Periodontology, Faculty of Dentistry, Université Saint Joseph, Beirut, Lebanon
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Sales PH, Gomes MV, Oliveira-Neto OB, de Lima FJ, Leão JC. Quality assessment of systematic reviews regarding the effectiveness of zygomatic implants: an overview of systematic reviews. Med Oral Patol Oral Cir Bucal 2020; 25:e541-e548. [PMID: 32520920 PMCID: PMC7338062 DOI: 10.4317/medoral.23569] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 06/04/2020] [Indexed: 12/20/2022] Open
Abstract
Background Oral rehabilitation of atrophic maxillae features high complexity, for which there are several therapeutic modalities reported on scientific literature. Zygomatic implant placement is a viable option that features low morbidity and allows immediate prosthetic loading. The purpose of the present study was to determine the methodological quality of systematic reviews that assessed the effectiveness of zygomatic implants placed in atrophic maxillae.
Material and Methods Searches were conducted on Medline via Pubmed, LILACS, Dare Cochrane, Scopus, and Sigle via Open Grey up to June 2019.
Results Seven systematic reviews were eligible for Overview and comprised a total of 2313 patients, 4812 zygomatic implants, and a 96,72% success rate. Common surgical complications, in decreasing order, were: maxillary sinusitis, peri-implant mucositis, prosthetic fracture, and infections. Methodological quality was assessed using the AMSTAR 2 tool, which revealed that six systematic reviews showed critically low methodological quality and one review was assessed as of low methodological quality.
Conclusions Zygomatic implants seem to be an adequate option for atrophic maxilla rehabilitation, however, new studies with a higher methodological rigor are needed to provide more reliable results to professionals and patients undergoing this modality of oral rehabilitation. Key words:Zygomatic Implants, dental Implants, complications, oral rehabilitation.
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Affiliation(s)
- P-H Sales
- Av. Professor Moraes Rego, 1235 Cidade Universitária, Recife Pernambuco Brazil
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Stefanelli LV, Mandelaris GA, Franchina A, Di Nardo D, Galli M, Pagliarulo M, Testarelli L, Di Carlo S, Gambarini G. Accuracy Evaluation of 14 Maxillary Full Arch Implant Treatments Performed with Da Vinci Bridge: A Case Series. MATERIALS 2020; 13:ma13122806. [PMID: 32580340 PMCID: PMC7344455 DOI: 10.3390/ma13122806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/07/2020] [Accepted: 06/18/2020] [Indexed: 11/29/2022]
Abstract
The use of pterygoid implants can be an attractive alternative to sinus bone grafting in the treatment of posterior atrophic maxilla. This technique has not been widely used because of the difficulty of the surgical access, the presence of vital structures, and the prosthetic challenges. The use of dynamic computer aided implantology (DCAI) allows the clinician to utilize navigation dental implant surgery, which allows the surgeon to follow the osteotomy site and implant positioning in real time. A total of 14 patients (28 pterygoid implants and 56 intersinusal implants) were enrolled in the study for a full arch implant prosthetic rehabilitation (4 frontal implants and 2 pterygoids implants), using a dynamic navigation system. The reported accuracy of pterygoid implants inserted using DCAI was 0.72 mm at coronal point, 1.25 mm at apical 3D, 0.66 mm at apical depth, and 2.86° as angular deviation. The use of pterygoid implants in lieu of bone grafting represents a valid treatment opportunity to carry out a safe, accurate, and minimally invasive surgery, while reducing treatment time and avoiding cantilevers for a full implant prosthetic rehabilitation of the upper arch.
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Affiliation(s)
- Luigi V. Stefanelli
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.V.S.); (M.G.); (L.T.); (S.D.C.); (G.G.)
| | - George A. Mandelaris
- Private Practice, Periodontics and Dental Implant Surgery; Periodontal Medicine & Surgical Specialists, LTD, Chicago, IL 60601, USA;
| | - Alessio Franchina
- Private Practice, Periodontics and Dental Implant Surgery, 36100 Vicenza, Italy;
| | - Dario Di Nardo
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.V.S.); (M.G.); (L.T.); (S.D.C.); (G.G.)
- Correspondence: ; Tel.: +39-339-3935-527
| | - Massimo Galli
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.V.S.); (M.G.); (L.T.); (S.D.C.); (G.G.)
| | - Michele Pagliarulo
- Faculty of Dental Medicine, University of Plovdiv, 4002 Plovdiv, Bulgary;
| | - Luca Testarelli
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.V.S.); (M.G.); (L.T.); (S.D.C.); (G.G.)
| | - Stefano Di Carlo
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.V.S.); (M.G.); (L.T.); (S.D.C.); (G.G.)
| | - Gianluca Gambarini
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.V.S.); (M.G.); (L.T.); (S.D.C.); (G.G.)
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Dryer RR, Conrad HJ. Displacement of a Dental Implant into the Pterygoid Fossa: A Clinical Report. J Prosthodont 2019; 28:1044-1046. [PMID: 31701581 DOI: 10.1111/jopr.13126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 11/30/2022] Open
Abstract
The placement of dental implants in the pterygomaxillary region can be advantageous in maxillary complete arch fixed implant-supported prosthetic rehabilitations to avoid bone grafting and sinus elevation surgeries. Pterygomaxillary implants improve implant biomechanics by eliminating distal cantilevers and increasing the anteroposterior spread with reported mean implant survival rates comparable to traditional implant sites. Although only minor surgical complications have been reported in the literature with the placement of dental implants in the pterygomaxillary region this clinical report describes a major surgical complication involving the displacement of a dental implant into the pterygoid fossa.
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Affiliation(s)
- Richard R Dryer
- Division of Prosthodontics, University of Minnesota School of Dentistry, Minneapolis, MN
| | - Heather J Conrad
- Division of Prosthodontics, University of Minnesota School of Dentistry, Minneapolis, MN
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