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Beri A, Pisulkar SG, Mundada B, Bansod A, Deshmukh S, Bhardwaj P. Revolutionizing Maxillary Rehabilitation: Zygomatic Implants Addressing Severe Alveolar Atrophy. Cureus 2024; 16:e61430. [PMID: 38947601 PMCID: PMC11214747 DOI: 10.7759/cureus.61430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
This case report describes the care given to a 58-year-old male patient with severe upper jaw atrophy. The treatment strategy involved utilizing zygomatic implants in conjunction with endosteal implants to rehabilitate both the maxilla and mandible. Temporary prostheses were used during the healing phase, followed by the fabrication and placement of final prostheses. The utilization of zygomatic implants offers advantages such as immediate stabilization and function without the need for extensive bone grafting. This approach not only reduces treatment time and costs but also enhances patient outcomes. Furthermore, guided surgical techniques are increasingly employed to ensure precise implant placement, optimizing prosthetic support.
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Affiliation(s)
- Arushi Beri
- Prosthodontics, Sharad Pawar Dental College and Hospital, Wardha, IND
- Prosthodontics, Acharya Vinoba Bhave Rural Hospital, Wardha, IND
| | - Sweta G Pisulkar
- Prosthodontics and Crown & Bridge, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Bhushan Mundada
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Akansha Bansod
- Prosthodontics, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Shruti Deshmukh
- Prosthodontics, Sharad Pawar Dental College and Hospital, Wardha, IND
| | - Pooja Bhardwaj
- Periodontics, Rishiraj College of Dental Science, Bhopal, IND
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2
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Pellegrino G, Bertacci A, Relics D, Ferri A, Grande F, Felice P. Hygienic maintenance in patients with maxillae atrophy and in oncological patients with maxillary resection rehabilitated with zygomatic implants: A nested monocentric prospective cohort study. Int J Dent Hyg 2023. [PMID: 37831522 DOI: 10.1111/idh.12776] [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: 05/27/2022] [Revised: 07/14/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To assess peri-implant soft tissues condition, comparing clinical parameters of implants placed in patients with atrophic upper jaws and patients who underwent maxillary resection for oncological reasons. BACKGROUND Zygomatic implants (ZIs) in oncologic patients could be affected by more complications compared to implants placed in atrophic maxillae. The soft tissue condition is an essential requirement for implant success, but few studies have investigated this topic. METHODS A nested monocentric prospective parallel cohort (atrophic vs. oncological patients) study was performed. Clinical visits and professional hygiene sessions were performed every three months, and bleeding on probing (BOP), probing pocket depth (PPD), gingival index (GI), plaque index (PI) and implant mobility were recorded by a blind outcome assessor. RESULTS In total, 77 ZIs placed in 21 patients were evaluated: 54 (70.1%) ZIs were inserted in patients belonging to the atrophic cohort (PAM) and 23 (29.9%) ZIs in the oncologic cohort (OP). The probability of having BOP at the considered mean follow-up (27 months) was 24.8% (95% CI 19.0-31.9) for PAM and 22.9% (95% CI 15.1-33.9) OP. The mean PPD values were 2.78 ± 1.28 (range 1-8) in PAM and 2.91 ± 1.98 (range 0-10) in OP. None of the implants showed mobility. No associations between group belongingness and the entity of PPD, PI, GI and the risk of BOP were found, adjusting for the considered confounding factors (age, smoking and implant position). CONCLUSIONS Under a strict supportive hygiene therapy protocol ZIs in oncologic patients showed similar peri-implant tissue conditions to that of patients with maxillary atrophy.
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Affiliation(s)
- Gerardo Pellegrino
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), School of Dentistry, University of Bologna, Bologna, Italy
| | - Angelica Bertacci
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), School of Dentistry, University of Bologna, Bologna, Italy
| | - Daniela Relics
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Agnese Ferri
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), School of Dentistry, University of Bologna, Bologna, Italy
| | - Francesco Grande
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Pietro Felice
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), School of Dentistry, University of Bologna, Bologna, Italy
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3
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Polido WD, Machado-Fernandez A, Lin WS, Aghaloo T. Indications for zygomatic implants: a systematic review. Int J Implant Dent 2023; 9:17. [PMID: 37391575 DOI: 10.1186/s40729-023-00480-4] [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: 02/06/2023] [Accepted: 05/09/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE The purpose of this systematic review was to assess the evidence regarding the indications for placement of zygomatic implants to rehabilitate edentulous maxillae. MATERIAL AND METHODS A focused question using the PIO format was developed, questioning "in patients in need of an implant-supported rehabilitation of the edentulous maxillae, what are the indications for the use of zygomatic implants''. The primary information analyzed and collected was a clear description of the indication for the use of zygomatic implants. RESULTS A total of 1266 records were identified through database searching. The full-text review was conducted for 117 papers, and 10 were selected to be included in this review. Zygomatic implant indications were extreme bone atrophy or deficiency secondary to different factors. The quad zygoma concept (two zygomatic implants bilaterally placed and splinted) was applied to 107 patients, the classic zygoma concept (one zygomatic implant bilaterally placed and splinted to standard anterior implants) was used in 88 patients, and the unilateral concept (one zygomatic implant on one side, splinted with one or more conventional implants) was employed in 14 patients. CONCLUSIONS The main indication for the use of zygomatic implants was considered extreme maxillary bone atrophy, resulting from many factors. The clear definition of what was considered "extreme bone atrophy" is not uniquely defined in each paper. Further studies are needed to develop clear indications for zygomatic implants.
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Affiliation(s)
- Waldemar D Polido
- Department of Oral and Maxillofacial Surgery, Indiana University School of Dentistry, Indianapolis, USA.
| | | | - Wei-Shao Lin
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, USA
| | - Tara Aghaloo
- Section of Oral and Maxillofacial Surgery, UCLA School of Dentistry, Los Angeles, CA, USA
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Raffaini M, Magri A, Conti M, Arcuri F. Advanced Facial Rejuvenation After Bimaxillary Surgery in Three Different Facial Types. Aesthetic Plast Surg 2022; 46:183-193. [PMID: 34131790 DOI: 10.1007/s00266-021-02399-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/03/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE Facial aging is the consequence of many mechanisms involving the bones and the "soft tissue" (skin, fat, ligaments, muscles, and periosteum) of the face such as downward migration of the soft tissue, adipose and muscular tissue atrophy, and skeletal resorption. The potential of orthognathic surgery (double jaw surgical advancement) of expanding the skeletal foundation to increase the facial drape support is now recognized and widely popularized by several authors. The aim of this study was to analyze the rejuvenation change of the face after bimaxillary advancement for orthognathic surgery, focusing on the previously mentioned stigmata of the middle and the lower third of the aging face. MATERIALS AND METHODS A retrospective monocentric chart review was conducted for all patients affected by aging signs of the face who underwent orthognathic surgery between January 2015 and December 2019 at the Face Surgery Center (Parma, Italy). During the postoperative follow-up examination, all patients underwent anthropometric photographs and esthetic assessment to evaluate facial rejuvenation after double jaw surgical advancement. RESULTS After application of the exclusion criteria, the final study sample included 85 patients (53 females, 32 males). Eighty-three patients (97%) showed a degree of rejuvenation after maxillo-mandibular advancement (MMA); the score of the postoperative face was less than the score of the preoperative face. Two patients reported no significant postoperative change; none reported a more aging face, with a successful "reverse face-lift" occurred in 97% of our cases. CONCLUSION "Reverse face-lift" by bimaxillary advancement is a surgical procedure which is indicated for a selected group of middle-aged patients with a diagnosis of bimaxillary skeletal retrusion or posterior divergence very motivated to an extreme rejuvenation; this procedure provides support for the facial mask resulting in whole facial rejuvenation.
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Affiliation(s)
| | - Alice Magri
- Private practitioner "Facesurgery" center, Parma, Italy
| | - Marco Conti
- Consultant of the Unit of of Maxillo-Facial Surgery, AOUC "Careggi", Florence, Italy
| | - Francesco Arcuri
- Consultant of the Unit of Maxillo-Facial Surgery, IRCCS "Policlinico San Martino", Largo Rosanna Benzi 10, 16132, Genoa, Italy.
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Retrospective Analysis of Clinical and Radiologic Data Regarding Zygomatic Implant Rehabilitation with a Long-Term Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412963. [PMID: 34948572 PMCID: PMC8701901 DOI: 10.3390/ijerph182412963] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/24/2022]
Abstract
Background: Zygomatic implants have been introduced to rehabilitate edentulous patients with severely atrophic maxillae. Their use has been reported by several studies, describing high overall survival rates at medium–long follow-up. The aim of this study was to retrospectively analyze if a few patient-related and implant-related features are correlated with implant success or the onset of complications. Materials and methods: Data of patients treated with zygomatic implants between May 2005 and November 2012 at three private clinics were collected and retrospectively analyzed. For each implant, the following data were collected: implant length, insertion path, ridge atrophy and sinus characteristics (width, pneumatization, thickness of mucosae, patency of sinus ostium). General patient characteristics and health status data were also recorded. The outcomes evaluated were implant failure, infective complications, early neurologic complications and overall complications. Results: A total of 33 patients (14 men, 17 women, mean age 59.1) that received 67 zygomatic implants were included in the study. The mean duration of the follow-up was of 141.6 months (min 109; max 198). In this period, a total of 16 (23.88%) implants in 8 (24.24%) patients were removed and 17 (51.51%) patients with 36 (53.73%) implants reported complications. Immediate loading resulted in a significantly lower risk of complications compared with the two-stage prosthetic rehabilitation (OR: 0.04, p = 0.002). A thickness of the sinus mucosa > 3 mm emerged to be correlated with a greater occurrence of infective complications (OR: 3.39, p = 0.019). Severe and extreme pneumatization of the sinus was significantly correlated with the incidence of overall complications (p = 0.037) and implant failure (p = 0.044). A large sinus width was predisposed to a higher risk of neurologic complications, infective complications and implant failure (p = 0.036, p = 0.032, p = 0.04, respectively). Conclusions: zygomatic implants are an alternative procedure for atrophic ridge rehabilitation when a conventional implant placement is not possible. Several clinical and anatomical factors can have a significant role in complication occurrence.
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Attitudes regarding zygomatic implant surgical and prosthodontic techniques-a cohort questionnaire study. Oral Maxillofac Surg 2021; 26:439-445. [PMID: 34542775 DOI: 10.1007/s10006-021-00999-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Zygomatic implant (ZI) surgery and restoration is a complex procedure, requiring experienced clinicians to execute with success. This study assessed the opinion and clinical experiences of a cohort of practitioners involved in provision of zygomatic implant treatment on aspects of the surgical and prosthodontic procedures. METHOD A survey was distributed among all 176 delegates attending 'Zygomatic 2019' International Conference in the UK, and all delegates completed the survey. RESULTS The respondents were clinicians from both prosthodontic and surgical specialties, with a range of experience. Strong agreements were found regarding the use of specific implant designs dependent on the anatomical situation, and that fixed restorations should be used where possible. There was limited agreement between respondents regarding surgical approaches to ZI treatment. CONCLUSION The limited agreement found between respondents highlights the varied and conflicting literature available on ZI surgery. High-quality research is required to inform clinicians and assist education.
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Andre A, Dym H. Zygomatic Implants: A Review of a Treatment Alternative for the Severely Atrophic Maxilla. Atlas Oral Maxillofac Surg Clin North Am 2021; 29:163-172. [PMID: 34325806 DOI: 10.1016/j.cxom.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Amanda Andre
- The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, USA.
| | - Harry Dym
- The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, USA
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Agliardi EL, Panigatti S, Romeo D, Sacchi L, Gherlone E. Clinical outcomes and biological and mechanical complications of immediate fixed prostheses supported by zygomatic implants: A retrospective analysis from a prospective clinical study with up to 11 years of follow-up. Clin Implant Dent Relat Res 2021; 23:612-624. [PMID: 34159707 DOI: 10.1111/cid.13017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/01/2021] [Accepted: 04/29/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Zygomatic implants alone or in combination with conventional implants have been used for severe atrophic maxillary arches. Long-term outcomes of extramaxillary technique need validations. PURPOSE To retrospectively assess the clinical outcomes and the prevalence of surgical, biological, and prosthetic complications of implant-fixed complete dental prostheses (IFCDPs) supported by zygomatic implants up to 11 years of follow-up. MATERIALS AND METHODS Dental records of 34 subjects treated between October 2008 and June 2019 were reviewed. Patients received an immediate fixed full-arch prosthesis supported solely by zygomatic implants or by a combination of zygomatic and conventional implants. RESULTS A total of 90 zygomatic implants and 53 standard implants were placed. Up to 11 years of follow-up, two conventional implants were lost, leading to 96.2% success rate for conventional implants and 100% for zygomatic implants. Marginal bone loss for conventional implants averaged 0.85 ± 0.17 mm after the first year and 1.36 ± 0.12 mm after 10 years, resulting in full implant success. No prosthesis was lost. The main surgical complication was the perforations of the Schneiderian membrane, occurring in five patients and in seven sinus cavities. Considering the biological complications, mucositis for standard and zygomatic implants ranged between 21%-35% and 26%-40%, respectively. No peri-implantitis were reported. Soft tissue hypertrophy ranged between 1.8% and 30% for conventional implants and 1.1%-35% for zygomatic implants. Inflammation under the prosthesis ranged between 33% and 50%. For the mechanical complications, abutment loosening was recorded in 5.8% of cases (two patients), tooth debonding and fracture of the prosthesis happened in five subjects (14.7%), and loosening of the prosthetic screws was reported in one patient (2.9%). CONCLUSIONS Immediate rehabilitation of the severely atrophic maxilla with zygomatic implants alone or in combination with standard implants could be considered a viable treatment modality.
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Affiliation(s)
- Enrico Luigi Agliardi
- Department of Dentistry, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | | | - Davide Romeo
- Department of Dentistry, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Lavinia Sacchi
- Department of Dentistry, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Enrico Gherlone
- Department of Dentistry, San Raffaele Hospital, Vita Salute University, Milan, Italy
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D'Agostino A, Lombardo G, Favero V, Signoriello A, Bressan A, Lonardi F, Nocini R, Trevisiol L. Complications related to zygomatic implants placement: A retrospective evaluation with 5 years follow-up. J Craniomaxillofac Surg 2021; 49:620-627. [PMID: 33581959 DOI: 10.1016/j.jcms.2021.01.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 12/03/2020] [Accepted: 01/31/2021] [Indexed: 10/22/2022] Open
Abstract
This retrospective study assessed zygoma implants in patients treated for upper maxilla extreme atrophy, trauma, cleft palate, or failed reconstruction. The implants were placed using Quad (4 zygoma implants) or mixed (zygoma and conventional implants in premaxilla) surgical technique, with intra-sinus or extra-sinus approach, followed by immediate or deferred loading. Clinical and radiographic evaluations were carried out at 5-year follow-up from loading. Implant survival, symptoms and signs of sinusitis, radiological alterations in terms of mucosal thickening or obliteration of the maxillary sinuses, oroantral communications, and peri-implant soft tissues were examined. A total of 42 patients, with 116 zygoma implants, were included in the study. The cumulative survival rate was 97.41%. One zygomatic bone fracture was assessed. Eight patients reported sinusitis, and two showed oro-antral communications. A comparison between mean pre- and post-operative Lund-Mackay scores showed a statistically significant increase of sino-nasal disease in the post-operative scores (p = 0.0019). Mucositis and gingival recession was observed in 21 and 8 implants respectively. Average recession was 2.52 ± 2.35 mm. According to our results, placement of zygoma implants has proved to be a predictable procedure, with a lower rate of severe complications compared to other treatment options in extreme upper jaw atrophy.
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Affiliation(s)
- Antonio D'Agostino
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Giorgio Lombardo
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Vittorio Favero
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy.
| | - Annarita Signoriello
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Anna Bressan
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Fabio Lonardi
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Riccardo Nocini
- Unit of Otolaryngology, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Lorenzo Trevisiol
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
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10
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Surgical treatment for zygomatic implant related maxillary sinusitis: A method for implant salvage. OTOLARYNGOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.xocr.2020.100196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Goker F, Grecchi E, Mancini EG, Del Fabbro M, Grecchi F. Zygomatic implant survival in 9 ectodermal dysplasia patients with 3.5- to 7-year follow-up. Oral Dis 2020; 26:1803-1809. [PMID: 32583493 DOI: 10.1111/odi.13505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/29/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Ectodermal dysplasia syndrome is a complex group of genetic disorders identified by the abnormal development of the ectodermal structures. The aim of this retrospective clinical case series report was to evaluate the outcomes of the ectodermal dysplasia syndrome patients that underwent zygomatic implant surgery. MATERIALS AND METHODS A total of 9 ectodermal dysplasia syndrome patients aged between 21 and 56 years (mean age 36.8) with severely atrophic maxilla were included in this study. All the patients were treated with a total of 19 zygomatic implants. The mean follow-up of the patients was 55 months (with a range of 44-84 months). The implant survival rate was evaluated as a primary outcome. The intra- and postoperative complications were evaluated as additional criteria for success. RESULTS The overall implant survival rate was 100% without any complications. Final or provisional prosthesis was delivered on the same day of surgery, which resulted in an improvement of the quality of life of the patients. CONCLUSION According to the results of this study, zygomatic surgery can be considered as a viable and safe alternative to conventional treatment modalities for oral rehabilitation of ectodermal dysplasia syndrome patients.
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Affiliation(s)
- Funda Goker
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy
| | - Emma Grecchi
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy
| | | | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy.,IRCCS Orthopedic Institute Galeazzi, Milano, Italy
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Goker F, Grecchi E, Del Fabbro M, Grecchi F. Clinical outcome of 302 zygomatic implants in 110 patients with a
follow‐up
between 6 months and 7 years. Clin Implant Dent Relat Res 2020; 22:415-423. [PMID: 32291961 DOI: 10.1111/cid.12909] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Funda Goker
- Department of Biomedical, Surgical and Dental Sciences University of Milano Milan Italy
| | - Emma Grecchi
- Department of Biomedical, Surgical and Dental Sciences University of Milano Milan Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences University of Milano Milan Italy
- IRCCS Orthopedic Institute Galeazzi Milan Italy
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13
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Gómez-Pedraza A, González-Cardín V, Díez-Suárez L, Herrera-Villalva M. Maxillofacial Rehabilitation With Zygomatic Implants in an Oncologic Patient: A Case Report. J Oral Maxillofac Surg 2019; 78:547-556. [PMID: 31705866 DOI: 10.1016/j.joms.2019.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/20/2019] [Accepted: 10/05/2019] [Indexed: 11/15/2022]
Abstract
Tumor ablation results in significant sequelae in the appearance, function, and esthetics of a patient with cancer, especially resection for head and neck cancer. Reconstruction with local and microvascular flaps is a workable option; however, the esthetic results will occasionally be unfulfilling and inadequate for the rehabilitation of lost structures. Prosthetic rehabilitation with conventional and zygomatic implants can provide favorable and predictable long-term results. We report the clinical case of a 53-year-old female patient with adenoid cystic carcinoma (ACC). The treatment protocol included radical surgery, radiotherapy, and maxillofacial rehabilitation with conventional and zygomatic implants. Management of an ACC case requires a timely, radical, and multidisciplinary approach. In our patient, rehabilitation of masticatory function was accomplished in the immediate postoperative period and before radiotherapy. The rehabilitation of masticatory function improved the patient's systemic and nutritional status and her speech, with coverage of the esthetic defect. These outcomes reduced the psychological and emotional effects of tumor ablation.
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Affiliation(s)
- Antonio Gómez-Pedraza
- Surgeon, Head and Neck Surgery Department, National Cancer Institute, Mexico City, Mexico
| | | | - Leandro Díez-Suárez
- Oral and Maxillofacial Surgery Resident, National Cancer Institute and National Autonomous University of Mexico UNAM, Mexico City, Mexico.
| | - María Herrera-Villalva
- Maxillofacial Prosthetics Resident, National Cancer Institute and National Autonomous University of Mexico UNAM, Mexico City, Mexico
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14
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D'Agostino A, Favero V, Nocini R, Venco J, Nocini PF, Trevisiol L. Does Middle Meatal Antrostomy Prevent the Onset of Maxillary Sinusitis After Zygomatic Implant Placement? J Oral Maxillofac Surg 2019; 77:2475-2482. [PMID: 31445033 DOI: 10.1016/j.joms.2019.06.189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/05/2019] [Accepted: 06/24/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate the role of middle meatal antrostomy in preventing the onset of maxillary sinusitis after placement of zygomatic implants. We hypothesized that middle meatal antrostomy might reduce the incidence of this complication. MATERIALS AND METHODS A prospective longitudinal study was performed of patients who had undergone placement of 4 zygomatic implants and concurrent middle meatal antrostomy with an endoscopic approach at the maxillofacial surgery unit of Verona University. The radiological results of the maxillary sinuses were evaluated on computed tomography scans performed 12 months after surgery using the Lund-Mackay staging system. Clinical symptoms were evaluated both preoperatively and 12 months after surgery using the Sino-Nasal Outcome Test-20 (SNOT-20). Intraoperative violation of the Schneiderian membrane was also assessed. The outcomes from the present study were compared with historical controls. RESULTS The sample included 13 patients, 26 maxillary sinuses with negative radiologic findings of sinonasal pathologic features, and 52 zygomatic implants. A moderate increase was found in radiologic findings of sinonasal pathologic features postoperatively compared with preoperatively, with mucosal hypertrophy in 3 maxillary sinuses (11.5%). The incidence and severity of mucosal hypertrophy was significantly lower than the outcomes of the historical controls. The average preoperative SNOT-20 score was 13.45, and the postoperative SNOT-20 score was 1.18. The Schneiderian membrane was pierced in 13 sinuses in 9 patients. CONCLUSIONS Shrinkage of the ostiomeatal complex seems to play a fundamental role in the onset of sinonasal pathologic features after zygomatic implant placement compared with implant-related causes. Although functional endoscopic sinus surgery is a supplementary surgical method in implant placement, it seems to provide statistically significant improvement in the health of the sinonasal system. Perforation of the Schneiderian membrane does not appear to correlate with the onset of sinus opacification and sinonasal symptoms.
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Affiliation(s)
- Antonio D'Agostino
- Associate Professor, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Vittorio Favero
- Clinical Assistant, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Riccardo Nocini
- Attending Physician, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Jessica Venco
- Attending Physician, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Pier Francesco Nocini
- Professor and Chief, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Lorenzo Trevisiol
- Associate Professor, Section of Oral and Maxillofacial Surgery, Department of Surgery, University of Verona, Verona, Italy.
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15
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Procacci P, Lanaro L, Trevisiol L, Bertossi D, Zotti F, Fabio L, D'Agostino A. Is post orthognathic maxillary sinusitis related to sino-nasal anatomical alterations? J Craniomaxillofac Surg 2019; 47:876-882. [DOI: 10.1016/j.jcms.2019.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/07/2019] [Accepted: 03/05/2019] [Indexed: 11/28/2022] Open
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Does Piezosurgery Influence the Severity of Neurosensory Disturbance Following Bilateral Sagittal Split Osteotomy? J Craniofac Surg 2019; 30:1154-1162. [PMID: 30839457 DOI: 10.1097/scs.0000000000005251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The present paper aims to evaluate the long-term incidence and severity of the neurosensory disturbance (NSD) of the inferior alveolar nerve following bilateral sagittal split osteotomy (BSSO) of the mandibular ramus performed with piezosurgery. A retrospective study on patients referred to the Maxillofacial Surgery and Dentistry Clinic of the University of Verona for orthognathic surgery between March 2013 and October 2015 was performed. Inclusion criteria were having undergone BSSO with piezosurgery and follow-up lasting at least 24 months. Exclusion criteria were history of surgical infection, osteosynthesis failure or re-do surgery. The extent of mandibular repositioning movements was retrieved and patients underwent 4 clinical neurosensory tests. Descriptive statistical analysis was performed. 52 patients met the inclusion criteria. Average follow-up was 40 months (range 24-75). 83% of the nerves examined have no or slightly altered sensitivity. Seventy-one percent of patients perceive a moderate to none discomfort and none describes the discomfort as serious (Visual Analogue Scale [VAS] >7). The extent of mandibular repositioning did not have significant influence on the development and severity of the NSD. Resulting data led the Authors to infer that using piezosurgery in BSSO, the severity of the NSD of inferior alveolar nerve is reduced, but the incidence of permanent nerve lesions remains unchanged, compared to historical controls.
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Aleksandrowicz P, Kusa-Podkańska M, Grabowska K, Kotuła L, Szkatuła-Łupina A, Wysokińska-Miszczuk J. Extra-Sinus Zygomatic Implants to Avoid Chronic Sinusitis and Prosthetic Arch Malposition: 12 Years of Experience. J ORAL IMPLANTOL 2018; 45:73-78. [PMID: 30074849 DOI: 10.1563/aaid-joi-d-18-00034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This report retrospectively at the 12-year follow-up results of the treatment and rehabilitation of edentulous maxillae, applying extra-sinus zygomatic implants alone or in combination with intra-sinus zygomatic implants. We recruited 22 patients with 35 zygomatic Brånemark system implants; 24 implants in the standard Brånemark protocol through the sinus and 11 extra-sinus implants outside the sinus. Additionally, 147 regular implants were placed. The minimum follow-up period was 50 months to a maximum of 152 months. The zygoma survival rate after 12 years was 97.15%. Chronic sinusitis occurred in 11.42% of patients. We lost 1 (2.85%) zygomatic implant placed through the sinus and none of those in the extra-sinus position. The survival rate of the regular implants was 93.87%. Chronic sinusitis occurred in 4 patients (11.42%) who received zygomatic implants using standard protocol through the sinus. None of the extra-sinus zygoma patients developed sinusitis. Peri-implantitis was detected with only 3 zygomatic implants. In the original P-I Brånemark zygoma protocol the implants were passing through the sinus, which resulted in chronic sinusitis in some patients and malposition of the prosthetic platform toward the palate. These complications can be avoided by the extra-sinus placement of zygoma implants as demonstrated in this study.
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Affiliation(s)
| | | | | | - Lidia Kotuła
- 3 Department of Clinical Genetics, Medical University of Lublin, Poland
| | - Anna Szkatuła-Łupina
- 4 Department of Otolaryngology and Laryngological Oncology, Medical University of Lublin, Poland
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Cumulative Success Rate of Short and Ultrashort Implants Supporting Single Crowns in the Posterior Maxilla: A 3-Year Retrospective Study. Int J Dent 2017; 2017:8434281. [PMID: 28751913 PMCID: PMC5511658 DOI: 10.1155/2017/8434281] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 05/23/2017] [Indexed: 12/14/2022] Open
Abstract
AIM To determine cumulative success rate (CSR) of short and ultrashort implants in the posterior maxilla restored with single crowns. PATIENTS AND METHODS We performed a retrospective study in 65 patients with 139 implants. 46 were ultrashort and 93 short. Implants were placed with a staged approach and restored with single crowns. Success rate, clinical and radiographic outcomes, and crown-to-implant ratio (CIR) were assessed after three years. Statistical analysis was performed by descriptive and inferential statistics. A log-binomial regression model where the main outcome was implant success was achieved. Coefficients and 95% confidence intervals were reported. Analyses were performed with Stata 13.2 for Windows. RESULTS 61.54% of patients were female and mean overall age was 51.9 ± 11.08 years old. Overall CSR was 97.1% (95% CI: 92.4-98.9): 97.9 and 95.1% for short and ultrashort, respectively (P value: 0.33). Four implants failed. Covariates were not associated with CSR (P value > 0.05). Regression model showed coefficients correlated with implant success for ultrashort implants (0.87) and most of covariates but none were statistically significant (P values > 0.05). CONCLUSIONS Our results suggest that short and ultrashort implants may be successfully placed and restored with single crowns in the resorbed maxillary molar region.
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Agliardi EL, Romeo D, Panigatti S, de Araújo Nobre M, Maló P. Immediate full-arch rehabilitation of the severely atrophic maxilla supported by zygomatic implants: a prospective clinical study with minimum follow-up of 6 years. Int J Oral Maxillofac Surg 2017; 46:1592-1599. [PMID: 28655434 DOI: 10.1016/j.ijom.2017.05.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/07/2017] [Accepted: 05/29/2017] [Indexed: 10/19/2022]
Abstract
The aim of this study was to evaluate the outcomes of immediate full-arch prostheses supported by zygomatic implants alone or in combination with standard fixtures after a minimum of 6 years of loading. From October 2008 to April 2010, 15 patients with severely atrophic maxillae were treated using four zygomatic implants or two zygomatic implants in conjunction with two conventional fixtures. All subjects received a fixed screw-retained prosthesis within 3hours of surgery, while the final restoration was delivered after 6 months. Follow-up examinations were scheduled to evaluate zygomatic implant survival, conventional dental implant success, prosthetic success, plaque and bleeding scores, marginal bone loss for conventional dental implants, and patient satisfaction. Forty-two zygomatic fixtures and 18 standard implants were placed. Patients were followed up for a minimum of 79 months (range 79-97 months, average 90.61 months). No implant was lost, leading to implant and prosthetic survival rates of 100%. Bone loss for conventional implants averaged 1.39±0.10mm after 6 years of function, leading to a 100% implant success rate. High levels of patient satisfaction were recorded. These medium-term results indicate that immediate full-arch rehabilitation supported by zygomatic implants could be considered a viable treatment modality for the severely atrophic maxilla.
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Affiliation(s)
- E L Agliardi
- Advanced Oral Surgery Unit, Department of Dentistry, Vita Salute University, San Raffaele Hospital, Milan, Italy.
| | - D Romeo
- Advanced Oral Surgery Unit, Department of Dentistry, Vita Salute University, San Raffaele Hospital, Milan, Italy
| | | | | | - P Maló
- Oral Surgery Department, Malo Clinic, Lisbon, Portugal
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Clinical, microbiologic and radiologic assessment of soft and hard tissues surrounding zygomatic implants: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:537-546. [DOI: 10.1016/j.oooo.2016.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/30/2016] [Accepted: 06/17/2016] [Indexed: 11/18/2022]
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