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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 2024; 22:696-702. [PMID: 37831522 DOI: 10.1111/idh.12776] [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: 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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Zaninovich M, Drago C. Prosthodontic criteria for maxillary immediate occlusal loading, surgical classifications of atrophic maxillae, and presentation of a new implant/anatomic classification system for immediate maxillary rehabilitation. J Prosthodont 2024. [PMID: 39008359 DOI: 10.1111/jopr.13898] [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: 12/22/2023] [Accepted: 06/06/2024] [Indexed: 07/16/2024] Open
Abstract
PURPOSE Immediate full-arch occlusal loading for patients with atrophic edentulous maxillae satisfies critical needs for this specific type of edentulous patient after placement of implants with high levels of primary implant stability. The needs include improved aesthetics, limited immediate improved function, and elimination of removable prostheses. Classification systems exist for edentulous maxillae but they do not include specifics regarding posterior implant placement. In conjunction with anterior implants, posterior implants improve Anterior/Posterior (A/P) spreads, decrease cantilevered segments (CLs), and likely will improve implant and prosthetic success rates. The purposes of this article include presenting a new classification system that outlines the different types of implants now available which will likely achieve the requisite primary stability for immediate fixed rehabilitation. This proposed classification system identifies a relationship between different implant options currently available and the remaining quantity of bone in the first and second maxillary molar zones. MATERIALS AND METHODS The available literature regarding current classification systems was reviewed. The benefits and limitations of each system were described. The parameters associated with Immediate Occlusal Loading (IOL) for full arch maxillary prostheses include: posterior cantilever lengths of full arch fixed prostheses; existing A/P spread considerations for full arch prostheses; and introduction of a new classification system for atrophic posterior maxillary edentulous ridges were identified. RESULTS Currently, there are no available classification systems that outline specific implant options for posterior maxillae which will likely achieve the minimum primary stability needed for immediate rehabilitation. A new classification system was proposed where the rationale was to show clinicians that when a certain amount of bone remains in the posterior maxilla, there are specific implants designed to maximize primary stability. High implant primary stability is required for rehabilitation with immediate fixed implant-supported provisional prostheses. The proposed classification system assists clinicians in understanding what implant geometry is available and can be expected to achieve the requisite primary stability for immediate occlusal loading based on the available bone in the posterior maxillary molar zone. CONCLUSIONS This article reviewed current classification systems for edentulous maxillary patients, as well as clinical parameters required for full arch, immediate occlusal loading. It also presented a new classification system to assist clinicians in selecting appropriate implants and surgical techniques for immediate fixed rehabilitation of patients with atrophic maxillae.
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Affiliation(s)
- Michael Zaninovich
- Aria Dental Specialist Implant Centre, Perth, Western Australia, Australia
| | - Carl Drago
- Greenbrook Dental Group, Brookfield, Wisconsin, USA
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Wang W, Zhuang M, Tao B, Wang F, Wu Y. Learning curve of dynamic navigation-assisted zygomatic implant surgery: An in vitro study. J Prosthet Dent 2024; 132:178.e1-178.e12. [PMID: 38609763 DOI: 10.1016/j.prosdent.2024.03.037] [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: 12/07/2023] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024]
Abstract
STATEMENT OF PROBLEM Dynamic computer-assisted zygomatic implant surgery (dCAZIS) has been reported to provide clinical efficacy with high accuracy and low risk of complications. However, the learning curve before performing dCAZIS effectively is unknown. PURPOSE The purpose of this in vitro study was to explore the learning curve of dCAZIS in dentists with different levels of experience in implant dentistry and navigation surgery. MATERIAL AND METHODS Six senior dental students were randomly divided into 3 groups for initial training (FH-CI group: pretraining on freehand conventional implant surgery; FH-ZI group: pretraining on freehand ZI surgery; DN-CI group: pretraining on conventional implant surgery under dynamic navigation). Then, every operator conducted 6 repeated dCAZIS training sessions on edentulous 3-dimensional (3D) printed skull models and was asked to complete a self-report questionnaire after each training session. A total of 36 postoperative cone beam computed tomography (CBCT) scans with 144 ZI osteotomy site preparations were obtained and superimposed over the preoperative design for accuracy measurements. The operation time, 3D deviations, and results of the self-reports were recorded. Comparisons among groups were analyzed with independent-sample Kruskal-Wallis tests (α=.05), and correlations between study outcomes and the number of practices were calculated. RESULTS Operator experience and increased practice times did not significantly affect the accuracy of dCAZIS (P>.05). However, the operation time varied among groups (P<.001), and significantly shortened with more practice, reaching 11.51 ±1.68 minutes at the fifth attempt in the FH-CI group (P<.001 compared with the first practice), 14.48 ±3.07 minutes at the third attempt in the FH-ZI group (P=.038), and 8.68 ±0.58 minutes at the sixth attempt in the DN-CI group (P<.001). All groups reached their own learning curve plateau stage within 6 practice sessions. As the number of practice sessions increased, the results from the self-report questionnaires gradually improved. CONCLUSIONS Among dentists with different levels of experience in implant dentistry and navigation surgery, dCAZIS was found to have a learning curve with respect to operation time but not implant accuracy. Experience in ZI surgery had little impact on the learning curve of dCAZIS, but experience in navigation surgery was a key factor.
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Affiliation(s)
- Wenying Wang
- Graduate student, 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, Shanghai, PR China
| | - Minjie Zhuang
- Graduate student, 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, Shanghai, PR China
| | - Baoxin Tao
- Graduate student, 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, Shanghai, PR China
| | - Feng Wang
- Professor, 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, Shanghai, PR China
| | - Yiqun Wu
- Professor, 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, Shanghai, PR China.
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Aparicio C, Polido WD, Chehade A, Shenouda M, Simon M, Simon P, Al-Nawas B. Round and flat zygomatic implants: effectiveness after a 3‑year follow‑up non‑interventional study. Int J Implant Dent 2024; 10:30. [PMID: 38856876 PMCID: PMC11164844 DOI: 10.1186/s40729-024-00548-9] [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: 02/26/2024] [Accepted: 05/21/2024] [Indexed: 06/11/2024] Open
Abstract
PURPOSE This non-interventional study investigates variations in the type and frequency of late complications linked to novel zygomatic implant designs, installed adhering to the Zygoma Anatomy-Guided Approach (ZAGA) concept, over an extended follow-up period of at least 3 years. METHODS Consecutive patients presenting indications for treatment with ZIs were treated according to ZAGA recommendations. Implants were immediately loaded. The ORIS success criteria for prosthetic offset, stability, sinus changes and soft-tissue status were used to evaluate the outcome. RESULTS Twenty patients were treated. Ten patients received two ZIs and regular implants; one received three ZIs plus regular implants, and nine received four ZIs. Fifty-nine ZIs were placed: thirty-six (61%) Straumann ZAGA-Flat implants and twenty-three (39%) Straumann ZAGA-Round implants. Four patients (20%) presented earlier sinus floor discontinuities. Fifteen patients (75%) had prior sinus opacities. Nineteen patients were followed for between 38 and 53 months (mean 46.5 months). One patient dropped out after 20 months. When comparing pre-surgical CBCT with post-surgical CBCT, 84.7% of the sites presented identical or less sinus opacity; nine locations (15%) showed decreased, and another nine increased (15%) post-surgical sinus opacity. Fifty-three ZIs (89.8%) maintained stable soft tissue. Six ZIs had recessions with no signs of infection. ZIs and prosthesis survival rate was 100%. CONCLUSIONS The study highlights the effectiveness of ZAGA-based zygomatic implant rehabilitations using Round and Flat designs. Despite patient number constraints, minimal changes in the frequency of late complications from the 1-year follow-up were observed. 100% implant and prosthesis survival rate over a mean follow-up of 46.5 months is reported.
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Affiliation(s)
- Carlos Aparicio
- Zygomatic Unit, Hepler Bone Clinic, ZAGA Center Barcelona, Roman Macaya, 22-24, 08022, Barcelona, Spain.
- International Teaching Scholar, Indiana University School of Dentistry, Indianapolis, USA.
| | - Waldemar D Polido
- Oral and Maxillofacial Surgery, Indiana University School of Dentistry Indianapolis, USA. ZAGA Center, Indiana University, 1121 W. Michigan Street, Indianapolis, IN, 46202, USA
| | - Antoine Chehade
- Seaforth Oral Surgery, ZAGA Center Montreal, 3550 côte des neiges, suite 170, Montreal, QC, H3H 1V4, Canada
| | - Marc Shenouda
- Seaforth Oral Surgery, ZAGA Center Montreal, 3550 côte des neiges, suite 170, Montreal, QC, H3H 1V4, Canada
| | - Madalina Simon
- ZAGA Center Stuttgart, All-On-4 Excellence Center, Kronprinzstraße 11, 70173, Stuttgart, Germany
| | - Peter Simon
- ZAGA Center Stuttgart, All-On-4 Excellence Center, Kronprinzstraße 11, 70173, Stuttgart, Germany
| | - Bilal Al-Nawas
- Department for Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Center of the J. Gutenberg University Mainz, Augustusplatz 2, 55131, Mainz, Germany
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Nunes M, de Araújo Nobre M, Camargo V. All-on-4 Hybrid with Extra-Long Transnasal Implants: Descriptions of the Technique and Short-Term Outcomes in Three Cases. J Clin Med 2024; 13:3348. [PMID: 38893060 PMCID: PMC11172536 DOI: 10.3390/jcm13113348] [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: 04/24/2024] [Revised: 05/11/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: There is a need for alternative approaches to full-arch rehabilitation of atrophic maxillae. The aim of this short case series was to describe the technique and assess the short term-outcomes of atrophic maxillae rehabilitation using transnasal implants in conjunction with zygomatic implants. Methods: Three female patients (average age: 62 years) presenting comorbidities and atrophic maxillae preventing the insertion of standard maxillary anchored implants received a full-arch fixed prosthesis supported by transnasal implants together with zygomatic implants, using the ad modum all-on-4 concept. Patients were followed during the functional osseointegration period. Primary outcome measures were prosthetic and implant survival based on function. Secondary outcome measures were complication parameters (biological and mechanical), plaque and bleeding levels, and probing pocket depths > 4 mm. Results: No implant failures were registered, and all prostheses remained in function. The only complication was a fracture of a provisional crown that was resolved. Plaque and bleeding scores were mild during the follow-up period. Conclusions: The present manuscript describes the use of extra-long transnasal implants in combination with zygomatic implants in immediate function for full-arch fixed prosthetic rehabilitation of atrophic maxillae, with the objective of promoting more research into this relatively recent technique. More studies are needed to validate the technique.
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Affiliation(s)
- Mariana Nunes
- Oral Surgery Department, Malo Clinic, Avenida dos Combatentes, 43, Level 9, 1600-042 Lisboa, Portugal;
| | - Miguel de Araújo Nobre
- R&D Department, Malo Clinic, Avenida dos Combatentes, 43, Level 11, 1600-042 Lisboa, Portugal
| | - Vanderlim Camargo
- CIIPO, Rua Germano Wendhausen, 203-3 andar-Centro, Florianópolis 88015-460, Brazil;
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Rajan G, Venkatakrishnan L, Balachandran A, Krti S. Importance of Assessing the Position of the Infraorbital Foramen in Quad Zygoma or Unilateral Double Zygoma Implant Surgery. J ORAL IMPLANTOL 2024; 50:212-214. [PMID: 38597150 DOI: 10.1563/aaid-joi-d-23-00088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
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Brauer HU, Mamar AK, Bartols A, Korsch M. All-on-4 Concept With Use Of Zygoma Implants for Rehabilitation in the Severely Atrophied Maxilla With a Definitive Immediate Restoration. J ORAL IMPLANTOL 2024; 50:173-177. [PMID: 38530850 DOI: 10.1563/aaid-joi-d-23-00130] [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] [Indexed: 03/28/2024]
Abstract
This case report of a 45-year-old patient at initial presentation shows an illustration of the limitations of periodontal maintenance therapy and subsequent implant prosthetic therapy. In close consultation with the patient, treatment strategies were adopted to maximize the preservation of prognostically questionable teeth. Eight years later, the patient had a highly atrophied maxilla that could be successfully restored with implants. This was achieved with 2 zygoma implants and 2 anterior conventional implants, which were immediately loaded according to the All-on-4 concept and immediately provided with a definitive prosthetic restoration. The case report demonstrates to the general practitioner that using zygoma implants in such constellations may offer a solution to achieve a fixed, rapid, and financially acceptable prosthetic rehabilitation.
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Affiliation(s)
- Hans Ulrich Brauer
- Dental Academy for Continuing Professional Development, Karlsruhe, Germany
| | - Abdel-Karim Mamar
- Dental Academy for Continuing Professional Development, Karlsruhe, Germany
| | - Andreas Bartols
- Dental Academy for Continuing Professional Development, Karlsruhe, Germany
| | - Michael Korsch
- Dental Academy for Continuing Professional Development, Karlsruhe, Germany
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Kudva A, Srikanth G, Singh A, Chitra A, Suryanarayan RK, Francis M. Reconstruction of Maxillary Defects Using Virtual Surgical Planning and Additive Manufacturing Technology: A Tertiary Care Centre Experience. J Maxillofac Oral Surg 2024; 23:644-652. [PMID: 38911428 PMCID: PMC11190103 DOI: 10.1007/s12663-023-02005-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 08/16/2023] [Indexed: 06/25/2024] Open
Abstract
Introduction Maxillary reconstruction is often a challenging task for the surgeons because of the complex anatomy. However, with the advances in virtual surgical planning (VSP) and 3D printing technology there is a new avenue for the surgeons which offers a suitable alternative to conventional flap-based reconstructions. Patients and Methods In this article, we have described 4 case scenarios which were managed with the help of VSP and additive manufacturing technology for complex maxillary reconstruction procedures. Use of the technologies aided the clinician in achieving optimal outcomes with regards to form, function and esthetics. Discussion Virtual surgical planning (VSP) has gained a lot of impetus in past 1 decade. These aides the surgeon in determining the extent of disease and also carry out the treatment planning. In addition to VSP, the concept of additive manufacturing provides a viable alternative to the conventional reconstruction modalities for maxillary defect rehabilitation. Increased accuracy, rehabilitation of normal anatomical configuration, appropriate dental rehabilitation, decreased intra-operative time and post-operative complications are some of the advantages. In addition, patient-specific implants eliminate the need for a separate donor site. Apart from the treatment of pathologies, they also can be used for reconstruction of post-traumatic defect, where endosteal implant placement is not possible. Conclusion These modalities show promising results for reconstruction of complex maxillary defects.
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Affiliation(s)
- Adarsh Kudva
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - G. Srikanth
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Anupam Singh
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - A. Chitra
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Ramya K. Suryanarayan
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Mugdha Francis
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education (MAHE), Manipal, India
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Rodrigues A, Abi-Nader S, Durand R, Rompré P, Janati AI, Atsu S, Morris M, Emami E. Effectiveness of zygomatic-implant fixed rehabilitation for the atrophic edentulous maxilla: protocol for a systematic review and network meta-analysis. Syst Rev 2024; 13:146. [PMID: 38822368 PMCID: PMC11140941 DOI: 10.1186/s13643-024-02561-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/14/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Atrophic edentulous maxilla is a debilitating condition caused by the progressive and irreversible bone resorption following loss of teeth, that results in bone of inadequate volume and density. This makes conventional implant therapy extremely challenging without complex reconstructive procedures. Several techniques such as sinus augmentation, short implants, and tilted implants have been used for the rehabilitation of the atrophic maxilla. In recent years, zygomatic implants have emerged as a graftless rehabilitation technique. However, few studies compare zygomatic-implant fixed rehabilitation with other fixed rehabilitation techniques. The existing body of evidence on zygomatic implants is largely based on clinical and disease-oriented outcomes. METHODS A network meta-analysis (NMA) will be conducted in order to compare the effectiveness of zygomatic-implant fixed rehabilitation with the other rehabilitation techniques. Experimental and observational studies comparing different implant-assisted fixed rehabilitation in adults with atrophic maxilla will be included. The primary and secondary outcomes will be patient's satisfaction and quality of life respectively. Additional outcomes include the implant's survival/success, and biological and prosthetic complications. An electronic search will be performed through various databases for articles in English and French, without time limits. Risk of bias will be assessed using the Revised Cochrane Risk-of-Bias tool for randomized controlled trials, and ROBINS-I for non-randomized and observational studies. Two independent reviewers will screen the titles and abstracts and extract data. Any discrepancy between reviewers will be discussed and resolved through consensus or with the help of a third reviewer. Pairwise meta-analyses will be performed using a random effects model. I2, τ2, transitivity, subgroup/meta-regression analyses will assess and explain heterogeneity and distribution of effect modifiers. A network plot will be created to connect the different interventions directly and indirectly. Interventions will be ranked using the surface under cumulative ranking curve. Confidence in the results of the NMA will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). DISCUSSION This study will be the first to assess the effectiveness of zygomatic-implant fixed rehabilitation for the atrophic maxilla using NMA. The evidence obtained will aid clinical decision-making and will advance the knowledge of the rehabilitation techniques for the atrophic maxilla. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023353303.
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Affiliation(s)
- Anisha Rodrigues
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Samer Abi-Nader
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Robert Durand
- Faculty of Dental Medicine, Université de Montréal, Montreal, Canada
| | | | - Amal Idrissi Janati
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Saadet Atsu
- Materials Engineering, McGill University, Montreal, Canada
| | - Martin Morris
- Schulich Library, Mcgill University, Montreal, Canada
| | - Elham Emami
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada.
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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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Yu Z, Guo H, Han W, Jiang X, Lin Y. Peri-zygomatic complications on zygomatic implants with or without penetrating the external surface of zygoma: A 2-year retrospective study. Clin Implant Dent Relat Res 2024; 26:197-205. [PMID: 37674300 DOI: 10.1111/cid.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/29/2023] [Accepted: 08/14/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES The main purpose of this retrospective study was to assess the difference in the incidence of peri-zygomatic complications (PZCs) when zygomatic implants (ZIs) penetrate or do not penetrate the external surface of zygoma. MATERIALS AND METHODS This study included 32 patients with edentulous maxillae or potentially edentulous maxillae undergo zygomatic implantation. The patients were divided into the penetration group (P-group) and the non-penetration group (N-group) according to whether the apex of implants penetrated the external surface of zygoma in postoperative CBCT. The extension length, the penetration section of the implants, and the skin thickness at the corresponding position were simultaneously measured. Clinical follow-up was conducted regularly until 2 years after surgery. The occurrence of PZCs (including peri-zygomatic infection, skin numbness, non-infectious pain, and foreign body sensation) was recorded. A mixed effect logistic model was used to compare the difference of complication rate between the P-group and the N-group, and odds ratio (OR) was calculated. Then identify the impact of the extension length, penetration section and skin thickness in P-group with the same model. RESULTS A total of 71 ZIs were implanted in 32 patients, including 37 implants in the P-group and 34 implants in the N-group. During the 2-year follow-up, a total of 13 implants occurred PZCs, with an overall complication rate of 18.3%. Thereinto, the incidence rate was 29.7% in the P-group, and 5.9% in the N-group (OR = 6.77). In P-group, there was a significant difference in complication rate of different extension lengths, while the penetration section and skin thickness had no statistical significance on the complication rate. CONCLUSION Under the limitation of this study, to minimize the risk of PZCs, ZI should be placed in a manner that avoids the apex penetrating the external surface of the zygoma.
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Affiliation(s)
- Ziyang Yu
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Houzuo Guo
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Weihua Han
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease, Beijing, China
| | - Xi Jiang
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Ye Lin
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
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12
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Herce-López J, Pingarrón MDC, Tofé-Povedano Á, García-Arana L, Espino-Segura-Illa M, Sieira-Gil R, Rodado-Alonso C, Sánchez-Torres A, Figueiredo R. Customized Subperiosteal Implants for the Rehabilitation of Atrophic Jaws: A Consensus Report and Literature Review. Biomimetics (Basel) 2024; 9:61. [PMID: 38275459 PMCID: PMC10812919 DOI: 10.3390/biomimetics9010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
(1) Background: The aim was to perform a literature review on customized subperiosteal implants (CSIs) and provide clinical guidelines based on the results of an expert consensus meeting held in 2023. (2) Methods: A literature search was performed in Pubmed (MEDLINE) in July 2023, including case series and cohort studies with a minimum follow-up of 6 months that analyzed totally or partially edentulous patients treated with CSIs. Previously, an expert consensus meeting had been held in May 2023 to establish the most relevant clinical guidelines. (3) Results: Six papers (four case series and two retrospective cohort studies) were finally included in the review. Biological and mechanical complication rates ranged from 5.7% to 43.8% and from 6.3% to 20%, respectively. Thorough digital planning to ensure the passive fit of the CSI is mandatory to avoid implant failure. (4) Conclusions: CSIs are a promising treatment option for rehabilitating edentulous patients with atrophic jaws; they seem to have an excellent short-term survival rate, a low incidence of major complications, and less morbidity in comparison with complex bone grafting procedures. As the available data on the use of CSIs are very scarce, it is not possible to establish clinical recommendations based on scientific evidence.
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Affiliation(s)
- Javier Herce-López
- Oral and Maxillofacial Surgeon, Virgen Macarena University Hospital, 41009 Seville, Spain;
| | | | - Álvaro Tofé-Povedano
- Oral and Maxillofacial Surgeon, Puerta del Mar University Hospital, 11009 Cádiz, Spain;
| | - Laura García-Arana
- Oral and Maxillofacial Surgeon, San Francisco de Asís University Hospital, 28002 Madrid, Spain;
| | | | - Ramón Sieira-Gil
- Oral and Maxillofacial Consultant, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain;
| | | | - Alba Sánchez-Torres
- Professors of Oral Surgery, Faculty of Medicine and Health Sciences, Researchers at the IDIBELL Institute, University of Barcelona (Spain), 08907 Barcelona, Spain;
| | - Rui Figueiredo
- Professors of Oral Surgery, Faculty of Medicine and Health Sciences, Researchers at the IDIBELL Institute, University of Barcelona (Spain), 08907 Barcelona, Spain;
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13
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Laurila M, Mäntynen P, Mauno J, Suojanen J. Prosthetic Oral Rehabilitation with CAD/CAM Suprastructures in Patients with Severe Tissue Deficits: A Case Series. Dent J (Basel) 2023; 11:289. [PMID: 38132427 PMCID: PMC10742847 DOI: 10.3390/dj11120289] [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: 11/10/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
This article presents the outcomes of prosthetic oral rehabilitation using CAD/CAM telescopic bar overdentures in patients with oral cancer (n = 3), severe facial trauma (n = 2), or various syndromes (n = 1), all suffering from severe tissue deficits and requiring complex and comprehensive oral rehabilitation. The aim was to assess the durability and functionality of implant-retained prosthetic structures, ensuring easy oral hygiene and minimizing specialized follow-up needs. The data for this study were sourced from a retrospective cohort at Helsinki University Hospital. The prosthetic reconstruction encompassed the Atlantis 2in1 and the Createch removable telescopic systems. Thus, 40 implants were placed (4 to 7 per patient), with prosthetic structures in the maxilla (n = 4 patients), in the mandible (n = 1), and in both jaws (n = 1). Two patients experienced no complications, two patients had part of the acrylic resin break, and one patient experienced loosening of the bar structure. All complications associated with prosthetic structures were successfully managed, and none of the implants were lost. The follow-up time ranged from 7 to 126 months. This rehabilitation is proved to be an effective solution for patients with complex oral conditions, facilitating both functional restoration and ease of maintenance. These findings underscore the importance of individualized treatment approaches in cases of tissue deficits.
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Affiliation(s)
- Marisa Laurila
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Lahti Central Hospital, 15850 Lahti, Finland; (M.L.)
| | - Pilvi Mäntynen
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Lahti Central Hospital, 15850 Lahti, Finland; (M.L.)
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland;
- Clinicum, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | - Jari Mauno
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland;
| | - Juho Suojanen
- Päijät-Häme Joint Authority for Health and Wellbeing, Department of Oral and Maxillofacial Surgery, Lahti Central Hospital, 15850 Lahti, Finland; (M.L.)
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland;
- Clinicum, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
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14
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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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15
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Chow KF. Stepwise osteotomy protocol for zygomatic implant placement under navigation in patients with extra-sinus trajectory. Int J Oral Maxillofac Surg 2023; 52:1286-1289. [PMID: 37620234 DOI: 10.1016/j.ijom.2023.07.007] [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: 03/19/2023] [Revised: 06/30/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
This technical note describes a stepwise osteotomy for zygomatic implant placement with an extra-sinus trajectory under navigation using virtual markers for registration. The stepwise osteotomy protocol divides the trajectory of the zygomatic implant osteotomy into three consecutive co-axial components. The aim is to achieve better control of the osteotomy under navigation and to minimize or eliminate any intermittent free-hand drilling. The stepwise osteotomy protocol facilitates the use of shorter drills to finish the zygomatic implant osteotomy at the entry location before switching back to the long drill to complete the whole osteotomy. This protocol has been applied in a patient and the preliminary result is promising. However, the clinical effectiveness of this approach requires further investigation in prospective clinical studies.
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Affiliation(s)
- K-F Chow
- Dental Implant and Maxillofacial Centre, Hong Kong.
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16
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Jin S, Ma H, Ling X, Tao B, Wang F, Wu Y. Longitudinal reactions of maxillary sinus in patients treated with multiple zygomatic implants: A modified radiographic evaluation with clinical follow-up. Clin Implant Dent Relat Res 2023; 25:1091-1102. [PMID: 37574767 DOI: 10.1111/cid.13256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/30/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES To investigate the effects of zygomatic implant placement on the maxillary sinus using radiographic and clinical indicators. METHODS Patients with an atrophic maxilla who underwent zygomatic implant placement were included. The thickness and morphology of the Schneiderian membrane (SM), infundibular obstruction, and posterior bone wall of the maxillary sinus were analyzed. The generalized estimating equation and chi-square tests were performed to compare the measurements. RESULTS Fifty patients with 100 maxillary sinuses were included. In total, 148 zygomatic implants and 105 regular implants were placed in the maxilla. Overall, the mean pre- and postoperative SM thickness was 2.79 ± 3.26 mm and 3.97 ± 5.45 mm, respectively (p = 0.063). In sinuses with two zygomatic implants, the SM thickness increased significantly from 2.12 ± 2.14 mm preoperatively to 4.07 ± 6.14 mm postoperatively (p = 0.026). The number of sinuses with type IV morphology (fully radiopaque) increased from zero preoperatively to six (13%) postoperatively. Sinuses with a single zygomatic implant showed no difference in the pre- and postoperative SM thickness. Postoperatively, six sinuses had infundibulum obstructions. Postoperative osteitis of the bilateral sinuses was found in two patients. CONCLUSIONS We have proposed a new imaging evaluation method and system for evaluating the maxillary sinus response. Preoperative infundibulum obstruction combined with mucosal thickening and double zygomatic implant placement are more likely to induce postoperative maxillary sinus mucositis and osteitis.
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Affiliation(s)
- Shufang Jin
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Hailong Ma
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaowan Ling
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Baoxin Tao
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Feng Wang
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yiqun Wu
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
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17
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Wang W, Yu X, Wang F, Wu Y. Clinical efficacy of computer-assisted zygomatic implant surgery: A systematic scoping review. J Prosthet Dent 2023:S0022-3913(23)00717-5. [PMID: 38007293 DOI: 10.1016/j.prosdent.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/27/2023]
Abstract
STATEMENT OF PROBLEM Digital technology can improve the success of zygomatic implant (ZI) surgery. However, the reliability and efficacy of computer-assisted zygomatic implant surgery (CAZIS) need further analysis. PURPOSE The purpose of this scoping review was to provide an overview of the placement accuracy, implant survival, and complications of CAZIS. MATERIAL AND METHODS A systematic search of English and Mandarin Chinese publications up to May 2023 was conducted in PubMed, Web of Science, Embase, and Wanfang database. The nonpeer-reviewed literature was searched in the trial register (clinicaltrials.gov). Clinical studies and cadaver studies on CAZIS were included. After data extraction and collection, the findings were critically reviewed, analyzed, interpreted, and discussed. RESULTS Forty-one studies met the inclusion criteria. After excluding publications with duplicate data, retaining the most recent, 28 articles were included in this scoping review. Of these, 18 were on static computer-assisted zygomatic implant surgery (sCAZIS), 8 on dynamic computer-assisted zygomatic implant surgery (dCAZIS), and 2 on robot-assisted zygomatic implant surgery (rAZIS). Excluding the outliers, the mean deviations of ZIs in the sCAZIS group (with 8 articles reporting implant placement accuracy, 183 ZIs involved) were: 1.15 ±1.37 mm (coronal deviation), 2.29 ±1.95 mm (apical deviation), and 3.32 ±3.36 degrees (angular deviation). The mean deviations of dCAZIS (3 articles, 251 ZIs) were: 1.60 ±0.74 mm (coronal), 2.27 ±1.05 mm (apical), and 2.89 ±1.69 degrees (angular). The mean deviations of rAZIS (2 articles, 5 ZIs) were: 0.82 ±0.21 mm (coronal), 1.25 ±0.52 mm (apical), and 1.46 ±0.35 degrees (angular). Among the CAZIS reported in the literature, the implant survival rate was high (96.3% for sCAZIS, 98.2% for dCAZIS, and 100% for rAZIS, specified in 14 of 21 clinical studies). The incidence of complications was low, but, because of the few relevant studies (4/21 specified), valid conclusions regarding complications could not be drawn. CONCLUSIONS CAZIS has demonstrated clinical efficacy with high implant survival rates and placement accuracy. Of the 3 guided approaches, rAZIS showed the smallest 3-dimensional deviation.
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Affiliation(s)
- Wenying Wang
- Graduate student, 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, Shanghai, PR China
| | - Xinbo Yu
- Undergraduate student, 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, Shanghai, PR China
| | - Feng Wang
- Professor, 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, Shanghai, PR China
| | - Yiqun Wu
- Professor, 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, Shanghai, PR China.
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18
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Deng H, Bian H, Liang Y, Cao J, Sun Y, Li Y. Semi-autonomous two-stage dental robotic technique for zygomatic implants: An in vitro study. J Dent 2023; 138:104687. [PMID: 37666465 DOI: 10.1016/j.jdent.2023.104687] [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: 04/06/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023] Open
Abstract
OBJECTIVE To assess the feasibility and accuracy of a semi-autonomous two-stage dental robotic technique for zygomatic implants. METHODS Twenty-six zygomatic implants were designed and randomly divided into two groups using 10 three-dimensionally printed resin models with severe maxillary atrophy. In one group, the conventional drilling technique was used, in the other group, the drilling process for the alveolar ridge section (first stage) was completed, after which drilling for the zygoma section (second stage) was done. Based on preoperative planning combined with postoperative cone-beam computed tomography (CBCT), coronal, apical, depth, and angle deviations were measured. Zygomatic implant placement technique-related deviations (sinus slot, intrasinus, and extrasinus) were also recorded and analyzed. RESULTS The two-stage technical group's coronal, apical, depth, and angle deviations were 0.57 ± 0.19 mm, 1.07 ± 0.48 mm, 0.30 ± 0.38 mm, and 0.91 ± 0.51°, respectively. The accuracy of the two-stage technique was significantly higher than that of the conventional one-stage technique (p < 0.05). The apical deviation in the intrasinus group was 1.12 ± 0.56 mm, which was significantly better than that in the other two groups (p < 0.05). The angle deviation in the sinus slot group was 1.96 ± 0.83°, which was significantly worse than that in the other two groups (p < 0.05). CONCLUSION Using the semi-autonomous two-stage dental robotic technique for zygomatic implants is feasible and is more accurate than using the conventional one-stage technique. CLINICAL SIGNIFICANCE The two-stage technique enabled the semi-autonomous robot to overcome the mouth-opening restriction for zygomatic implants and improved accuracy.
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Affiliation(s)
- Huanze Deng
- Medical School of Chinese PLA, Beijing, China; Department of Stomatology, the Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Huan Bian
- Department of Stomatology, the Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yijie Liang
- Department of Stomatology, the Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China; Graduate Training Base, the Fourth Medical Centre, Chinese PLA General Hospital, Jinzhou Medical University, Beijing, 100048, China
| | - Jing Cao
- Department of Stomatology, the Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yinxia Sun
- Department of Stomatology, the Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yanfeng Li
- Medical School of Chinese PLA, Beijing, China; Department of Stomatology, the Fourth Medical Centre, Chinese PLA General Hospital, Beijing, China; Graduate Training Base, the Fourth Medical Centre, Chinese PLA General Hospital, Jinzhou Medical University, Beijing, 100048, China.
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19
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Kämmerer PW, Al-Nawas B. Bone reconstruction of extensive maxillomandibular defects in adults. Periodontol 2000 2023; 93:340-357. [PMID: 37650475 DOI: 10.1111/prd.12499] [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: 03/26/2023] [Revised: 05/21/2023] [Accepted: 05/26/2023] [Indexed: 09/01/2023]
Abstract
Reconstruction of significant maxillomandibular defects is a challenge that has been much discussed over the last few decades. Fundamental principles were developed decades ago (bone bed viability, graft immobilization). Clinical decision-making criteria are highly relevant, including local/systemic factors and incision designs, the choice of material, grafting technique, and donor site morbidity. Stabilizing particulated grafts for defined defects-that is, via meshes or shells-might allow significant horizontal and vertical augmentation; the alternatives are onlay and inlay techniques. More significant defects might require extra orally harvested autologous bone blocks. The anterior iliac crest is often used for nonvascularized augmentation, whereas more extensive defects often require microvascular reconstruction. In those cases, the free fibula flap has become the standard of care. The development of alternatives is still ongoing (i.e., alloplastic reconstruction, zygomatic implants, obturators, distraction osteogenesis). Especially for these complex procedures, three-dimensional planning tools enable facilitated planning and a surgical workflow.
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Affiliation(s)
- Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Mainz, Germany
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20
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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: 0] [Impact Index Per Article: 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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21
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Mao Y, Li X, Wang Q, Zhang J. Application of titanium 3D-printed double-sleeve guide for zygomatic implants: A technique report. J Prosthodont 2023; 32:752-756. [PMID: 37294613 DOI: 10.1111/jopr.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023] Open
Abstract
The unique anatomical structure of the atrophic edentulous maxilla limits the placement of endosteal root form dental implants without bone grafting and augmentation. Surgical placement of zygomatic implants in an optimal position remains challenging. This technique report illustrates a novel digital guide technology, including the design workflow, application method, and indications for assisting with the placement of zygomatic implants using a bone-supported titanium double-sleeve guide. In addition, when the implant body reaches the zygomatic bone following an intra-sinus path, including ZAGA type 0 and ZAGA type 1 cases, a matching window osteotomy surgical guide is used to locate the lateral window boundary and protect the sinus membrane. With this technique, the surgical procedure is simplified, and the precision of guided zygomatic implant placement is improved.
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Affiliation(s)
- Yupu Mao
- Department of Oral and Maxillofacial Surgery, Tianjin Stomatological Hospital, Nankai University & Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin, China
| | - Xiaoban Li
- Department of Oral Implantology, Tianjin Stomatological Hospital, Tianjin Stomatological Hospital, School of Medicine, Nankai University & Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin, China
| | - Qingfu Wang
- Department of Oral Implantology, Tianjin Stomatological Hospital, Tianjin Stomatological Hospital, School of Medicine, Nankai University & Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin, China
| | - Jian Zhang
- Department of Oral Implantology, Tianjin Stomatological Hospital, Tianjin Stomatological Hospital, School of Medicine, Nankai University & Tianjin Key Laboratory of Oral and Maxillofacial Function Reconstruction, Tianjin, China
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Sanavia C, Vallerga E, Alessi F, Tealdo T, Bevilacqua M, Alberti C, Menini M, Pesce P. Five Steps for the Maintenance and Interception of Complications in Zygomatic Implants. Dent J (Basel) 2023; 11:226. [PMID: 37886911 PMCID: PMC10605483 DOI: 10.3390/dj11100226] [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: 08/11/2023] [Revised: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
Zygomatic implants are used for the rehabilitation of the upper jaw of patients with severe and moderate bone atrophy. Possible post-surgical complications include soft tissue dehiscence, sinusitis, and prosthodontic fractures, and maintaining an accurate control is crucial. Additionally, zygomatic implants have a unique peri-implant anatomy, making traditional periodontal parameters unsuitable. The present paper aims to provide guidelines for the maintenance and interception of complications in patients rehabilitated with these kinds of implants. The proposed protocol includes: 1. intra/extraoral and temporo-mandibular joint examination; 2. soft tissue and transmucosal path observation with magnifiers; 3. peri-implant health indices and digital stimulation of tissues; 4. examination of prosthodontic devices; and 5. photographic recording. These steps facilitate the comprehensive evaluation and monitoring of clinical conditions of zygomatic-supported rehabilitations, including dehiscence and occlusal wear during follow-up appointments.
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Affiliation(s)
- Consuela Sanavia
- Department of Surgical Sciences, University of Genoa, 16126 Genoa, Italy; (C.S.); (T.T.); (M.B.)
| | | | - Fanny Alessi
- Independent Researcher, 36027 Rosà, Italy; (F.A.); (C.A.)
| | - Tiziano Tealdo
- Department of Surgical Sciences, University of Genoa, 16126 Genoa, Italy; (C.S.); (T.T.); (M.B.)
| | - Marco Bevilacqua
- Department of Surgical Sciences, University of Genoa, 16126 Genoa, Italy; (C.S.); (T.T.); (M.B.)
| | | | - Maria Menini
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences, University of Genoa, 16126 Genoa, Italy;
| | - Paolo Pesce
- Department of Surgical Sciences, University of Genoa, 16126 Genoa, Italy; (C.S.); (T.T.); (M.B.)
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23
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Fan S, Sáenz-Ravello G, Diaz L, Wu Y, Davó R, Wang F, Magic M, Al-Nawas B, Kämmerer PW. The Accuracy of Zygomatic Implant Placement Assisted by Dynamic Computer-Aided Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5418. [PMID: 37629460 PMCID: PMC10455221 DOI: 10.3390/jcm12165418] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE The present systematic review aimed to investigate the accuracy of zygomatic implant (ZI) placement using dynamic computer-aided surgery (d-CAIS), static computer-aided surgery (s-CAIS), and a free-hand approach in patients with severe atrophic edentulous maxilla and/or deficient maxilla. METHODS Electronic and manual literature searches until May 2023 were performed in the PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases. Clinical trials and cadaver studies were selected. The primary outcome was planned/placed deviation. Secondary outcomes were to evaluate the survival of ZI and surgical complications. Random-effects meta-analyses were conducted and meta-regression was utilized to compare fiducial registration amounts for d-CAIS and the different designs of s-CAIS. RESULTS A total of 14 studies with 511 ZIs were included (Nobel Biocare: 274, Southern Implant: 42, SIN Implant: 16, non-mentioned: 179). The pooled mean ZI deviations from the d-CAIS group were 1.81 mm (95% CI: 1.34-2.29) at the entry point and 2.95 mm (95% CI: 1.66-4.24) at the apex point, and angular deviations were 3.49 degrees (95% CI: 2.04-4.93). The pooled mean ZI deviations from the s-CAIS group were 1.19 mm (95% CI: 0.83-1.54) at the entry point and 1.80 mm (95% CI: 1.10-2.50) at the apex point, and angular deviations were 2.15 degrees (95% CI: 1.43-2.88). The pooled mean ZI deviations from the free-hand group were 2.04 mm (95% CI: 1.69-2.39) at the entry point and 3.23 mm (95% CI: 2.34-4.12) at the apex point, and angular deviations were 4.92 degrees (95% CI: 3.86-5.98). There was strong evidence of differences in the average entry, apex, and angular deviation between the navigation, surgical guide, and free-hand groups (p < 0.01). A significant inverse correlation was observed between the number of fiducial screws and the planned/placed deviation regarding entry, apex, and angular measurements. CONCLUSION Using d-CAIS and modified s-CAIS for ZI surgery has shown clinically acceptable outcomes regarding average entry, apex, and angular deviations. The maximal deviation values were predominantly observed in the conventional s-CAIS. Surgeons should be mindful of potential deviations and complications regardless of the decision making in different guide approaches.
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Affiliation(s)
- Shengchi Fan
- Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center Mainz, 55131 Mainz, Germany
- Second Dental Clinic, Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University, School of Medicine, National Clinical Research Center for Oral Disease, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Gustavo Sáenz-Ravello
- Center for Epidemiology and Surveillance of Oral Diseases (CESOD), Faculty of Dentistry, Universidad de Chile, Santiago 8380420, Chile
| | - Leonardo Diaz
- Postgraduate School, Faculty of Dentistry, Universidad de Chile, Santiago 8380420, Chile
| | - Yiqun Wu
- Second Dental Clinic, Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University, School of Medicine, National Clinical Research Center for Oral Disease, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Rubén Davó
- Department of Implantology and Maxillofacial Surgery, Vithas Davó Instituto Dental, 03016 Alicante, Spain
| | - Feng Wang
- Second Dental Clinic, Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University, School of Medicine, National Clinical Research Center for Oral Disease, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200011, China
| | - Marko Magic
- School of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center Mainz, 55131 Mainz, Germany
| | - Peer W. Kämmerer
- Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center Mainz, 55131 Mainz, Germany
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24
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Deng H, Bian H, Li C, Li Y. Autonomous dental robotic surgery for zygomatic implants: A two-stage technique. J Prosthet Dent 2023:S0022-3913(23)00408-0. [PMID: 37567843 DOI: 10.1016/j.prosdent.2023.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 08/13/2023]
Abstract
Zygomatic implants (ZIs) can be a treatment option for patients with severe atrophy in the maxilla, but deviation during ZI placement could lead to serious complications. Surgical guides and dynamic navigation have been used to improve the accuracy of ZI placement, but both techniques are subject to human error. A 2-stage technique is described that enabled an autonomous dental robot to overcome mouth-opening restrictions for ZI placement. The technique enables the complete digitalization of ZI placement, further improving the accuracy of the drilling process.
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Affiliation(s)
- Huanze Deng
- Doctoral student, Department of Stomatology, the Fourth Medical Centre, Chinese PLA General Hospital, Beijing, PR China; and Medical School of Chinese PLA, Beijing, China
| | - Huan Bian
- Attending, Department of Stomatology, the Fourth Medical Centre, Chinese PLA General Hospital, Beijing, PR China
| | - Changjian Li
- Attending, Department of Stomatology, the Fourth Medical Centre, Chinese PLA General Hospital, Beijing, PR China
| | - Yanfeng Li
- Professor, Department of Stomatology, the Fourth Medical Centre, Chinese PLA General Hospital, Beijing, PR China; and Medical School of Chinese PLA, Beijing, China.
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25
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Kumar L, Verma A, Pal US, Mattoo K, Algarni YA, Bin Hassan SA, Baba SM, Jeri SY, Khateeb SU. Influence of Prosthodontic Rehabilitation Using Zygomatic Implants in Covid 19 Related Mucormycosis (Rhino-Orbital-Cerebral) Maxillectomy Patients Upon Post-Operative Stress, Anxiety and Functional Impairment: A Prospective Cohort Study. Clin Interv Aging 2023; 18:1201-1219. [PMID: 37547381 PMCID: PMC10404046 DOI: 10.2147/cia.s412625] [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: 03/16/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023] Open
Abstract
Purpose To determine the influence of prosthodontic rehabilitation using zygomatic implants in partial maxillectomy upon post-operative stress, anxiety and functional impairment, due to covid 19 associated rhino-orbital-cerebral mucormycosis (ROCM). Patients and Methods Twenty maxillectomy patients fulfilling study criterion, received zygomatic implants (ZI) (quad zygoma) (ZDI Simpladent, Switzerland) retained/supported complete maxillary denture. Assessment of stress, anxiety, masticatory performance and speech were determined using diurnal salivary cortisol level, Appearance Anxiety Inventory, multiple sieve technique and auditory perception analysis, respectively. Data were recorded at 6 different stages of rehabilitation (after maxillectomy, implant placement, and after prosthesis delivery (1 week, 1 month, 6 months and 1 year)). Demographic data were expressed as frequency distribution, while mean values were used to find differences between various rehabilitation stages using Friedman and chi-square test with statistical significance value at p < 0.05. Results Average daily salivary cortisol levels declined from post maxillectomy (22.80 ± 0.902) to 1 year after prosthesis wearing (8.65 ± 0.985), indicating stress reduction after ZI rehabilitation. Mean scores for appearance anxiety reduced from pre-prosthetic rehabilitation (27.350 ± 3.030) to 1 year (8.950 ± 0.887) following prosthesis wearing. Functional parameters for mastication and speech also improved significantly during the course of rehabilitation. All differences between pre-prosthetic to 1-year stage after prosthesis wearing were found to be statistically significant at p < 0.05. Conclusion Post ROCM maxillectomy cases after prosthetic rehabilitation using zygomatic implants showed significant improvement in the psychological (stress and anxiety) as well as function (mastication and speech) characteristics. Rehabilitation post ROCM maxillectomy with the present approach of fixed prosthesis using zygomatic implants mitigates deficient mastication and speech. It also impacts positively on patient psychology by decreasing stress and anxiety.
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Affiliation(s)
- Lakshya Kumar
- Department of Prosthodontics, King George`s Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Aditi Verma
- Department of Prosthodontics, King George`s Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Uma Shanker Pal
- Department of Oral and Maxillofacial Surgery, King George`s Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Khurshid Mattoo
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan, 45142, Kingdom of Saudi Arabia
| | - Youssef Abdullah Algarni
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
| | - Saeed Awod Bin Hassan
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
| | - Suheel Manzoor Baba
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
| | - Sumaya Yousuf Jeri
- Department of Orthodontics and Dentofacial Orthopedics, I.T.S Centre for Dental Studies and Research, Chaudhary Charan Singh University, Ghaziabad, Uttar Pradesh, 201206, India
| | - Shafait Ullah Khateeb
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia
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26
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Brennand Roper M, Vissink A, Dudding T, Pollard A, Gareb B, Malevez C, Balshi T, Brecht L, Kumar V, Wu Y, Jung R. Long-term treatment outcomes with zygomatic implants: a systematic review and meta-analysis. Int J Implant Dent 2023; 9:21. [PMID: 37405545 DOI: 10.1186/s40729-023-00479-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/09/2023] [Indexed: 07/06/2023] Open
Abstract
PURPOSE The purpose of this study was to perform a systematic review with meta-analysis on the long-term survival rates of zygomatic implants (ZI). ZI success, prostheses survival and success, sinus pathology and patient reported outcomes were also investigated. METHODS Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed. Embase and OvidMedline databases were searched alongside the grey literature. The systematic review was recorded in PROSPERO (CRD42022358024). Studies reporting titanium/titanium alloy ZI survival data, ZI-supported prosthesis data, ZIs directly compared to any other implant therapy including grafted sites, a minimum follow-up time of 3 years and a minimum number of 10 patients were included. All study designs were considered if they met the inclusion criteria. Studies not involving ZIs, ZIs not made from titanium/titanium alloy, a follow-up time of < 3 years or < 10 patients, animal studies and in vitro studies were excluded. Long-term follow-up has not been defined in the literature. A minimum of 3 years follow-up was considered acceptable to capture survival after initial healing, alongside in-function prosthesis data via delayed or immediate load protocols. ZI success, was predominantly defined as ZI survival without biological or neurological complications. Meta-analyses were performed for ZI survival, ZI failure incidence, ZI success, loading protocol, prosthesis survival, and prevalence of sinusitis using random effects models. Descriptive analysis was used for ZI success, prosthesis success and patient reported outcome measures. RESULTS Five hundred and seventy-four titles were identified, of which 18 met the inclusion criteria. Eligible studies included 1349 ZIs in 623 patients. Mean follow-up period was 75.4 months (range 36-141.6). The mean survival of ZIs was 96.2% [95% CI: 93.8; 97.7] at 6 years. Mean survival for delayed loading was 95% [95% CI: 91.7; 97.1] and 98.1% [95% CI: 96.2; 99.0] for immediate loading (p = 0.03). Annual incidence rate of ZI failure was 0.7% [95% CI 0.4; 1.0]. Mean ZI success was 95.7% [95% CI 87.8; 98.6]. Mean prosthesis survival was 94% [95% CI 88.6; 96.9]. Sinusitis prevalence was 14.2% [95% CI 8.8; 22.0] at 5 years. Patients' reported increased satisfaction with ZIs. CONCLUSIONS ZIs have long-term survival comparable to conventional implants. Immediate loading showed a statistically significant increase in survival over delayed loading. Prosthesis survival was similar to that of prostheses supported by conventional implants, with similar complications. Sinusitis was the most frequently encountered biological complication. Patients reported improved outcome measures with ZI use.
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Affiliation(s)
- Matthew Brennand Roper
- Department of Restorative Dentistry, University Hospitals Bristol and Weston Foundation Trust, Bristol Dental Hospital, Lower Maudlin Street, Bristol, BS1 2LY, UK.
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, Universtitair Medisch Centrum Gronigen, Groningen, The Netherlands
| | - Tom Dudding
- Department of Restorative Dentistry, University Hospitals Bristol and Weston Foundation Trust, Bristol Dental Hospital, Lower Maudlin Street, Bristol, BS1 2LY, UK
| | - Alex Pollard
- Department of Restorative Dentistry, University Hospitals Bristol and Weston Foundation Trust, Bristol Dental Hospital, Lower Maudlin Street, Bristol, BS1 2LY, UK
| | - Barzi Gareb
- Department of Oral and Maxillofacial Surgery, Universtitair Medisch Centrum Gronigen, Groningen, The Netherlands
| | - Chantal Malevez
- Department of Oral and Maxillofacial Surgery, Clinique Saint-Jean, Brussels, Belgium
| | | | - Lawrence Brecht
- Division of Prosthodontics and Restorative Dentistry, NYC College of Dentistry, New York City, NY, USA
| | - Vinay Kumar
- Department of Oral and Maxillofacial Surgery, Uppsala University, Uppsala, Sweden
| | - Yiqun Wu
- Department of Oral Implantology, Second Dental Center, Ninth People's Hospital Affiliated with Shanghai Jaio Tong University, School of Medicine, Shanghai, China
| | - Ronald Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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27
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Kämmerer PW, Fan S, Aparicio C, Bedrossian E, Davó R, Morton D, Raghoebar GM, Zarrine S, Al-Nawas B. Evaluation of surgical techniques in survival rate and complications of zygomatic implants for the rehabilitation of the atrophic edentulous maxilla: a systematic review. Int J Implant Dent 2023; 9:11. [PMID: 37198345 DOI: 10.1186/s40729-023-00478-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE To assess the outcome [zygomatic implant (ZI) survival] and complications of the original surgical technique (OST) and an Anatomy-Guided approach (AGA) in the placement of ZI in patients with severely atrophic maxillae. METHODS Two independent reviewers conducted an electronic literature search from January 2000 to August 2022. The inclusion criteria were articles reporting at least five patients with severely atrophic edentulous maxilla undergoing placement OST and/or AGA, with a minimum of 6 months of follow-up. Number of patients, defect characteristics, number of ZI, implant details, surgical technique, survival rate, loading protocol, prosthetic rehabilitation, complications, and follow-up period were compared. RESULTS Twenty-four studies comprised 2194 ZI in 918 patients with 41 failures. The ZI survival rate was 90.3-100% in OST and 90.4-100% in AGA. Probability of complications with ZI with OST was as follows: sinusitis, 9.53%; soft tissue infection, 7.50%; paresthesia, 10.78%; oroantral fistulas, 4.58%; and direct surgical complication, 6.91%. With AGA, the presenting complications were as follows: sinusitis, 4.39%; soft tissue infection, 4.35%; paresthesia, 0.55%; oroantral fistulas, 1.71%; and direct surgical complication, 1.60%. The prevalence of immediate loading protocol was 22.3% in OST and 89.6% in the AGA. Due to the heterogeneity of studies, statistical comparison was only possible after the descriptive analysis. CONCLUSIONS Based on the current systematic review, placing ZI in severely atrophic edentulous maxillae rehabilitation with the OST and AGA is associated with a high implant survival rate and surgical complications within a minimum of 6 months follow-up. Complications, including sinusitis and soft tissue infection around the implant, are the most common. The utilization of immediate loading protocol is more observed in AGA than in OST.
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Affiliation(s)
- Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery-Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - Shengchi Fan
- Department of Oral and Maxillofacial Surgery-Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, School of Medicine Second Dental Clinic, Ninth People's Hospital, National Clinical Research Center for Oral Disease, College of Stomatology, Shanghai Jiao Tong University, 200011, Shanghai, China
| | - Carlos Aparicio
- Indiana University School of Dentistry, Indianapolis, USA
- Zygomatic Unit at Hepler Bone Clinic, ZAGA Center Barcelona, Barcelona, Spain
| | - Edmond Bedrossian
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, USA
| | - Rubén Davó
- Department of Implantology and Maxillofacial Surgery, Vithas Davó Instituto Dental, Alicante, Spain
| | - Dean Morton
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, USA
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | | | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery-Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
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28
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Sverzut TFV, Sverzut AT, Trivellato AE, Sverzut CE. Retrospective analysis of the predictability of using three-dimensional models for preoperative planning of the length of zygomatic implants. Oral Maxillofac Surg 2023; 27:53-58. [PMID: 35166998 DOI: 10.1007/s10006-022-01047-0] [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: 10/28/2021] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE This present study aimed to retrospectively evaluate the predictability of using three-dimensional models (TDMs) to plan the preoperative lengths of zygomatic implants (ZIs). METHODS The records of all patients that received such implants between March 2007 and March 2019 were evaluated. The ZI lengths predicted on the TDMs were compared to the lengths of the implants the patients received. RESULTS In total, the records of 74 patients were evaluated, of which 37 records met the criteria of inclusion, and were included in the study. Twenty-seven (73%) of the patients were female and 10 (27%) were male, ranging from 34 to 80 years of age, with the average age being 55.7 years. Seventeen (43.2%) of these patients were classified as ASA I and 21 (56.8%) as ASA II. A total of 142 ZIs were planned and installed in the time frame mentioned. Without distinguishing the region of the maxilla, the implants used were, on average, 1.1 mm larger in length than those initially planned. CONCLUSION Overall, the data indicates moderate agreement between the planned and surgical lengths of the ZIs and indicates that using TDMs is a predictable and reliable preoperative planning technique of the length of posterior ZIs.
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Affiliation(s)
- Thales Fabro Vanzela Sverzut
- Residency Training Program in Oral and Maxillofacial Surgery, School of Dentistry of Ribeirão Preto of the University of São Paulo, Avenida Do Café, s/n, Monte Alegre, Ribeirão Preto, São Paulo, 14040-904, Brazil
| | - Alexander Tadeu Sverzut
- Department of Oral Diagnosis, Maxillofacial Surgery Division, Piracicaba Dental School of the University of Campinas, Av. Limeira, 901, Bairro Areião, Piracicaba, São Paulo, 13414-903, Brazil
| | - Alexandre Elias Trivellato
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto of the University of São Paulo, Avenida Do Café, s/n, Monte Alegre, Ribeirão Preto, São Paulo, 14040-904, Brazil
| | - Cássio Edvard Sverzut
- Department of Oral and Maxillofacial Surgery and Periodontology, School of Dentistry of Ribeirão Preto of the University of São Paulo, Avenida Do Café, s/n, Monte Alegre, Ribeirão Preto, São Paulo, 14040-904, Brazil.
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29
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Alzoubi F, Wong A. Fixed prosthetic rehabilitation of a patient with Papillon-Lefevre syndrome supported by a Quad Zygoma Approach: A clinical report. SPECIAL CARE IN DENTISTRY 2023; 43:240-249. [PMID: 35802392 DOI: 10.1111/scd.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/28/2022]
Abstract
Papillon-Lefevere syndrome (PLS) is a rare disorder with severe oral manifestations resulting in premature tooth loss at an early stage of life. As a result, extensive bone resorption pattern in the maxilla negates conventional implant treatment in the majority of cases. This clinical report describes a prosthetic rehabilitation revision of a 26-year-old female diagnosed with PLS using an implant supported fixed complete denture with a quad zygoma approach. A 1 year follow-up is also presented.
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Affiliation(s)
- Fawaz Alzoubi
- Department of General Dental Practice, Faculty of Dentistry, Kuwait University, Jabriya, Kuwait
| | - Allen Wong
- AEGD Program Director Hospital Dentistry Program, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, USA
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30
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Yildirim G, Kocaelli HA. Assessment of the content and quality of YouTube videos related zygomatic implants: A content-quality analysis. Clin Implant Dent Relat Res 2023. [PMID: 36808698 DOI: 10.1111/cid.13194] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/19/2023] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION This study aimed to evaluate the content and quality of YouTube videos of zygomatic implants. METHODS According to Google Trends (2021), "zygomatic implant" was the most preferred keyword related to the topic. Therefore, in this study "zygomatic implant" was used as a keyword for the video search. Demographic characteristics such as the number of views, likes/dislikes, comments, video duration, number of days after upload, uploaders, and target audiences of the videos were evaluated. To evaluate the accuracy and content quality of videos (available from YouTube), the video information and quality index (VIQI) and global quality scale (GQS) were used. Statistical analyses were performed using the Kruskal-Wallis test, Mann-Whitney U test, chi-square test, Fisher's exact chi-square test, Yates continuity correction, and Spearman correlation analysis (p < 0.05). RESULTS A total of 151 videos were searched; 90 met all inclusion criteria. According to the video content score, 78.9% of the videos were identified as low content, 20% as moderate, and 1.1% as high content. There was no statistical difference between the groups in video demographic characteristics (p > 0.001). Conversely, information flow, accuracy of information, video quality and precision, and total VIQI scores were statistically different between the groups. The moderate-content group had a higher GQS score than the low-content group (p < 0.001). The videos were mainly uploaded (40%) from hospitals and universities. Most videos were targeted toward professionals (46.75%). Low-content videos had higher ratings than the moderate- and high-content videos. CONCLUSIONS Most YouTube videos on zygomatic implants showed low-content quality. This implies that YouTube is not a reliable source of information on zygomatic implants. Dentists, prosthodontists, and oral and maxillofacial surgeons should be aware of the content of video-sharing platforms and take responsibility for enriching video content.
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Affiliation(s)
- Gulhan Yildirim
- Department of Prosthodontics, Beykent University, Istanbul, Turkey
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31
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Vrielinck L, Moreno-Rabie C, Coucke W, Jacobs R, Politis C. Retrospective cohort assessment of survival and complications of zygomatic implants in atrophic maxillae. Clin Oral Implants Res 2023; 34:148-156. [PMID: 36541107 DOI: 10.1111/clr.14027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 11/24/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To report on zygomatic implant (ZI) survival rate and associated complications through a longitudinal retrospective cohort assessment. MATERIAL AND METHODS A total of 940 ZIs (rough: 781, machined: 159; immediate loading: 454, delayed loading: 486) and 451 standard implants (rough: 195, machined: 256; immediate loading: 58, delayed loading: 393) were placed in 302 adult patients with atrophic maxilla from December 1998 till September 2020. Following data collection reported complications were grouped based on their origin as infectious/ non-infectious biological and mechanical. Statistical analysis was performed to identify risk factors and preceding complications leading to implant loss (P < 0.05). RESULTS The survival rate of ZI was found to be 89.9% and the average time between implant placement and an eventual loss was 4.8 years. The mean ZI follow-up period was 7.9 ± 4.9 years. Amongst the infectious biological complications, sinusitis was the most reported (n = 138) occurring at a mean follow-up time-point of 4.5 years, whereas infraorbital nerve hypoesthesia occurred more frequently in the non-infectious biological category (n = 8, meantime: 0.3 years). The prosthetic screw fracture was the most reported complication of mechanical origin (n = 29, meantime: 4 years). Furthermore, sinusitis, standard implant loss, zygomatic/peri-zygomatic region infection, and oroantral communication were significantly associated with ZI loss. CONCLUSIONS ZI placement offered a high survival rate for the rehabilitation of severely atrophied maxilla with most losses occurring within the first 5 years at follow-up. The most frequently observed complication was sinusitis which tends to develop several years following implant placement.
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Affiliation(s)
- Luc Vrielinck
- Department of Oral and Maxillofacial Surgery, Saint John's Hospital, Genk, Belgium
| | - Catalina Moreno-Rabie
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Wim Coucke
- Certified Freelance Statistician, Heverlee, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium.,Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Moraschini V, de Queiroz TR, Sartoretto SC, de Almeida DCF, Calasans-Maia MD, Louro RS. Survival and complications of zygomatic implants compared to conventional implants reported in longitudinal studies with a follow-up period of at least 5 years: A systematic review and meta-analysis. Clin Implant Dent Relat Res 2023; 25:177-189. [PMID: 36373779 DOI: 10.1111/cid.13153] [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: 08/17/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Zygomatic implants (ZI) have been frequently indicated to rehabilitate patients with extensive atrophies in alternatives to major bone reconstructions. It can be installed inside the maxillary sinus, called instrasinus zygomatic implant (IZI) or outside the maxillary sinus (EZI), depending on the surgery technique. OBJECTIVE To evaluate the survival and complication rates of ZI in longitudinal studies when compared with conventional implants (CI). METHODS An electronic search was performed in five databases and in Gray literature for articles published until April, 2022. The eligibility criteria comprised observational cohort studies (prospective or retrospective) and randomized clinical trials (RCTs) with at least 5 years of follow-up, reporting survival rate of ZI versus CI. A meta-analysis was conduct with 18 studies. RESULTS A total of 5434 implants (2972 ZI and 2462 CI) were analyzed in 1709 patients. The mean survival rate was 96.5% ± 5.02 and 95.8% ± 6.36 for ZI and CI, respectively (mean follow-up time of 78 months). There were observed no statistically significant between ZI and CI in prospective studies (risk ratio [RR] of 1.21; 95% confidence intervals [CIs]: 0.28 to 5.28; chi-squared [Chi2 ] = 11.37; I2 = 56%; degrees of freedom [df] = 5; z-score = 0.25; P = 0.80), retrospective studies IZI (RR of 1.29; 95% CIs: 0.52 to 3.23; Chi2 = 4.07; I2 = 2%; df = 4; z-score = 0.55; P = 0.58) and retrospective studies EZI (RR of 0.72; 95% CIs: 0.31 to 1.66; Chi2 = 1.99; I2 = 0%; df = 3; z-score = 0.78; P = 0.44). The biological complications most related to ZI was sinusitis, followed by infection and oroantral communication. CONCLUSION ZI have a high long-term survival rate (96.5% with a mean of 91.5 months of follow-up), showing no significant difference when compared with CI. The most prevalent biological complication is sinusitis, being most commonly to the IZI technique. This systematic review (SR) was registered in INPLASY under number INPLASY202280025.
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Affiliation(s)
- Vittorio Moraschini
- Department of Dental Research, School of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil.,Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Tiago Rocha de Queiroz
- Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Rio de Janeiro, Brazil
| | | | | | | | - Rafael Seabra Louro
- Department of Oral Surgery, School of Dentistry, Fluminense Federal University, Rio de Janeiro, Brazil
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Olivetto M, Bettoni J, Testelin S, Lefranc M. Zygomatic implant placement using a robot-assisted flapless protocol: proof of concept. Int J Oral Maxillofac Surg 2022; 52:710-715. [PMID: 36517307 DOI: 10.1016/j.ijom.2022.12.002] [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: 02/20/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
Robotic assistance can help in physically guiding the drilling trajectory during zygomatic implant positioning. A new robot-assisted strategy for a flapless zygomatic implant placement protocol is reported here. In this protocol, a preoperative computed tomography scan is used to plan the surgical path. After surface registration, the ROSA robot (Zimmer Biomet Robotics) guides several steps, which are performed with shared control. The surgeon performs the drilling and tapping, guided by the robotic arm, which is positioned according to the planned trajectory. Placement of the zygomatic implant is done manually. Immediate intraoperative 3D verification is performed by cone beam computed tomography (flat-panel detector, Medtronic O-arm II). Four zygomatic implants were placed in the case patient according to the flapless protocol, with a mean vector error of 1.78 mm (range 0.52-4.70 mm). A screw-retained temporary prosthesis was placed on the same day. No significant complications were observed. The application of this robot-assisted surgical protocol, which guarantees a very high degree of precision, may reduce inaccuracies in the positioning of zygomatic implants that could deviate from the surgeon's plan. This appears to be a potentially safe flapless surgery technique. Drill slipping on the crest or on the maxillary wall is the main source of error in this procedure, emphasizing the usefulness of the assisted surgical guidance with haptic feedback.
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Affiliation(s)
- M Olivetto
- Department of Maxillofacial Surgery, Hospital Centre of Annecy Geneva, Épagny Metz-Tessy, France; Department of Maxillofacial Surgery, University Hospital of Amiens-Picardy, University Medical Centre, Amiens, France.
| | - J Bettoni
- Department of Maxillofacial Surgery, University Hospital of Amiens-Picardy, University Medical Centre, Amiens, France
| | - S Testelin
- Department of Maxillofacial Surgery, University Hospital of Amiens-Picardy, University Medical Centre, Amiens, France
| | - M Lefranc
- Department of Neurosurgery, University Hospital of Amiens-Picardy, University Medical Centre, Amiens, France
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Laventure A, Lauwers L, Nicot R, Kyheng M, Ferri J, Raoul G. Autogenous bone grafting with conventional implants vs zygomatic implants for atrophic maxillae: a retrospective study of the oral health-related quality of life. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e782-e789. [PMID: 35817319 DOI: 10.1016/j.jormas.2022.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Autogenous bone grafting (ABG)-combined or not with Le Fort I osteotomy (LFIO)-and zygomatic implants (ZI) are two reliable techniques for the fixed rehabilitation of atrophic maxillae. ZI allow a reduced treatment duration with no need to graft, immediate loading and in principle less morbidity. The aim of this retrospective study was to compare these two protocols on oral health-related quality of life (OHRQoL). We also discussed implant and prosthetic survival rates, and biological complications. MATERIAL AND METHODS All patients who benefited from ZI or ABG with conventional implants (CI) for a fixed maxillary rehabilitation, from November 2011 to April 2019, were included: 21 patients in the ABG group and 22 in the ZI group. OHRQoL was evaluated postoperatively by OHIP-14 questionnaire. RESULTS OHIP-14 median scores were respectively 6.5 (interquartile range [IQR] 2.0-13.0) and 6.0 (IQR 3.0-10.0) without significant difference (p = 0.97). Implant/prosthetic survival rates were 97.9%/100% and 97.1%/95.5%. Biological complications rates were 33.3% and 36.4% without significant difference (p = 0.83). DISCUSSION The type of surgery or prosthesis does not seem to affect final OHRQoL, implant and prosthetic survival rates or biological complications rates.
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Affiliation(s)
- Alexandre Laventure
- University of Lille, F-59000 Lille, France; Department of oral and maxillofacial surgery, Roger Salengro hospital, Lille university hospital, Boulevard du Professeur Émile Laine, F-59000 Lille, France.
| | - Ludovic Lauwers
- University of Lille, F-59000 Lille, France; Department of oral and maxillofacial surgery, Roger Salengro hospital, Lille university hospital, Boulevard du Professeur Émile Laine, F-59000 Lille, France; University of Lille, Lille university hospital, ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Romain Nicot
- University of Lille, F-59000 Lille, France; Department of oral and maxillofacial surgery, Roger Salengro hospital, Lille university hospital, Boulevard du Professeur Émile Laine, F-59000 Lille, France; Inserm, U1008, Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France
| | - Maéva Kyheng
- University of Lille, F-59000 Lille, France; University of Lille, Lille university hospital, ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France; Lille university hospital, department of biostatistics, F-59000 Lille, France
| | - Joël Ferri
- University of Lille, F-59000 Lille, France; Department of oral and maxillofacial surgery, Roger Salengro hospital, Lille university hospital, Boulevard du Professeur Émile Laine, F-59000 Lille, France; Inserm, U1008, Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France
| | - Gwénaël Raoul
- University of Lille, F-59000 Lille, France; Department of oral and maxillofacial surgery, Roger Salengro hospital, Lille university hospital, Boulevard du Professeur Émile Laine, F-59000 Lille, France; Inserm, U1008, Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France
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Bidra AS, Peña-Cardelles JF, Iverson M. Implants in the pterygoid region: An updated systematic review of modern roughened surface implants. J Prosthodont 2022; 32:285-291. [PMID: 36069239 DOI: 10.1111/jopr.13600] [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: 07/30/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine the survival rates of modern roughened surface dental implants in the pterygoid region. MATERIAL AND METHODS This systematic review was an update from a previously published systematic review in 2011, which largely reported data on older machined surface dental implants. An electronic search for articles in the English language literature published from January 1, 2010 to December 8, 2021 was performed using PubMed, Scopus, and CENTRAL search engines. After applying a systematic search process in 3 stages, the final list of selected articles on roughened surface pterygoid implants was obtained. Data from the selected articles were collated with data from pertinent articles on roughened implant surface from the previous systematic review. The combined data was then used for calculating the interval survival rate (ISR) and cumulative survival rate (CSR) of pterygoid implants. RESULTS The initial electronic search resulted in 1263 titles. The systematic search process eventually resulted in 10 clinical studies reporting on modern roughened surface pterygoid implants. These 10 studies reported on a total of 911 pterygoid implants with 39 reported failures over a 6-year period. The majority of failures (37) were reported during the first year time interval and a majority of them (30) occurred before loading of the pterygoid implants. Only 2 late failures were reported after loading, during the 6th year time interval. The majority of implants were used for rehabilitation of full arch fixed implant supported prosthesis. At the maximum follow-up interval of 6 years, the cumulative survival rate of pterygoid implants with roughened surfaces was 95.5%, which was 5% higher than reported in the previous systematic review which combined machined and roughed surface pterygoid implants. CONCLUSIONS The survival rate of modern roughened surface dental implants in the pterygoid region is favorable at 95.5% over a 6 year period, and comparable to the existing evidence on survival of implants in other regions of the maxilla and mandible. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Avinash S Bidra
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, CT
| | | | - Marissa Iverson
- Research Support Librarian, L.M Stowe Library, University of Connecticut Health Center, Farmington, Connecticut
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Success Rates of Zygomatic Implants for the Rehabilitation of Severely Atrophic Maxilla: A Systematic Review. Dent J (Basel) 2022; 10:dj10080151. [PMID: 36005249 PMCID: PMC9406716 DOI: 10.3390/dj10080151] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/02/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
Zygomatic implants are a treatment solution for patients with severe maxillary atrophy. This treatment option allows delivering immediate fixed teeth within 24 h. Numerous peer-reviewed publications have reported different success rates, resulting in a disagreement on the topic. Therefore, the overall efficacy and predictability of this rehabilitation is still a matter of discussion. With this study, we aimed to identify the published literature on the use of zygomatic implants for the reconstruction of the severely atrophic maxilla and report the cumulative success rate (CSR) as a function of follow-up time. A systematic review of the literature on zygomatic implant for the treatment of severe maxillary atrophy was performed and 196 publications were included in the study. The cumulative success rate of zygomatic implants for the treatment of severe maxillary atrophy was 98.5% at less than 1 year, 97.5% between 1 and 3 years, 96.8% between 3 and 5 years and 96.1% after more than 5 years. The most commonly reported complications were soft tissue dehiscence, rhinosinusitis and prosthetic failures. The treatment of severe lack of bone in the upper maxilla with zygomatic implants is a safe procedure, reaching a cumulative success rate of 96.1% after more than 5 years.
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Stress Distribution Pattern in Zygomatic Implants Supporting Different Superstructure Materials. MATERIALS 2022; 15:ma15144953. [PMID: 35888420 PMCID: PMC9323759 DOI: 10.3390/ma15144953] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/25/2022]
Abstract
The aim of this study was to assess and compare the stress–strain pattern of zygomatic dental implants supporting different superstructures using 3D finite element analysis (FEA). A model of a tridimensional edentulous maxilla with four dental implants was designed using the computer-aided design (CAD) software. Two standard and two zygomatic implants were positioned to support the U-shaped bar superstructure. In the computer-aided engineering (CAE) software, different materials have been simulated for the superstructure: cobalt–chrome (CoCr) alloy, titanium alloy (Ti), zirconia (Zr), carbon-fiber polymers (CF) and polyetheretherketone (PEEK). An axial load of 500 N was applied in the posterior regions near the zygomatic implants. Considering the mechanical response of the bone tissue, all superstructure materials resulted in homogeneous strain and thus could reconstruct the edentulous maxilla. However, with the aim to reduce the stress in the zygomatic implants and prosthetic screws, stiffer materials, such Zr, CoCr and Ti, appeared to be a preferable option.
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Sáez-Alcaide LM, Cortés-Bretón-Brinkmann J, Sánchez-Labrador L, Pérez-González F, Forteza-López A, Molinero-Mourelle P, López-Quiles J. Patient-reported outcomes in patients with severe maxillary bone atrophy restored with zygomatic implant-supported complete dental prostheses: a systematic review. Acta Odontol Scand 2022; 80:363-373. [PMID: 35044889 DOI: 10.1080/00016357.2021.2018494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Introduction and Objective: Zygomatic implants (ZI) offer a good and predictable alternative to reconstructive procedures of atrophic maxillae. The main objetive of this systematic review was to assess the effect of rehabilitation with zygomatic implants on patient's quality of life (QLP) using Patient Reported Outcomes Measures (PROMs).Materials and Methods: This review followed PRISMA guidelines. An automated electronic search was conducted in four databases supplemented by a manual search for relevant articles published until the end of January 2021. The Cochrane Collaboration Risk of Bias tool and the Newcastle-Ottawa Quality Assessment Scale were used to assess the quality of evidence in the studies reviewed.Results: General findings of this systematic review showed substantial increases in Oral health-related quality of life (OHRQoL) among patients restored with ZI and high scores in terms of general satisfaction, especially in chewing ability and esthetics. An overall survival rate of ZI was 98.3% after a mean follow-up time of 46.5 months was observed. Occurrence of 13.1% biological complications and 1.8% technical complications were reported.Conclusions: Patients rehabilitated with zygomatic implant-supported complete dental prostheses showed substantial improvements in OHRQoL and general satisfaction with the treatment received.
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Affiliation(s)
- Luis Miguel Sáez-Alcaide
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain
| | | | - Luis Sánchez-Labrador
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - Fabián Pérez-González
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - Alba Forteza-López
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - Pedro Molinero-Mourelle
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Juan López-Quiles
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain
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Vrielinck L, Blok J, Politis C. Survival of conventional dental implants in the edentulous atrophic maxilla in combination with zygomatic implants: a 20-year retrospective study. Int J Implant Dent 2022; 8:27. [PMID: 35704150 PMCID: PMC9200924 DOI: 10.1186/s40729-022-00425-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Implant-supported prosthetic rehabilitation in the resorbed maxilla is a great challenge. The aim of this study was to determine the survival rate of conventional anterior implants placed in combination with zygomatic implants according to the Brånemark technique, and to identify risk factors for implant failure. METHODS We collected data retrospectively from 72 consecutive patients who received treatment from 1998 to 2018 at our center, according to Brånemark's original technique. Kaplan-Meier analysis was conducted to assess survival rate, and a survival regression model was used with the patient as the random factor, applying the Weibull distribution. RESULTS A total of 236 maxillary anterior implants were included, with a mean follow-up of 12.1 years. Kaplan-Meier analysis showed overall cumulative survival rates of 95.3% at 1 year, 94.8% at 2 years, 93.0% at 5 years, 90.5% at 10 years, 81.6% at 15 years, and 67.7% at 20 years. Survival regression showed an association between bruxism and implant failure as well as implants bearing an overdenture. Implants with length ≤ 10 mm had a significantly lower survival time. No significant association was found between the number of anterior implants and survival rate. CONCLUSIONS We found acceptable long-term anterior conventional implant survival. Significant risk factors for failure were bruxism, overdentures, and implants shorter than 10 mm.
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Affiliation(s)
- Luc Vrielinck
- Department of Oral and Maxillofacial Surgery, East-Limburg Hospital, Genk, Belgium
| | - Jorden Blok
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium. .,OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium.
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40
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Pathways for the rehabilitation of resection defects in the maxilla. Br Dent J 2022; 232:783-789. [PMID: 35689055 DOI: 10.1038/s41415-022-4342-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/13/2021] [Indexed: 11/08/2022]
Abstract
Oral rehabilitation of head and neck cancer patients is an integral component of the care pathway. Maxillectomy procedures can cause significant defects, such as oronasal fistulas, loss of support for the cheek and lip, aesthetic defects in the middle third of the face and functional impairments. Orofacial rehabilitation plays a fundamental role in restoring aesthetics and functional capabilities, such as speech, mastication and deglutition.Rehabilitation of maxillectomy patients poses a challenge for both clinicians and patients. This paper utilises case examples to demonstrate the treatment options for the oral rehabilitation of these patients. We will summarise the treatment pathways for conventional obturators, delayed (secondary) implant retained fixed rehabilitation following composite free flap and early rehabilitation using a zygomatic implant perforated flap technique. This paper aims to highlight the challenges in treatment planning and the importance of a multidisciplinary approach in improving patient outcomes.
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Wang F, Fan S, Huang W, Shen Y, Li C, Wu Y. Dynamic navigation for prosthetically driven zygomatic implant placement in extensive maxillary defects: Results of a prospective case series. Clin Implant Dent Relat Res 2022; 24:435-443. [PMID: 35605154 DOI: 10.1111/cid.13101] [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: 12/28/2021] [Revised: 05/02/2022] [Accepted: 05/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Zygomatic implants (ZIs) that are anchored in remote locations can significantly improve the retention and stability of prosthetic obturation in maxillary defect sites without the need for complex surgical reconstruction. However, ZI placement without alveolar bone guidance is challenging, especially when identifying the ideal three-dimensional location of the "coronal part" of the implant fixture for further rehabilitation. PURPOSE To investigate the feasibility and accuracy of surgical navigation for ZI placement using prosthetically driven plans to treat extensive maxillary defects. MATERIAL AND METHODS Software was used to virtually plan the number and distribution of ZIs for maxillary defect patients according to the existing residual maxillofacial bone. The "coronal part" of the ZI was identified based on the existing maxillodental prosthetic flange, virtually planned infrastructure framework and superstructure. ZI placement was fully guided by surgical navigation. RESULTS Ten patients were enrolled. One patient had loose reflective spheres, which resulted in an inaccurate back-reflection of the position during navigation. A total of 27 ZIs in the remaining 9 patients were placed uneventfully. The mean of the "coronal part" of the ZI, entry point of the zygomatic bone, apical deviation, and apical angle deviation were 1.50 mm, 1.39 mm, 1.95 mm, and 2.32°, respectively. A Computer-aided design and computer-aided manufacture milled bar and additional attachments were fabricated according to preoperative planning. No osseointegrated implant loss was detected. Six ZIs in three patients received implant surface polishing to reduce soft tissue irritation, and one ZI was submerged. DISCUSSION Surgical navigation facilitated the accurate and feasible placement of prosthetically driven ZIs that were preoperatively planned in patients with extensive maxillary defects.
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Affiliation(s)
- Feng Wang
- Department of Oral Implantology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China.,Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Shengqi Fan
- National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China.,Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.,Department of Second Dental Center, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Huang
- Department of Oral Implantology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China.,Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yihan Shen
- National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China.,Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.,Department of Second Dental Center, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chaolun Li
- National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China.,Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.,Department of Second Dental Center, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiqun Wu
- National Center for Stomatology, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China.,Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.,Department of Second Dental Center, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Vosselman N, Glas HH, Merema BJ, Kraeima J, Reintsema H, Raghoebar GM, Witjes MJH, de Visscher SAHJ. Three-Dimensional Guided Zygomatic Implant Placement after Maxillectomy. J Pers Med 2022; 12:jpm12040588. [PMID: 35455704 PMCID: PMC9027393 DOI: 10.3390/jpm12040588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 12/27/2022] Open
Abstract
Zygomatic implants are used in patients with maxillary defects to improve the retention and stability of obturator prostheses, thereby securing good oral function. Prosthetic-driven placement of zygomatic implants is even difficult for experienced surgeons, and with a free-hand approach, deviation from the preplanned implant positions is inevitable, thereby impeding immediate implant-retained obturation. A novel, digitalized workflow of surgical planning was used in 10 patients. Maxillectomy was performed with 3D-printed cutting, and drill guides were used for subsequent placement of zygomatic implants with immediate placement of implant-retained obturator prosthesis. The outcome parameters were the accuracy of implant positioning and the prosthetic fit of the obturator prosthesis in this one-stage procedure. Zygomatic implants (n = 28) were placed with good accuracy (mean deviation 1.73 ± 0.57 mm and 2.97 ± 1.38° 3D angle deviation), and in all cases, the obturator prosthesis fitted as pre-operatively planned. The 3D accuracy of the abutment positions was 1.58 ± 1.66 mm. The accuracy of the abutment position in the occlusal plane was 2.21 ± 1.33 mm, with a height accuracy of 1.32 ± 1.57 mm. This feasibility study shows that the application of these novel designed 3D-printed surgical guides results in predictable zygomatic implant placement and provides the possibility of immediate prosthetic rehabilitation in head and neck oncology patients after maxillectomy.
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Aparicio C, Polido WD, Chow J, Davó R, Al-Nawas B. Round and flat zygomatic implants: effectiveness after a 1-year follow-up non-interventional study. Int J Implant Dent 2022; 8:13. [PMID: 35359196 PMCID: PMC8971328 DOI: 10.1186/s40729-022-00412-8] [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: 12/20/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION There are few zygomatic implants (ZI) designs available. The objective of this non-interventional study was to report the effectiveness of two new site-specific ZI, selected and placed following the zygoma anatomy-guided approach (ZAGA). MATERIALS AND METHODS Consecutive patients presenting indications for rehabilitation using ZI were treated according to ZAGA Concept recommendations. Implants were immediately loaded following the manufacturer's instructions. Success criteria regarding prosthetic offset, rhino-sinus status, soft tissue condition, and implant stability were additionally used as outcome parameters. RESULTS Twenty patients were followed for a period of 12 to 28 months (average 18.8 months). Ten received 2 ZI plus regular anterior implants; One received 3 ZI plus regular implants and nine received 4 ZI. In total, 59 ZI were placed, 34 (58%) Straumann ZAGA-Flat design, and 25 (42%) ZAGA-Round. Forty-nine percent of the sites were classified as ZAGA-4 type and 27% as ZAGA-2. Four patients (20%) presented discontinuities of the sinus-nose floor before surgery and 15 patients (75%) presented previous sinus opacities. All implants bar one reached more than 45 N.cm of insertion torque. No surgical complications were observed. After 1 year, the modified Lund-Mackay score was negative in 17 patients. Seventeen sites in 11 patients exhibited decreased opacity when pre-surgical imaging was compared to 1-year post-surgical CBCT. All implants and prostheses remained stable and in function. CONCLUSIONS The study concluded 100% implant/prosthesis survival rates and low complication levels. Within the limitations of the sample and observation period, results suggest that even in cases of extremely resorbed maxillae (as per cases in this study), ZAGA-Flat and ZAGA-Round ZI are viable treatment options when restoring atrophic maxillae following the ZAGA protocol.
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Affiliation(s)
- Carlos Aparicio
- Zygomatic Unit at Hepler Bone Clinic, ZAGA Center, Roman Macaya, 22-24, 08022, Barcelona, Spain. .,International Teaching Scholar, Indiana University School of Dentistry, Indianapolis, USA.
| | - Waldemar D Polido
- Oral and Maxillofacial Surgery, Indiana University School of Dentistry, 1121 W. Michigan Street, Indianapolis, IN, 46202, USA.,ZAGA Center, Indiana University, Bloomington, USA
| | - James Chow
- ZAGA Center Hong Kong, Associated Brånemark Osseointegration Center, 1901-1905, 1912-1913, The Center, 99 Queen's Road Central, Hong Kong, Hong Kong SAR
| | - Rubén Davó
- ZAGA Center, Alicante, Spain.,Dentistry and Maxillofacial Department, International Vithas Medimar Hospital, c/ Padre Arrupe, 20, 03016, Alicante, Spain
| | - Bilal Al-Nawas
- Department for Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Center of the J. Gutenberg University Mainz, Augustusplatz 2, 55131, Mainz, Germany
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Vrielinck L, Moreno‐Rabie C, Schepers S, Van Eyken P, Coucke W, Politis C. Peri‐zygomatic Infection Associated to Zygomatic Implants: a retrospective longitudinal cohort study. Clin Oral Implants Res 2022; 33:405-412. [DOI: 10.1111/clr.13900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/23/2021] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Luc Vrielinck
- Department of Oral and Maxillofacial Surgery Saint John´s Hospital Genk Belgium
| | - Catalina Moreno‐Rabie
- OMFS‐IMPATH Research Group Department of Imaging and Pathology Faculty of Medicine University of Leuven Leuven Belgium
- Department of Oral and Maxillofacial Surgery University Hospitals Leuven Leuven Belgium
| | - Serge Schepers
- Department of Oral and Maxillofacial Surgery Saint John´s Hospital Genk Belgium
| | | | - Wim Coucke
- Certified Freelance Statistician Heverlee Belgium
| | - Constantinus Politis
- OMFS‐IMPATH Research Group Department of Imaging and Pathology Faculty of Medicine University of Leuven Leuven Belgium
- Department of Oral and Maxillofacial Surgery University Hospitals Leuven Leuven Belgium
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Wu Y, Tao B, Lan K, Shen Y, Huang W, Wang F. Reliability and accuracy of dynamic navigation for zygomatic implant placement. Clin Oral Implants Res 2022; 33:362-376. [PMID: 35113463 PMCID: PMC9305866 DOI: 10.1111/clr.13897] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/19/2021] [Accepted: 01/24/2022] [Indexed: 11/29/2022]
Abstract
Objectives To assess the accuracy of a real‐time dynamic navigation system applied in zygomatic implant (ZI) surgery and summarize device‐related negative events and their management. Material and methods Patients who presented with severely maxillary atrophy or maxillary defects and received dynamic navigation‐supported ZI surgery were included. The deviations of entry, exit, and angle were measured after image data fusion. A linear mixed‐effects model was used. Statistical significance was defined as p < .05. Device‐related negative events and their management were also recorded and analyzed. Results Two hundred and thirty‐one zygomatic implants (ZIs) with navigation‐guided placement were planned in 74 consecutive patients between Jan 2015 and Aug 2020. Among them, 71 patients with 221 ZIs received navigation‐guided surgery finally. The deviations in entry, exit, and angle were 1.57 ± 0.71 mm, 2.1 ± 0.94 mm and 2.68 ± 1.25 degrees, respectively. Significant differences were found in entry and exit deviation according to the number of ZIs in the zygomata (p = .03 and .00, respectively). Patients with atrophic maxillary or maxillary defects showed a significant difference in exit deviation (p = .01). A total of 28 device‐related negative events occurred, and one resulted in 2 ZI failures due to implant malposition. The overall survival rate of ZIs was 98.64%, and the mean follow‐up time was 24.11 months (Standard Deviation [SD]: 12.62). Conclusions The navigation‐supported ZI implantation is an accurate and reliable surgical approach. However, relevant technical negative events in the navigation process are worthy of attention.
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Affiliation(s)
- 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; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Baoxin Tao
- 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; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Kengliang Lan
- 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; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yihan Shen
- 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; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Wei Huang
- Department of Oral Implantology, 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; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Feng Wang
- Department of Oral Implantology, 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; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
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Mechanical Behaviour and Primary Stability of a Self-Condensing Implant: A Laboratory Critical Simulation of a Severe Maxillary Atrophy on Polyurethane Lamina. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12030966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Background: Posterior maxillary atrophies could emerge after the loss of teeth, trauma, infections, or lesions that often require regenerative approaches. In these critical conditions, the achievement of implant primary stability represents a clinical challenge in the operative practice. Therefore, a two-stage approach is often preferred with a delay of the rehabilitation time and a consistent increasing of the biological and the operative costs. The aim of this study was to evaluate the mechanical behaviour of a self-condenser implant compared to a standard implant in a critical simulation on different thicknesses and densities of polyurethane lamina. Materials and methods: A total of two implant models were tested: a self-condensing device (test) and a standard implant (control). The study evaluated the insertion torque and the pull-out strength values of the test and control implants inserted in different sizes (1, 2, and 3 mm) and density polyurethane lamina (10, 20, and 30 pcf) for a total of 320 experimental sites. Results: In total, 320 experimental sites were produced in the polyurethane samples. A statistically significant difference of insertion and pull-out torque values between the test and control Implants was found in the different bone densities (p < 0.05). The insertion and pull-out torque values were always higher for the test implants in all experimental conditions. In all bone densities, the insertion torque values were higher than the pull-out torque values. The self-condenser dental implant design evaluated in this in vitro study showed a high level of stability in all experimental conditions. Conclusions: The test implant could represent a useful tool for a one-stage surgical approach in the presence of limited residual native bone as an alternative to a delayed technique.
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Maxillary Sinusitis as a Complication of Zygomatic Implants Placement: A Narrative Review. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aims: The aim of this review is to consider maxillary sinusitis as a complication of zygomatic implants placements. Maxillary sinusitis a common complication but in the literature there are no reviews that focus only on this condition and its possible treatment. This review was carried out with to highlight the main findings of the literature on this topic and to improve knowledge in this field. Methods: The search strategy resulted in 155 papers. After selection of the inclusion criteria only 11 papers were examined. From the papers these, 12.3% patients presented maxillary sinusitis but only four studies evaluated sinusitis (both clinical and radiological evaluation). The most common treatment used by the authors were antibiotics alone or combined with functional endoscopic sinus surgery (FESS). Results: The literature shows an absence of precise and shared guidelines diagnosis and post-operative follow-up, and of the treatment of maxillary sinusitis following zygomatic implantology. It has not been determined if the surgical placement of ZIs is better than the other techniques for treatment of the onset of maxillary sinusitis in the post-operative period. Conclusion: To date there are no shared protocols for maxillary sinusitis treatment. In our experience, and according to the literature in the presence of risk factors such as age, comorbidities, smoking, nasal septal deviation or other anatomical variants, we suggested that FESS is performed at the same time as placement of zygomatic implants.
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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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Amid R, Kadkhodazadeh M, Moscowchi A, Nami M. Effect of Schneiderian Membrane Thickening on the Maxillary Sinus Augmentation and Implantation Outcomes: A Systematic Review. J Maxillofac Oral Surg 2021; 20:534-544. [PMID: 34776681 DOI: 10.1007/s12663-021-01551-y] [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: 11/05/2020] [Accepted: 03/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background Schneiderian membrane thickness may influence the final clinical outcome of sinus augmentation and dental implantation. Mucosal thickening has been regarded as a contributing factor for post-treatment complications. This study aimed to systematically review the available literature on the association between mucosal thickening and potential complications related to sinus augmentation and implant placement. Methods An electronic search was carried out in MEDLINE, Embase, and Web of Science by two independent reviewers. It was complemented by manual search of the reference lists of all relevant studies. The studies reporting on sinus augmentation and dental implantation in cases with preoperative mucosal thickening were considered eligible for this study. Results The initial search yielded 1032 articles. Five hundred and sixty-four records were screened by title and abstract, and 57 studies succeeded the inclusion criteria for full-text evaluation. Finally, 10 records remained for data extraction. The included studies assessed sinus augmentation and implantation procedures in 765 patients, 324 (42.3%) of them showed mucosal thickening. Increased membrane thickness did not significantly elevate the frequency of sinus augmentation complications. In addition, the overall implant survival rate was 99.03%. Conclusions Within the limitations of the present study, the presence of mucosal thickening might not be a risk factor for sinus augmentation and implant survival rate.
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Affiliation(s)
- Reza Amid
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Kadkhodazadeh
- Research Institute for Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anahita Moscowchi
- Department of Periodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majedeh Nami
- Department of Prosthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, Evin, Shahid Chamran Highway, Tehran, Iran
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Ayinala M, Shetty G. Rehabilitation of Maxillary Defect Using Zygomatic Implant Retained Obturator. Case Rep Dent 2021; 2021:2391331. [PMID: 34691789 PMCID: PMC8528630 DOI: 10.1155/2021/2391331] [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: 05/24/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022] Open
Abstract
Tumors involving the hard palate, maxillary sinus, or nasal cavity require maxillectomy based on the extent of the lesion. Lack of these boundaries affects the speech, esthetics, and masticatory function. Prosthetic rehabilitation of these defects can be done utilizing zygomatic implants. This present case describes the use of a zygomatic implant to retain a maxillary obturator in a 22-year-old male patient following partial maxillectomy (Brown's Class 2b) due to odontogenic myxoma. A surgical obturator was secured in position subsequent to the implant placement. Following the healing period, an interim obturator using heat cure acrylic was fabricated. Mechanical retention for the definitive obturator was obtained through the ball attachment suspended from the multiunit abutment of the zygomatic implant. The case was followed up closely for a year to evaluate the function of the prosthesis. The prosthetic rehabilitation not only promoted esthetics and function but also improved the patient's quality of life.
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Affiliation(s)
- Mounika Ayinala
- Department of Prosthodontics, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
| | - Gautam Shetty
- Department of Prosthodontics, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
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