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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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Dental and Craniomaxillofacial Implant Surgery. J Oral Maxillofac Surg 2023; 81:E75-E94. [PMID: 37833030 DOI: 10.1016/j.joms.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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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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Polido WD, Machado-Fernandez A, Lin WS, Aghaloo T. Indications for zygomatic implants: a systematic review. Int J Implant Dent 2023; 9:17. [PMID: 37391575 DOI: 10.1186/s40729-023-00480-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/09/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE The purpose of this systematic review was to assess the evidence regarding the indications for placement of zygomatic implants to rehabilitate edentulous maxillae. MATERIAL AND METHODS A focused question using the PIO format was developed, questioning "in patients in need of an implant-supported rehabilitation of the edentulous maxillae, what are the indications for the use of zygomatic implants''. The primary information analyzed and collected was a clear description of the indication for the use of zygomatic implants. RESULTS A total of 1266 records were identified through database searching. The full-text review was conducted for 117 papers, and 10 were selected to be included in this review. Zygomatic implant indications were extreme bone atrophy or deficiency secondary to different factors. The quad zygoma concept (two zygomatic implants bilaterally placed and splinted) was applied to 107 patients, the classic zygoma concept (one zygomatic implant bilaterally placed and splinted to standard anterior implants) was used in 88 patients, and the unilateral concept (one zygomatic implant on one side, splinted with one or more conventional implants) was employed in 14 patients. CONCLUSIONS The main indication for the use of zygomatic implants was considered extreme maxillary bone atrophy, resulting from many factors. The clear definition of what was considered "extreme bone atrophy" is not uniquely defined in each paper. Further studies are needed to develop clear indications for zygomatic implants.
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Affiliation(s)
- Waldemar D Polido
- Department of Oral and Maxillofacial Surgery, Indiana University School of Dentistry, Indianapolis, USA.
| | | | - Wei-Shao Lin
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, USA
| | - Tara Aghaloo
- Section of Oral and Maxillofacial Surgery, UCLA School of Dentistry, Los Angeles, CA, USA
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Li C, Wang M, Deng H, Li S, Fang X, Liang Y, Ma X, Zhang Y, Li Y. Autonomous robotic surgery for zygomatic implant placement and immediately loaded implant-supported full-arch prosthesis: a preliminary research. Int J Implant Dent 2023; 9:12. [PMID: 37204483 PMCID: PMC10199156 DOI: 10.1186/s40729-023-00474-2] [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: 01/29/2023] [Accepted: 03/15/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVES A patient with extensive atrophy of the alveolar ridge in the posterior portion of the maxilla was selected to complete an experimental and clinical case of the robotic zygomatic implant to investigate the viability of an implant robotic system in clinical use. METHODS The preoperative digital information was collected, and the implantation position and personalized optimization marks needed for robot surgery were designed in advance in a repair-oriented way. The resin models and marks of the patient's maxilla and mandible are all printed in 3D. Custom-made special precision drills and handpiece holders for robotic zygomatic implants were used to perform model experiments and compare the accuracy of the robotic zygomatic implant group (implant length = 52.5 mm, n = 10) with the alveolar implant group (implant length = 18 mm, n = 20). Based on the results of extraoral experiments, a clinical case of robotic surgery for zygomatic implant placement and immediate loading of implant-supported full arch prosthesis was carried out. RESULTS In the model experiment, the zygomatic implant group reported an entry point error of 0.78 ± 0.34 mm, an exit point error of 0.80 ± 0.25 mm, and an angle error of 1.33 ± 0.41degrees. In comparison, the alveolar implant group (control group) reported an entry point error of 0.81 ± 0.24 mm, an exit point error of 0.86 ± 0.32 mm, and an angle error of 1.71 ± 0.71 degrees. There was no significant difference between the two groups (p > 0.05). In clinical cases, the average entry point error of two zygomatic implants is 0.83 mm, the average exit point error is 1.10 mm and the angle error is 1.46 degrees. CONCLUSIONS The preoperative planning and surgical procedures developed in this study provide enough accuracy for robotic zygomatic implant surgery, and the overall deviation is small, which is not affected by the lateral wall deviation of maxillary sinus.
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Affiliation(s)
- Changjian Li
- Department of Stomatology, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, 100048, China
| | - Menglin Wang
- Department of Stomatology, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, 100048, China
- Medical School of Chinese PLA, Beijing, China
| | - Huanze Deng
- Department of Stomatology, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, 100048, China
- Medical School of Chinese PLA, Beijing, China
| | - Shumao Li
- Department of Stomatology, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, 100048, China
| | - Xinyu Fang
- Department of Stomatology, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, 100048, China
| | - Yijie Liang
- Department of Stomatology, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, 100048, China
| | - Xihua Ma
- Department of Stomatology, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, 100048, China.
| | - Yue Zhang
- Department of Stomatology, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, 100048, China.
- Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, 100048, China.
| | - Yanfeng Li
- Department of Stomatology, The Fourth Medical Centre, Chinese PLA General Hospital, Beijing, 100048, China.
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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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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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Gu Y, Zhang D, Tao B, Wang F, Chen X, Wu Y. A novel technique to quantify bone-to-implant contact of zygomatic implants: a radiographic analysis based on three-dimensional image registration and segmentation. Dentomaxillofac Radiol 2023; 52:20220210. [PMID: 36645052 PMCID: PMC9974236 DOI: 10.1259/dmfr.20220210] [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: 06/17/2022] [Revised: 11/01/2022] [Accepted: 11/21/2022] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES The purpose of this study is to establish a novel, reproducible technique to obtain the BIC area (BICA) between zygomatic implants and zygomatic bone based on post-operative cone-beam computed tomography (CBCT) images. Three-dimensional (3D) image registration and segmentation were used to eliminate the effect of metal-induced artifacts of zygomatic implants. METHODS An ex-vivo study was included to verify the feasibility of the new method. Then, the radiographic bone-to-implant contact (rBIC) of 143 implants was measured in a total of 50 patients. To obtain the BICA of zygomatic implants and the zygomatic bone, several steps were necessary, including image preprocessing of CBCT scans, identification of the position of zygomatic implants, registration, and segmentation of pre- and post-operative CBCT images, and 3D reconstruction of models. The conventional two-dimensional (2D) linear rBIC (rBICc) measurement method with post-operative CBCT images was chosen as a comparison. RESULTS The mean values of rBIC and rBICc were 15.08 ± 5.92 mm and 14.77 ± 5.14 mm, respectively. A statistically significant correlation was observed between rBIC and rBICc values ([Formula: see text]=0.86, p < 0.0001). CONCLUSIONS This study proposed a standardized, repeatable, noninvasive technique to quantify the rBIC of post-operative zygomatic implants in 3D terms. This technique is comparable to conventional 2D linear measurements and seems to be more reliable than these conventional measurements; thus, this method could serve as a valuable tool in the performance of clinical research protocols.
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Affiliation(s)
| | - Dingzhong Zhang
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Baoxin Tao
- Department of Second Dental Center and Oral Rehabilitation, 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
| | | | - Yiqun Wu
- Department of Second Dental Center and Oral Rehabilitation, 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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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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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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11
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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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12
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Andre A, Dym H. Zygomatic Implants: A Review of a Treatment Alternative for the Severely Atrophic Maxilla. Atlas Oral Maxillofac Surg Clin North Am 2021; 29:163-172. [PMID: 34325806 DOI: 10.1016/j.cxom.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Amanda Andre
- The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, USA.
| | - Harry Dym
- The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, USA
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13
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Affiliation(s)
- Rubén Davó
- Department of Implantology and Maxillofacial Surgery, Vithas Davó Instituto Dental, Padre Arrupe, 20. 5a Planta. 03016, Alicante, Spain
| | - Lesley David
- Implant Surgical Care, 1849 Yonge Street, #302, Toronto, Ontario M4S 1Y2, Canada.
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14
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Gutiérrez Muñoz D, Obrador Aldover C, Zubizarreta-Macho Á, González Menéndez H, Lorrio Castro J, Peñarrocha-Oltra D, Montiel-Company JM, Hernández Montero S. Survival Rate and Prosthetic and Sinus Complications of Zygomatic Dental Implants for the Rehabilitation of the Atrophic Edentulous Maxilla: A Systematic Review and Meta-Analysis. BIOLOGY 2021; 10:biology10070601. [PMID: 34209770 PMCID: PMC8301194 DOI: 10.3390/biology10070601] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 12/26/2022]
Abstract
Simple Summary Zygomatic dental implants have been proposed as an alternative to atrophic total edentulous maxillae rehabilitation with the necessity of bone grafting procedures. However, surgical, prosthetic, and maxillary sinus complications have been associated with this surgical procedure. Therefore, it is necessary to produce a systematic review and meta-analysis that provides evidence associated with the prognosis when using zygomatic dental implants as an alternative to atrophic total edentulous maxillae rehabilitation. Abstract The aim of this systematic review and meta-analysis was to analyze and compare the survival rate and prosthetic and sinus complications of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla. Materials and methods: We conducted a systematic literature review and meta-analysis, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, of clinical studies that evaluated the survival rate and prosthetic and sinus complications of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla. Four databases were consulted during the literature search: Pubmed–Medline, Scopus, Embase, and Web of Science. After eliminating duplicate articles and applying the inclusion criteria, 46 articles were selected for the qualitative analysis and 32 for the quantitative analysis. Results: Four randomized controlled trials, 19 prospective clinical studies, 20 retrospective studies, and 3 case series were included in the meta-analysis. Conventional dental implants failure (n = 3549) were seen in 2.89% (IC-95% 1.83–3.96%), while zygomatic dental implants failure (n = 1895) were seen in 0.69% (IC-95% 0.21–1.16%). The measure of the effect size used was the Odds Ratio, which was estimated at 2.05 with a confidence interval of 95% between 1.22 and 3.44 (z test = 2.73; p-value = 0.006). The failure risk of conventional dental implants is 2.1 times higher than that of zygomatic dental implants. Slight heterogeneity was determined in the meta-analysis between 23 combined studies (Q test = 32.4; p-value = 0.070; I2 = 32.1%). Prosthetic complications were recorded in 4.9% (IC-95% 2.7–7.3%) and mild heterogeneity was observed in a meta-analysis of 28 combined studies (Q test = 88.2; p-value = 0.001; I2 = 69.4%). Sinus complications were seen in 4.7% (IC-95% 2.8–6.5%) and mild heterogeneity was observed in a meta-analysis of 32 combined studies (Q test = 75.3; p-value = 0.001; I2 = 58.8%). Conclusions: The high survival rate and low prosthetic and sinus complications related to zygomatic dental implants suggest the use of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla.
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Affiliation(s)
- David Gutiérrez Muñoz
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (D.G.M.); (C.O.A.); (H.G.M.); (J.L.C.); (S.H.M.)
| | - Caterina Obrador Aldover
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (D.G.M.); (C.O.A.); (H.G.M.); (J.L.C.); (S.H.M.)
| | - Álvaro Zubizarreta-Macho
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (D.G.M.); (C.O.A.); (H.G.M.); (J.L.C.); (S.H.M.)
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain
- Correspondence:
| | - Héctor González Menéndez
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (D.G.M.); (C.O.A.); (H.G.M.); (J.L.C.); (S.H.M.)
| | - Juan Lorrio Castro
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (D.G.M.); (C.O.A.); (H.G.M.); (J.L.C.); (S.H.M.)
| | - David Peñarrocha-Oltra
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (D.P.-O.); (J.M.M.-C.)
| | - José María Montiel-Company
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (D.P.-O.); (J.M.M.-C.)
| | - Sofía Hernández Montero
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (D.G.M.); (C.O.A.); (H.G.M.); (J.L.C.); (S.H.M.)
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15
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Evaluation of Quality of Life and Satisfaction in Patients with Fixed Prostheses on Zygomatic Implants Compared with the All-on-Four Concept: A Prospective Randomized Clinical Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073426. [PMID: 33806189 PMCID: PMC8037824 DOI: 10.3390/ijerph18073426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022]
Abstract
Purpose: No published research has compared patients’ quality of life and satisfaction with fixed prostheses supported by zygomatic implants with those supported by all-on-four prostheses. The aim of this study was to evaluate patients’ quality of life and satisfaction with fixed prostheses on zygomatic implants compared with the all-on-four concept. Materials and Methods: A total of 80 patients with atrophic edentulous maxillae were randomized into two groups: Group 1 (rehabilitated with fixed prostheses supported by 2–4 zygomatic and 2–4 conventional implants in the anterior region) and Group 2 (fixed prostheses on four implants in the anterior region following an all-on-four concept). One year after placement of the definitive prostheses, patients completed OHIP-14 and satisfaction questionnaires. Results: In all seven domains of the OHIP-14 and in the overall scores, a worse quality of life was found in Group 2 patients, with statistically significant differences between the two groups (p ≤ 0.05). Patients with zygomatic implants were more satisfied with their prostheses, with a statistically significant difference (p < 0.001). Conclusions: According to the results of this study, rehabilitation of patients with edentulous atrophic maxillae with prostheses supported by zygomatic implants combined with anterior implants provided better patient quality of life and satisfaction than prostheses supported by four implants.
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16
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Gracher AHP, de Moura MB, da Silva Peres P, Thomé G, Padovan LEM, Trojan LC. Full arch rehabilitation in patients with atrophic upper jaws with zygomatic implants: a systematic review. Int J Implant Dent 2021; 7:17. [PMID: 33634393 PMCID: PMC7907402 DOI: 10.1186/s40729-021-00297-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background The main objective of this systematic review was to present the outcomes of the treatment with zygomatic implants (ZIs) in the rehabilitations of atrophic upper jaw. Findings An electronic database search in PubMed, along with a manual search, taking into account language and study period, was performed by two observers; any type of clinical trial and series that included the use of ZIs was used. In the search strategy, the following search terms were used: zygom* AND dental (Implant OR implants) AND edentulous NOT (biomechanic* OR finite element) NOT cadaver. The search was limited to English language, full text, and humans. Literature reviews and clinical case reports were not considered. Forty-two articles published between March 2003 and April 2019 were included in this analysis. The cases of 1247 patients were recovered; these patients received 2919 ZIs. Fifty-two ZIs were removed during the follow-up time. The survival rate of these implants was 98.22%, with a minimum follow-up of 1 month and a maximum of 228 months. Different surgical techniques were used to place ZIs; however, the intrasinusal technique was the most used (23 studies). Post-surgical sinusitis was the most common complication reported in the studies (39 cases). Conclusions Based on this review, ZIs were commonly used for rehabilitation of patients with atrophic upper jaw. The survival rates presented were high, and the surgical technique is dependent on the professional experience and the local anatomy. However, it needed additional clinical evidence on bone resorption, esthetic outcomes, and physiological characteristics.
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Affiliation(s)
| | - Marcos Boaventura de Moura
- Department of Occlusion, Fixed Prosthodontics and Dental Materials, School of Dentistry, Federal University of Uberlandia, Av. Pará 1720, Bloco 4LB, sala 39, Uberlandia, MG, 38405-902, Brazil.
| | | | - Geninho Thomé
- Department of Implantology, ILAPEO College, Curitiba, PR, Brazil
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17
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D'Agostino A, Lombardo G, Favero V, Signoriello A, Bressan A, Lonardi F, Nocini R, Trevisiol L. Complications related to zygomatic implants placement: A retrospective evaluation with 5 years follow-up. J Craniomaxillofac Surg 2021; 49:620-627. [PMID: 33581959 DOI: 10.1016/j.jcms.2021.01.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 12/03/2020] [Accepted: 01/31/2021] [Indexed: 10/22/2022] Open
Abstract
This retrospective study assessed zygoma implants in patients treated for upper maxilla extreme atrophy, trauma, cleft palate, or failed reconstruction. The implants were placed using Quad (4 zygoma implants) or mixed (zygoma and conventional implants in premaxilla) surgical technique, with intra-sinus or extra-sinus approach, followed by immediate or deferred loading. Clinical and radiographic evaluations were carried out at 5-year follow-up from loading. Implant survival, symptoms and signs of sinusitis, radiological alterations in terms of mucosal thickening or obliteration of the maxillary sinuses, oroantral communications, and peri-implant soft tissues were examined. A total of 42 patients, with 116 zygoma implants, were included in the study. The cumulative survival rate was 97.41%. One zygomatic bone fracture was assessed. Eight patients reported sinusitis, and two showed oro-antral communications. A comparison between mean pre- and post-operative Lund-Mackay scores showed a statistically significant increase of sino-nasal disease in the post-operative scores (p = 0.0019). Mucositis and gingival recession was observed in 21 and 8 implants respectively. Average recession was 2.52 ± 2.35 mm. According to our results, placement of zygoma implants has proved to be a predictable procedure, with a lower rate of severe complications compared to other treatment options in extreme upper jaw atrophy.
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Affiliation(s)
- Antonio D'Agostino
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Giorgio Lombardo
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Vittorio Favero
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy.
| | - Annarita Signoriello
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Anna Bressan
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Fabio Lonardi
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Riccardo Nocini
- Unit of Otolaryngology, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Lorenzo Trevisiol
- Unit of Maxillo-Facial Surgery and Dentistry, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
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18
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Bone Regeneration and Soft Tissue Enhancement Around Zygomatic Implants: Retrospective Case Series. MATERIALS 2020; 13:ma13071577. [PMID: 32235372 PMCID: PMC7178084 DOI: 10.3390/ma13071577] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/26/2020] [Indexed: 01/17/2023]
Abstract
Purpose: To present a case series of zygomatic implants combined with bone regeneration and soft tissue enhancement techniques to reduce the risk of biological delayed complications such as maxillary sinusitis and soft tissue recession. Materials and methods: Zygomatic implants placed simultaneously with different bone regeneration techniques (buccal, palatal and buccal-palatal bone regeneration) and soft tissue enhancement techniques (pediculate and free connective tissue graft) were followed for at least 12 months. The following information was collected: patient age and sex, number of zygomatic implants, zygomatic implant success rate, zygomatic implant position according to classification of the Zygomatic Anatomy Guide Approach (ZAGA), sinus membrane perforation, type and outcome of the bone regeneration or the soft tissue enhancement technique, bone gain (width and length along the zygomatic implant) and keratinized buccal mucosa width, duration of follow-up, loading protocol (immediate or delayed) and biological complications (maxillary sinusitis and soft tissue recession). Results: Thirty-one zygomatic implants placed in 19 patients were included. All implants were successful and none of the implants presented biological complications. The bone regeneration technique was successful in 30 of 31 cases with a mean palatal bone width of 3 mm, buccal bone width of 2.65 mm, palatal bone length of 6.5 mm and buccal bone length of 8.3 mm. The success rate of soft tissue enhancement was 100% and it established at least 2 mm of keratinized buccal mucosa width in all implants. Conclusions: Within the limitations of the present study, bone regeneration and soft tissue enhancement techniques were useful to establish more favorable conditions of the peri-implant tissues around zygomatic implants. This could prevent biological complications such as maxillary sinusitis and soft tissue recessions. Prospective and randomized controlled clinical trials with longer follow-up periods are advisable.
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19
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Abstract
Four zygomatic implants may be used in patients with severe maxillary atrophy for rehabilitation with a fixed or removable prosthesis. Immediate loading is also typically performed, providing patients with a less invasive and more efficient solution for rehabilitation. Options for immediate loading are presented. The indications, contraindications, procedure, and complications are reviewed. Appropriate treatment planning and work-up are highlighted, as they are required for success in conjunction with advanced surgical skill. Scientific evidence, although lacking in quantity, suggests that the quad zygoma approach offers a predictable solution for the challenge of severe maxillary atrophy; high implant survival rates are noted.
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Affiliation(s)
- Rubén Davó
- Department of Implantology and Maxillofacial Surgery, Medimar International Hospital, Padre Arrupe, 20, 5th floor, Alicante 03016, Spain
| | - Lesley David
- Oral and Maxillofacial Surgery, Trillium Health Partners, University of Toronto, Private Practice, Toronto, Canada.
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20
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Wilson PH, Fasanmade K, Anand P. Oro-facial rehabilitation of cancer patients: 'Zygomatic 2019'-1-2 March 2019, London, UK. Ecancermedicalscience 2019; 13:925. [PMID: 31281422 PMCID: PMC6546261 DOI: 10.3332/ecancer.2019.925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Indexed: 11/25/2022] Open
Abstract
This first truly global conference on the use of zygomatic implants for the oral reconstruction of patients with compromised or deficient maxillae was held at the Museum of London from 1 to 2 March 2019. It attracted over 200 clinicians and academics from 24 nations and reviewed over 25 years’ experience and research in this field. This conference presented concepts heralding new opportunities for the oro-facial rehabilitation of doctor-induced osteonecrosis of the jaw (ONJ), both osteonecrosis radiation-induced (ORN) and medication-induced ONJ (MRONJ) in oncology patients.
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Affiliation(s)
- Paul Hr Wilson
- Department of Maxillofacial Surgery, Orthodontics and Restorative Dentistry, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Kumni Fasanmade
- Department of Maxillofacial Surgery, Orthodontics and Restorative Dentistry, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Prad Anand
- Department of Maxillofacial Surgery, Orthodontics and Restorative Dentistry, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
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21
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Grecchi F, Bianchi AE, Siervo S, Grecchi E, Lauritano D, Carinci F. A new surgical and technical approach in zygomatic implantology. ORAL & IMPLANTOLOGY 2018; 10:197-208. [PMID: 29876045 DOI: 10.11138/orl/2017.10.2.197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose Different surgical approaches for zygomatic implantology using new designed implants are reported. Material and methods The surgical technique is described and two cases reported. The zygomatic fixture has a complete extrasinus path in order to preserve the sinus membrane and to avoid any post-surgical sinus sequelae. Results The surgical procedure allows an optimal position of the implant and consequently an ideal emergence of the fixture on the alveolar crest. Conclusion The surgical procedures and the zygomatic implant design reduce remarkably the serious post-operative sequelae due to the intrasinus path of the zygomatic fixtures.
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Affiliation(s)
- F Grecchi
- Department of Maxillofacial Surgery, Galeazzi Hospital, Milan, Italy
| | - A E Bianchi
- Department of Maxillofacial Surgery, "Istituto Stomatologico Italiano", Milan, Italy
| | - S Siervo
- Department of Maxillofacial Surgery, "Istituto Stomatologico Italiano", Milan, Italy
| | - E Grecchi
- Department of Maxillofacial Surgery, Galeazzi Hospital, Milan, Italy
| | - D Lauritano
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - F Carinci
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
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22
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Zhao K, Lian M, Fan S, Huang W, Wang F, Wu Y. Long-term Schneiderian membrane thickness changes following zygomatic implant placement: A retrospective radiographic analysis using cone beam computed tomography. Clin Oral Implants Res 2018; 29:679-687. [PMID: 29774595 DOI: 10.1111/clr.13259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The purpose of this retrospective study was to evaluate the long-term changes in the thickness of Schneiderian membranes after zygomatic implant placement using cone beam computed tomography (CBCT). MATERIAL AND METHODS Twenty-five consecutive patients were included in this study. All the patients underwent bilateral zygomatic implant placement. Schneiderian membrane thickness (SMT) in 49 maxillary sinuses (one sinus was not included because of early loss of the zygomatic implants) was measured using CBCT before and at least 1 year after zygomatic implant placement. Ostium patency of each sinus was also evaluated and recorded. RESULTS In total, 84 zygomatic implants and 30 regular implants were placed in included patients. Two unilateral maxillary zygomatic implants in one patient were removed 2 months after implant placement. The SMT increased from 1.03 mm (inter-quartile range: 1.57 mm) to 1.33 mm (inter-quartile range: 1.98 mm) after a median follow-up time of 23.00 months (inter-quartile range: 14 months), and the difference was statistically significant. Before zygomatic implant insertion, 24.5% (12/49) of sinuses had SMT greater than 2 mm, whereas this value was 28.6% (14/49) after zygomatic implant placement. The percentage of sinuses observed with ostium patency also increased from 2.0% (1/49) to 12.2% (6/49). CONCLUSIONS Chronic Schneiderian membrane thickening could result from zygomatic implant insertion. Intensive postoperative care and clinical and radiographic monitoring are recommended after zygomatic implant placement.
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Affiliation(s)
- Kai Zhao
- Second Dental Clinic, Department of Oral Implantology, Shanghai Key Laboratory of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, National Clinical Research Center of Stomatology, Shanghai, China
| | - Meifei Lian
- Department of Prosthodontics, Shanghai Ninth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengchi Fan
- Second Dental Clinic, Department of Oral Implantology, Shanghai Key Laboratory of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, National Clinical Research Center of Stomatology, Shanghai, China
| | - Wei Huang
- Department of Oral Implantology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Wang
- Department of Oral Implantology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiqun Wu
- Second Dental Clinic, Department of Oral Implantology, Shanghai Key Laboratory of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, National Clinical Research Center of Stomatology, Shanghai, China
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23
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Aparicio C, Manresa C, Francisco K, Claros P, Alández J, González-Martín O, Albrektsson T. Zygomatic implants: indications, techniques and outcomes, and the zygomatic success code. Periodontol 2000 2016; 66:41-58. [PMID: 25123760 DOI: 10.1111/prd.12038] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 12/18/2022]
Abstract
The zygoma implant has been an effective option in the management of the atrophic edentulous maxilla as well as for maxillectomy defects. Brånemark introduced the zygoma implant not only as a solution to obtain posterior maxillary anchorage but also to expedite the rehabilitation process. The zygoma implant is a therapeutic option that deserves consideration in the treatment-planting process. This paper reviews the indications for zygoma implants and the surgical and prosthetic techniques (including new developments) and also reports on the clinical outcome of the zygomatic anatomy-guided approach. An overview of conventional grafting procedures is also included. Finally, a Zygoma Success Code, describing specific criteria to score the success of rehabilitation anchored on zygomatic implants, is proposed.
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24
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Chrcanovic BR, Albrektsson T, Wennerberg A. Survival and Complications of Zygomatic Implants: An Updated Systematic Review. J Oral Maxillofac Surg 2016; 74:1949-64. [PMID: 27422530 DOI: 10.1016/j.joms.2016.06.166] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/01/2016] [Accepted: 06/08/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE To assess the survival rate of zygomatic implants (ZIs) and the prevalence of complications based on previously published studies. MATERIALS AND METHODS An electronic search of 3 databases was performed in December 2015 and was supplemented by manual searching. Clinical series of ZIs were included. Interval survival rate and cumulative survival rate (CSR) were calculated. The untransformed proportion of complications (sinusitis, soft tissue infection, paresthesia, oroantral fistulas) was calculated by considering the prevalence reported in the studies. RESULTS Sixty-eight studies were included, comprising 4,556 ZIs in 2,161 patients with 103 failures. The 12-year CSR was 95.21%. Most failures were detected within the 6-month postsurgical period. Studies (n = 26) that exclusively evaluated immediate loading showed a statistically lower ZI failure rate than studies (n = 34) evaluating delayed loading protocols (P = .003). Studies (n = 5) evaluating ZIs for the rehabilitation of patients after maxillary resections presented lower survival rates. The probability of presenting postoperative complications with ZIs was as follows: sinusitis, 2.4% (95% confidence interval [CI], 1.8-3.0); soft tissue infection, 2.0% (95% CI, 1.2-2.8); paresthesia, 1.0% (95% CI, 0.5-1.4); and oroantral fistulas, 0.4% (95% CI, 0.1-0.6). However, these numbers might be underestimated, because many studies failed to mention the prevalence of these complications. CONCLUSION ZIs present a high 12-year CSR, with most failures occurring at the early stages postoperatively. The main observed complication related to ZIs was sinusitis, which can appear several years after ZI installation surgery.
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Affiliation(s)
- Bruno Ramos Chrcanovic
- PhD student, Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
| | - Tomas Albrektsson
- Retired Professor and former Department Head, Department of Biomaterials, Göteborg University, Göteborg; Guest Professor, Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Ann Wennerberg
- Professor and Department Head, Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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D'Agostino A, Trevisiol L, Favero V, Pessina M, Procacci P, Nocini PF. Are Zygomatic Implants Associated With Maxillary Sinusitis? J Oral Maxillofac Surg 2016; 74:1562-73. [PMID: 27070844 DOI: 10.1016/j.joms.2016.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/15/2016] [Accepted: 03/15/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of the present study was to analyze the relation between zygomatic implants and symptomatic and radiologic modifications of the maxillary sinuses. MATERIALS AND METHODS A retrospective cohort study of patients who underwent zygomatic implant rehabilitation at the Clinic of Dentistry and Maxillofacial Surgery of the University of Verona from January 2005 through May 2014 was designed. The primary predictor variable was time (pre- vs postoperative). Concerning outcome variables, radiologic findings of thickened mucosa or opacification of the maxillary sinuses were evaluated on computed tomograms using the Lund-Mackay Staging System. Clinical symptoms were evaluated using the Sino-Nasal Outcome Test-20 (SNOT-20). The parameters assessed underwent descriptive statistical analysis. RESULTS The sample was composed of 41 patients (mean age, 54 yr; 61% women). Preoperatively, 12% had sinus findings. Postoperatively, 46% had sinus findings (P = .0001 by McNemar paired test). Preoperatively, 12% had a SNOT-20 score higher than 11. Postoperatively, 15% had a SNOT-20 score higher than 11 (P = 1 by McNemar paired test). CONCLUSIONS In accordance with data in the literature data, placement of zygomatic implants does not seem to be associated with severe rhinosinusitis complications. However, in a considerable number of patients, asymptomatic radiologic alterations of the paranasal sinuses were observed. Therefore, it is important to plan assessments of the prosthetic and peri-implant components of the procedure and the postoperative homeostasis of the maxillary sinuses.
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Affiliation(s)
- Antonio D'Agostino
- Associate Professor, Section of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy
| | - Lorenzo Trevisiol
- Associate Professor, Section of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy
| | - Vittorio Favero
- Clinical Assistant, Section of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy.
| | - Mattia Pessina
- Clinical Assistant, Section of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy
| | - Pasquale Procacci
- Assistant Professor, Section of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy
| | - Pier Francesco Nocini
- Professor and Chief, Section of Oral and Maxillofacial Surgery, University of Verona, Verona, Italy
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