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Davó R, Fan S, Wang F, Wu Y. Long-term survival and complications of Quad Zygoma Protocol with Anatomy-Guided Approach in severely atrophic maxilla: A retrospective follow-up analysis of up to 17 years. Clin Implant Dent Relat Res 2024; 26:343-355. [PMID: 38084831 DOI: 10.1111/cid.13296] [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: 08/30/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION The objective of the study was to provide long-term clinical outcomes and complications in the severely atrophic edentulous maxillae treated by means of the quad zygoma protocol (QZP) using the Anatomy-Guided Approach (AGA). METHODS This was a retrospective cohort study of all consecutive patients with severely atrophic edentulous maxilla and insufficient bone height and width in the anterior and posterior regions bilaterally, who underwent rehabilitation with the QZP between May 2006 and December 2021. All patients were followed for at least 1 year. All zygomatic implants (ZIs) were placed by the same surgeon. The primary endpoint of the study was the implant survival rate. Secondary endpoints were implant success rate, prosthesis success rate, complications, and Oral Health-Related Quality of Life using the OHIP-14 questionnaire. RESULTS A total of 56 patients (men 16, women 40) with 224 ZIs (Nobel Biocare, n = 204; Straumann, n = 16; Southern Implant, n = 4) placement were included with a mean follow-up period 8.8 ± 3.9 years (range, 1.2-17.0). The survival (success) rate was 97.7%. Five ZIs in four patients failed. The mean time between implant placement and failure was 8.6 years (range, 0.5-13.3). All patients received immediate loading with acrylic prosthesis. The successful rates for the definitive prosthesis were 98.2%. Forty-two patients received posterior cantilever for rehabilitation of fixed definitive prosthesis. Local orofacial inflammation (35.7%) and Sinusitis (12.5%) were the most common complications, occurring at a mean follow-up of 10.0 (range, 4.2-14.9) and 10.3 (range, 4.3-16.2) years, respectively. In 48 patients, the mean score of the OHIP-14 questionnaire was 1.7 ± 2.6 with the follow-up period of 9.0 ± 4.1 years. CONCLUSIONS The rehabilitation of severely atrophic edentulous maxilla using the QZP has shown a predictable and high survival rate in the long term. The implementation of an immediate loading protocol offers potential benefits in stabilizing ZIs with cross-arch stabilization. Moreover, the use of a posterior cantilever in reconstruction can effectively establish functional occlusion through well-distributed ZIs, eliminating the need for additional implant placement.
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Affiliation(s)
- Rubén Davó
- Department of Implantology and Maxillofacial Surgery, Vithas Davó Instituto Dental, Hospital Medimar Internacional, Alicante, Spain
| | - Shengchi Fan
- Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center Mainz, 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, China
| | - 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, China
| | - 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, China
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Lan R, Wu Y, Dai Q, Wang F. Gene mutations and chromosomal abnormalities in syndromes with tooth agenesis. Oral Dis 2023; 29:2401-2408. [PMID: 36219525 DOI: 10.1111/odi.14402] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/19/2022] [Accepted: 10/03/2022] [Indexed: 11/28/2022]
Abstract
This study aims to review the pathogenic mechanisms and clinical manifestations in syndromes with tooth agenesis (TA). Online Mendelian Inheritance in Man and PubMed databases were searched for a comprehensive review. Previous publications reported complicated aetiologies of syndromic TA. Gene mutations in conserved signalling pathways (WNT, EDA, SHH, FGF, and TGF-β/BMP) and crucial molecules (PAX9, PIXT2, IRF6, the p53 family, and subunits of RNA polymerase III) are the main causes of syndromic TA. In the process of odontogenesis, antagonistic or synergistic interactions are demonstrated in patients and murine models. Mutations in some genes (WNT10A, WNT10B, AXIN2, ANTXR1, MSX1, EDA, EDAR, and EDARADD) can result in both syndromic and isolated TA. In addition, chromosomal anomalies are also responsible for syndromic TA (Down syndrome, Wolf-Hirschhorn syndrome, Williams syndrome, and Pierre Robin sequence). The causes and manifestations of syndromic TA are highly complex, and this constitutes a clinical challenge. Mutations in signalling pathways and crucial molecules as well as chromosomal anomalies are responsible for syndromic TA. And there are overlaps between the causative genes of syndromic and isolated TA.
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Affiliation(s)
- Rong Lan
- Department of Oral Implantology, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; 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, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; 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
| | - Qinggang Dai
- Department of Second Dental Center, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; 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, College of Stomatology, Shanghai Jiao Tong University School of Medicine; 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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Wang F, Tao B, Shen Y, Li C, Huang W, Sun Y, Wu Y. A single-arm clinical trial investigating the feasibility of the zygomatic implant quad approach for Cawood and Howell Class 4 edentulous maxilla: An option for immediate loading. Clin Implant Dent Relat Res 2021; 23:800-808. [PMID: 34580991 DOI: 10.1111/cid.13046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 08/06/2021] [Accepted: 08/30/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The traditional way to treat maxillary edentulous Cawood and Howell Class 4 (CH4) patients who exhibit the knife-edge ridge form of edentulous jaws that are adequate in height and inadequate in width is extensive autologous bone grafting for conventional implant placement. PURPOSE To evaluate the feasibility of the zygomatic implant (ZI) quad approach in edentulous CH4 patients who presented a knife-edge ridge form in the anterior maxilla for immediate loading. MATERIAL AND METHODS Eligible patients with maxillary CH4 edentulism treated with the ZI quad approach were enrolled. Bone reduction and implant placement were performed under the guidance of a navigation system according to preoperative planning. The outcome variable was the implant survival rate, and additional variables were the ratio of immediate loading, complications and the relationship of the zygomatic implant path to the sinus wall. Statistical analysis was performed with the SAS statistical package. RESULTS Fifteen patients (3 men, 12 women; age range, 19-71 years; average age 47.2 years) eligible for the study received the ZI quad approach from January 2017 through January 2020. All ZIs achieved osseointegration, with no implant loss after early healing and a mean follow-up of 17.2 ± 6.2 months. Thirteen of 15 patients (86.7%) received immediate loading. No critical anatomic structure injuries occurred during surgery. Most mesially placed implants (23/30, 76.6%) presented ZAGA 2 and 3, and most distally placed implants were distributed in ZAGA 0 (20/30, 66.7%). DISCUSSION In terms of realizing immediate loading in CH4 patients with a knife-edge ridge form in the anterior maxilla, quad approaches have advantages over other grafting methods. At the same time, it seems the survival rate of zygomatic implants is comparable with that of other indications. With the limitations of this study, the quad approach might be a feasible option to realize edentulous maxillary reconstruction and to make immediate loading possible.
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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
| | - Baoxin Tao
- 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
| | - 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
| | - 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
| | - Yuanyuan Sun
- 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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Goker F, Grecchi E, Mancini EG, Del Fabbro M, Grecchi F. Zygomatic implant survival in 9 ectodermal dysplasia patients with 3.5- to 7-year follow-up. Oral Dis 2020; 26:1803-1809. [PMID: 32583493 DOI: 10.1111/odi.13505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/29/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Ectodermal dysplasia syndrome is a complex group of genetic disorders identified by the abnormal development of the ectodermal structures. The aim of this retrospective clinical case series report was to evaluate the outcomes of the ectodermal dysplasia syndrome patients that underwent zygomatic implant surgery. MATERIALS AND METHODS A total of 9 ectodermal dysplasia syndrome patients aged between 21 and 56 years (mean age 36.8) with severely atrophic maxilla were included in this study. All the patients were treated with a total of 19 zygomatic implants. The mean follow-up of the patients was 55 months (with a range of 44-84 months). The implant survival rate was evaluated as a primary outcome. The intra- and postoperative complications were evaluated as additional criteria for success. RESULTS The overall implant survival rate was 100% without any complications. Final or provisional prosthesis was delivered on the same day of surgery, which resulted in an improvement of the quality of life of the patients. CONCLUSION According to the results of this study, zygomatic surgery can be considered as a viable and safe alternative to conventional treatment modalities for oral rehabilitation of ectodermal dysplasia syndrome patients.
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Affiliation(s)
- Funda Goker
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy
| | - Emma Grecchi
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy
| | | | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy.,IRCCS Orthopedic Institute Galeazzi, Milano, Italy
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Wang H, Hung K, Zhao K, Wang Y, Wang F, Wu Y. Anatomical analysis of zygomatic bone in ectodermal dysplasia patients with oligodontia. Clin Implant Dent Relat Res 2019; 21:310-316. [PMID: 30793468 PMCID: PMC6593974 DOI: 10.1111/cid.12731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/17/2019] [Indexed: 11/29/2022]
Abstract
Background Abnormalities of some facial bones derived from the ectomesenchyme have been found in ectodermal dysplasia (ED) patients, but the characteristics of the zygoma are unknown. Purpose Comparison between ED patients and normal individuals to understand the anatomical features of the zygoma in ED patients. Materials and Methods Thirty patients diagnosed with ED based on clinical features and/or gene sequence tests and 80 normal individuals were recruited from 2016 to 2018. The thickness of the zygomatic body at 12 points on the superior, middle, and inferior areas and the length of four lines were measured on a three‐dimensional cone beam computed tomography image. Differences between ED patients and normal individuals were then compared. Results The zygomatic thicknesses and lengths were smaller in ED patients than in normal individuals. For ED patients, the largest thicknesses on the superior, middle, and inferior areas of the zygoma were 8.47 ± 1.49, 7.03 ± 1.56, and 5.99 ± 1.22 mm. Conclusion The development of zygomatic thickness on the inferior area and the zygomatic length were insufficient in ED patients with oligodontia. Consequently, zygomatic hypoplasia presented difficulties for the “quad approach” to zygomatic implants in this group of patients.
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Affiliation(s)
- Haowei Wang
- Second Dental Clinic, Department of Oral Implantology, 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, China
| | - Kuofeng Hung
- Faculty of Dentistry, Oral and Maxillofacial Radiology, Applied Oral Sciences, The University of Hong Kong, Hong Kong, China
| | - Kai Zhao
- Second Dental Clinic, Department of Oral Implantology, 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, China
| | - Yueping 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, China
| | - Feng Wang
- Department of Oral Implantology, 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, China
| | - Yiqun Wu
- Second Dental Clinic, Department of Oral Implantology, 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, China
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