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Minase DA, Sathe S, Borle A, Mundada BP, Doshi K. Zygomatic Implants in a Patient With History of Mucormycosis: A Case Report. Cureus 2024; 16:e65512. [PMID: 39188455 PMCID: PMC11346810 DOI: 10.7759/cureus.65512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 07/27/2024] [Indexed: 08/28/2024] Open
Abstract
Exposure to mucor mold can lead to mucormycosis, a rare fungal infection with severe consequences, especially in immunocompromised individuals. The year 2020 highlighted the need for orofacial rehabilitation, presenting challenges in cases of maxillary absence. This case report details zygomatic implants, which offer a promising solution by providing stable support even in the absence of significant bone mass due to surgical excision post-COVID-19 mucormycosis. Zygomatic implants outperform traditional grafting techniques. The atrophic or resected jaws can be effectively restored with a single-piece zygomatic implant, which has the lowest rate of postoperative problems, including bone loss, mucositis, peri-implantitis, and screw loosening or fractures. In this case report, four zygomatic implants were placed in the zygomatic bone, and immediate loading was performed. Restoration of patient aesthetics, phonetics, and functional masticatory efficiency were restored.
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Affiliation(s)
- Dhanashree A Minase
- Prosthodontics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Seema Sathe
- Prosthodontics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anjali Borle
- Prosthodontics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Bhushan P Mundada
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Khushbu Doshi
- Prosthodontics, Sharad Pawar Dental College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Leblebicioğlu Kurtuluş İ, Kilic D, Kilic K. Dental Versus Zygomatic Implants in the Treatment of Maxillectomy: A Finite Element Analysis. J ORAL IMPLANTOL 2024; 50:220-230. [PMID: 38839068 DOI: 10.1563/aaid-joi-d-24-00008] [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: 06/07/2024]
Abstract
This study analyzed the stress distributions on zygomatic and dental implants placed in the zygomatic bone, supporting bones, and superstructures under occlusal loads after maxillary reconstruction with obturator prostheses. A total of 12 scenarios of 3-dimensional finite element models were constructed based on computerized tomography scans of a hemimaxillectomy patient. Two obturator prostheses were analyzed for each model. A total force of 600 N was applied from the palatal to buccal bones at an angle of 45°. The maximum and minimum principal stress values for bone and von Mises stress values for dental implants and prostheses were calculated. When zygomatic implants were applied to the defect area, the maximum principal stresses were similar in intensity to the other models; however, the minimum principal stress values were higher than in scenarios without zygomatic implants. In models that used zygomatic implants in the defect area, von Mises stress levels were significantly higher in zygomatic implants than in dental implants. In scenarios where the prosthesis was supported by tissue in the nondefect area, the maximum and minimum principal stress values on cortical bone were higher than in scenarios where implants were applied to defect and nondefect areas. In patients who lack an alveolar crest after maxillectomy, a custom bar-retained prosthesis placed on the dental implant should reduce stress on the zygomatic bone. The stress was higher on zygomatic implants without alveolar crest support than on dental implants.
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Affiliation(s)
| | - Duygu Kilic
- Department of Periodontology, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - Kerem Kilic
- Department of Prosthodontics, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
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Daniel D, Pande D, Bakshi JHI, Jose J. Biomechanical Evaluation of Zygomatic Implant Versus Pterygoid Implant in Atrophic Maxilla: An In vitro Finite Element Study. J Maxillofac Oral Surg 2024; 23:734-744. [PMID: 38911426 PMCID: PMC11189858 DOI: 10.1007/s12663-024-02128-1] [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: 10/27/2023] [Accepted: 01/24/2024] [Indexed: 06/25/2024] Open
Abstract
Background and Purpose Dental implants are considered to be one of several treatment options that can be used to replace missing teeth. The objective of the study is to examine and compare the biomechanics of zygomatic and pterygoid implants planned on the atrophic maxilla with three different bone types. Materials and Methods An in vitro finite element study was conducted on a three-dimensional model of zygomatic and pterygoid implants. In a total of 24 implants, two bilateral zygomatic and pterygoid implants with two anterior dental implants were inserted in models. 150 N vertical occlusal and 300 N load on masseter and medial pterygoid were simulated on the modeled prosthesis. The data were processed with ANSYS software. The stress on and deformations of the bones and implants were observed and compared. Results When comparing the D4, D3, and D2 bones in subgroup I with zygomatic implants, the D2 bone was subjected to less stress compared to D3 and D4. The smallest displacement (0.125784 mm) was seen in D4 followed by the largest displacement (0.74073 mm) in D2. Similarly, when comparing the D2, D3, and D4 bone in subgroup II with pterygoid implants, the D2 bone in the atrophic maxilla received the least amount of stress from the pterygoid implants compared to D3 and D4. Furthermore, the smallest displacement (0.030934 mm) was seen in D2, and the largest (0.046319 mm) in D4. Conclusion Results suggest firstly, that the overall stress was better distributed in D2 bone and secondly, the pterygoid implant showed higher stress concentration than the zygomatic implant.
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Affiliation(s)
- Diana Daniel
- The Oxford Dental College, Rajiv Gandhi University of Health Science, Bengaluru, India
| | - Deepa Pande
- The Oxford Dental College, Rajiv Gandhi University of Health Science, Bengaluru, India
| | - Javeed Hussain I. Bakshi
- Smile Arc Dental Studio - Rayasandra Bangalore, Rajiv Gandhi University of Health Science, #229, Vivek Nagar (W), Behind B.D.A, Hudco, Jalnagar, Vijayapura, Karnataka 586109 India
| | - Jerin Jose
- Nurture Multispeciality Dental Clinic - Panathur Bangalore, Bengaluru, India
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Manekar VS, Datarkar AN, Ghormode A, Daware S, Pandilwar P, Sapkal P. Comparison of Two Types of Patient Specific Implants (PSI) and Quad Zygoma Implant (QZI) for Rehabilitation of Post-COVID Maxillary Mucormycosis Defect (PCMMD): Finite Element Analysis. J Maxillofac Oral Surg 2023; 22:688-694. [PMID: 37534346 PMCID: PMC10390377 DOI: 10.1007/s12663-023-01950-3] [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: 10/11/2022] [Accepted: 05/29/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction The residual post-COVID maxillary mucormycosis defect (PCMMD) were extensive, due to unilateral or bilateral maxillectomies. The Goal of rehabilitation of PCMMD is to deliver a prosthetically driven reconstruction. FEA was to evaluate the biomechanical response of PSI struts (PSI 1), PSI Screw retained (PSI 2) and QZI to masticatory load on virtual simulation to improve accuracy and enhance the design. Aim To validate and compare the Biomechanical benefit of the PSI struts, PSI Screw retained, QZI in a case of rehabilitation of post-COVID maxillary mucormycosis defect (PCMMD) by FEA study. Methodology The result of stress to masticatory load on virtual simulation for (1) Maximum and minimum stress (Von Mises stress); (2) the Displacement (in three positions) and (3) the Deformation (Plastic strain) was compared on virtual simulation for PSI 1 and PSI 2 and QZI. Conclusion The FEA and comparative evaluation of PSI 1, PSI 2 and QZI showed a good resistance to displacement. The stress and strain values are low and acceptable. In comparison QZI shows more stress in the anterior region.
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Affiliation(s)
- Varsha Sunil Manekar
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
| | - Abhay N. Datarkar
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
| | - Ashlesha Ghormode
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
| | - Surendra Daware
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
| | - Prashant Pandilwar
- Oral and Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, Maharashtra 444003 India
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Mousa MA, Abdullah JY, Jamayet NB, Alam MK, Husein A. Biomechanical Stress in Obturator Prostheses: A Systematic Review of Finite Element Studies. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6419774. [PMID: 34447852 PMCID: PMC8384539 DOI: 10.1155/2021/6419774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022]
Abstract
AIM This systematic review is aimed at investigating the biomechanical stress that develops in the maxillofacial prostheses (MFP) and supporting structures and methods to optimize it. Design and Methods. A literature survey was conducted for full-text English articles which used FEA to examine the stress developed in conventional and implant-assisted MFPs from January 2010 to December 2020. RESULTS 87 articles were screened to get an update on the desired information. 74 were excluded based on a complete screening, and finally, 13 articles were recruited for complete reviewing. Discussion. The MFP is subjected to stress, which is reflected in the form of compressive and tensile strengths. The stress is mainly concentrated the resection line and around the apices of roots of teeth next to the defect. Diversity of designs and techniques were introduced to optimize the stress distribution, such as modification of the clasp design, using materials with different mechanical properties for dentures base and retainer, use of dental (DI) and/or zygomatic implants (ZI), and free flap reconstruction before prosthetic rehabilitation. CONCLUSION Using ZI in the defective side of the dentulous maxillary defect and defective and nondefective side of the edentulous maxillary defect was found more advantageous, in terms of compression and tensile stress and retention, when compared with DI and free flap reconstruction.
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Affiliation(s)
- Mohammed A. Mousa
- Prosthodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
- Department of Prosthetic Dental Sciences, College of Dentistry, Jouf University, Sakakah, Jouf Province, Saudi Arabia
| | - Johari Yap Abdullah
- Craniofacial Imaging Laboratory, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Nafij B. Jamayet
- Division of Restorative Dentistry, International Medical University, Bukit Jalil, Jalan Jalil Perkasa-19, 57000 Kuala Lumpur, Malaysia
| | | | - Adam Husein
- Prosthodontic Unit, School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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Sender B, Lacroix T, Jaby P, Chaux-Bodard AG. Are zygomatic implants a simple and reliable technique for the stabilization of obturator prostheses? Case report and review of the literature. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2020. [DOI: 10.1051/mbcb/2020002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Zygomatic implants have been used for several years for the treatment of extremely resorbed maxilla. Indications were extended for oral rehabilitations after maxillectomy in oncologic patients. A 24-year old patient with a triple A syndrome who underwent a left maxillectomy due to a spinocellular tumour was addressed for prosthetic rehabilitation. As his obturator prosthesis failed, surgical closure of the defect combined with 2 zygomatic implants to support the prosthesis was proposed. Despite a small persistent oro-antral fistula, the new obturator prosthesis restored the patient's functions and esthetics and improved his quality of life. The literature reports less than 40 cases of maxillectomy patients rehabilitated with zygomatic implants (with or without flap closure of the defect). Regardless of implant placement, there is no significant difference between reconstructive surgery and obturator prosthesis. Thus, zygomatic implants seem to be a reliable method for the stabilization of obturator prosthesis, without complex surgical procedure. Nonetheless, reservations should be expressed given the lack of data in terms of long-term follow up.
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Comparison of Three Different Types of Two-Implant-Supported Magnetic Attachments on the Stress Distribution in Edentulous Mandible. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2019; 2019:6839517. [PMID: 31089390 PMCID: PMC6476138 DOI: 10.1155/2019/6839517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 01/21/2019] [Indexed: 11/17/2022]
Abstract
Two-implant-retained mandibular overdentures with magnetic attachments can provide an effective treatment modality for edentulous patients. In this study, a three-dimensional finite element analysis was used to compare the biomechanical characteristics of three different types of magnetic attachments in two-implant-retained mandibular overdentures. Flat-type, dome-type, and cushion-type of the magnetic attachments were designed to retain the overdenture. Four types of load were applied to the overdenture in each model: 100 N vertical and oblique loads on the right first molar and a 100 N vertical load on the right canine and the lower incisors. The biomechanical behaviors of peri-implant bone, abutment, and mucosa were recorded. In vertical incisors, vertical right canine, and oblique molar loading condition, the flat-type group exhibited the highest levels of maximum equivalent strain/stress in the peri-implant bone. The total deformation of mucosa and the maximum equivalent strain/stress in the oblique molar loading condition are about two times as the vertical molar loading condition. These results suggested that both cushion-type and dome-type of the magnetic attachments are better choices in two-implant-retained mandibular overdentures, and oblique loading is more harmful than vertical loading.
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Abstract
PURPOSE The aim of this study was to systematically review and compare the survival rates (SRs) of oral rehabilitations performed with 2 zygomatic implants (ZIs) combined with regular implants (RIs) versus 4 ZI. MATERIAL AND METHODS An electronic search was performed in several databases for articles published in English between 2007 and 2015. Articles reporting human studies were included in this systematic review. RESULTS The search yielded to a total of 417 studies, of which 6 were included in this study. ZIs SR weighted mean was 98.0% with a 95% confidence interval (CI) of 96.7% to 99.8%. For the control group (2 ZIs + 2 RIs) and the test group (4 ZIs), the implant SR was 98.6% and 97.4%, respectively, with a 95% CI. No statistically significant differences in terms of SRs were obtained between both groups P = 0.286. CONCLUSIONS The data analysis showed favorable results for treatment with 4 ZIs. The results showed no statistical differences in using 1 or another treatment, in terms of survival and failure rates. The reduction on treatment time and morbidity related to regenerative approaches may be its main advantage. In conclusion, the zygoma quad seems to be the treatment of choice for the rehabilitation of the severely atrophic maxilla.
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WANG D, QU A, ZHOU H, WANG M. BIOMECHANICAL ANALYSIS OF THE APPLICATION OF ZYGOMA IMPLANTS FOR PROSTHESIS IN UNILATERAL MAXILLARY DEFECT. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416400303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of this research is to evaluate the biomechanical effect of zygomatic implant-supported obturator prostheses in unilateral maxillary defect. Based on CT data, four 3D numerical models were built. One model was a normal craniofacial complex (model 1) and other three models were structures with unilateral maxilla defect reconstructed using clasp-retained obturator prosthesis (model 2), one zygomatic implant-supported and clasp-retained prosthesis (model 3), two zygomatic implant-supported and clasp-retained prosthesis (model 4). Bilateral vertical loads of 300[Formula: see text]N were imposed and the stress and displacement distribution were calculated, analyzed and compared. The bilateral occlusal forces dispersed along the three-mechanical-pillar of the maxillofacial region and the displacement distributed symmetrically in model 1. Because of mechanical pillars break on the affected side, all occlusal forces were transferred by clasps and abutment teeth in model 2, which induced the increase in stress and displacement level. The zygomatic implant restored mechanical pillars and greatly reduced the stress and displacements levels in models 3 and 4. The stress and displacement distributions on clasps, bones, teeth and periodontal ligaments were more reasonable with the support of zygomatic implants. Therefore, the zygomatic implant-supported and clasp-retained prostheses were found to be more effective for unilateral maxillary defect reestablishment.
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Affiliation(s)
- D. WANG
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - A. QU
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, P. R. China
| | - H. ZHOU
- Shanghai Testing & Inspection Institute for Medical Devices, Shanghai 201318, P. R. China
| | - M. WANG
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People’s Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, P. R. China
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Qu XZ, Wang MY, Ong HS, Zhang CP. Post-operative hemimaxillectomy rehabilitation using prostheses supported by zygoma implants and remaining natural teeth. Clinics (Sao Paulo) 2016; 71:575-579. [PMID: 27759845 PMCID: PMC5054771 DOI: 10.6061/clinics/2016(10)04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 07/25/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES: This study aimed to evaluate the stability of prostheses supported by zygoma implants and remaining teeth for subjects who had undergone hemi-maxillectomy. METHODS: Ten patients were included in the study. Oral rehabilitation was performed using a temporary prosthesis that was supported by remaining teeth for the first three months. Then, a zygoma implant was placed to provide support for a final prosthesis in addition to the remaining teeth. Each prosthesis was tailor-made according to biomechanical three-dimensional finite element analysis results. The patients were assessed using the prosthesis functioning scale of the Memorial Sloan-Kettering Cancer Center. In addition, retention and bite force were recorded for both the temporary prosthesis and the final prosthesis. RESULTS: The mean bite force of the prosthetic first molar was increased to 69.2 N. The mean retentive force increased to 13.5 N after zygoma implant insertion. The bite force on the prosthetic first molar was improved to 229.3 N. CONCLUSION: Bite force increased significantly with the support of a zygoma implant. The use of zygoma implants in the restoration of maxillary defects improved functional outcome and patient satisfaction.
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Affiliation(s)
- Xing Zhou Qu
- Shanghai Ninth People’s Hospital, Affiliated to Shanghai Jiao Tong University, Department of Oral Maxillofacial-Head & Neck Oncology, Shanghai, China
| | - Ming Yi Wang
- Shanghai Ninth People’s Hospital, Affiliated to Shanghai Jiao Tong University, Department of Oral Maxillofacial-Head & Neck Oncology, Shanghai, China
| | - Hui Shan Ong
- Shanghai Ninth People’s Hospital, Affiliated to Shanghai Jiao Tong University, Department of Oral Maxillofacial-Head & Neck Oncology, Shanghai, China
| | - Chen Ping Zhang
- Shanghai Ninth People’s Hospital, Affiliated to Shanghai Jiao Tong University, Department of Oral Maxillofacial-Head & Neck Oncology, Shanghai, China
- E-mail:
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Stress distribution of implant retained obturators using different types of attachments: A three dimensional finite element analysis. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.tdj.2015.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Akay C, Yaluğ S. Biomechanical 3-dimensional finite element analysis of obturator protheses retained with zygomatic and dental implants in maxillary defects. Med Sci Monit 2015; 21:604-11. [PMID: 25714086 PMCID: PMC4350528 DOI: 10.12659/msm.892680] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The objective of this study was to investigate the stress distribution in the bone around zygomatic and dental implants for 3 different implant-retained obturator prostheses designs in a Aramany class IV maxillary defect using 3-dimensional finite element analysis (FEA). Material\Methods A 3-dimensional finite element model of an Aramany class IV defect was created. Three different implant-retained obturator prostheses were modeled: model 1 with 1 zygomatic implant and 1 dental implant, model 2 with 1 zygomatic implant and 2 dental implants, and model 3 with 2 zygomatic implants. Locator attachments were used as a superstructure. A 150-N load was applied 3 different ways. Qualitative analysis was based on the scale of maximum principal stress; values obtained through quantitative analysis are expressed in MPa. Results In all loading conditions, model 3 (when compared models 1 and 2) showed the lowest maximum principal stress value. Model 3 is the most appropirate reconstruction in Aramany class IV maxillary defects. Two zygomatic implants can reduce the stresses in model 3. The distribution of stresses on prostheses were more rational with the help of zygoma implants, which can distribute the stresses on each part of the maxilla. Conclusions Aramany class IV obturator prosthesis placement of 2 zygomatic implants in each side of the maxilla is more advantageous than placement of dental implants. In the non-defective side, increasing the number of dental implants is not as suitable as zygomatic implants.
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Affiliation(s)
- Canan Akay
- Prosthodontist, Private Practice, Ankara, Turkey
| | - Suat Yaluğ
- Department of Prosthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
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Goiato M, Pellizzer E, Moreno A, Gennari-Filho H, dos Santos D, Santiago J, dos Santos E. Implants in the zygomatic bone for maxillary prosthetic rehabilitation: a systematic review. Int J Oral Maxillofac Surg 2014; 43:748-57. [DOI: 10.1016/j.ijom.2014.01.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 01/06/2014] [Accepted: 01/09/2014] [Indexed: 11/16/2022]
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Romeed SA, Malik R, Dunne SM. Zygomatic Implants: The Impact of Zygoma Bone Support on Biomechanics. J ORAL IMPLANTOL 2014; 40:231-7. [DOI: 10.1563/aaid-joi-d-11-00245] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Maxillectomy and severely resorbed maxilla are challenging to restore with provision of removable prostheses. Dental implants are essential to restore esthetics and function and subsequently quality of life in such group of patients. Zygomatic implants reduce the complications associated with bone grafting procedures and simplify the rehabilitation of atrophic maxilla and maxillectomy. The purpose of this study was to compare, by means of 3-dimensional finite element analysis, the impact of different zygomatic bone support (10, 15, and 20 mm) on the biomechanics of zygomatic implants. Results indicated that maximum stresses within the fixture were increased by 3 times when bone support decreased from 20 to 10 mm and were concentrated at the fixture/bone interface. However, stresses within the abutment screw and the abutment itself were not significantly different regardless of the bone support level. Supporting bone at 10 mm sustained double the stresses of 15 and 20 mm. Fixture's deflection was decreased by 2 to 3 times when bone support level increased to 15 mm and 20 mm, respectively. It was concluded that zygomatic bone support should not be less than 15 mm, and abutment screw is not at risk of fracture regardless of the zygomatic bone support.
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Affiliation(s)
- Shihab A. Romeed
- Deptartment Restorative Dentistry, King's College London Dental Institute, London, UK
| | | | - Stephen M. Dunne
- Deptartment Restorative Dentistry, King's College London Dental Institute, London, UK
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Wen H, Guo W, Liang R, Xiang L, Long G, Wang T, Deng M, Tian W. Finite element analysis of three zygomatic implant techniques for the severely atrophic edentulous maxilla. J Prosthet Dent 2014; 111:203-15. [PMID: 24314571 DOI: 10.1016/j.prosdent.2013.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 05/10/2013] [Accepted: 05/16/2013] [Indexed: 01/13/2023]
Abstract
STATEMENT OF PROBLEM A variety of zygomatic implantation techniques currently exist; however, a consensus regarding the most suitable method has not yet been reached. PURPOSE The purpose of this study was to evaluate and compare 3 zygomatic implantation techniques and to clarify the optimal number and position of zygomatic and dental implants for the reconstruction of the severely atrophied edentulous maxilla. MATERIAL AND METHODS A 3-dimensional finite element analysis craniofacial model was constructed from the computed tomography data of a selected patient with a severely atrophic edentulous maxilla. Modeled zygomatic implants were inserted into the craniofacial model with 3 surgical techniques (classic Brånemark, exteriorized, and extramaxillary), and with 3 model variations that involved the number and position of zygomatic and dental implants. The zygomatic implants were loaded with a vertical force of 150 N and a lateral force of 50 N. The stresses on and deformations of the bones and implants were then observed and compared. RESULTS No obvious differences in the amount and distribution of stress on the external craniofacial bones were detected in the models. The lowest stresses on the zygomatic implants were observed in the exteriorized technique group. The lowest deformations of the bone that surrounds zygomatic implants and dental implants were observed in the exteriorized technique and classic Brånemark technique groups. For the exteriorized technique group, the model with 1 dental implant in the site of the maxillary lateral incisor exhibited the lowest stress on the zygomatic implants and the least deformation of the bone surrounding the zygomatic and dental implants. CONCLUSIONS All 3 zygomatic implant techniques resulted in more or less homogeneous transference of force and thus could reconstruct the edentulous maxilla; however, the exteriorized technique with 1 dental implant in the lateral incisor appeared to be the most appropriate reconstruction method for the severely atrophied edentulous maxilla.
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Affiliation(s)
- Hailin Wen
- Postgraduate student, Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University; National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Weihua Guo
- Associate Professor, Department of Pedodontics, West China College of Stomatology, Sichuan University; National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Rui Liang
- Postgraduate student, College of Architecture and Environment, Sichuan University; National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lin Xiang
- Postgraduate student, Department of Implantology, West China College of Stomatology, Sichuan University; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Gang Long
- Postgraduate student, Department of Implantology, West China College of Stomatology, Sichuan University; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tingting Wang
- Postgraduate student, Department of Endodontics, West China College of Stomatology, Sichuan University; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Meng Deng
- Postgraduate student, Department of Endodontics, West China College of Stomatology, Sichuan University; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Weidong Tian
- Professor and Director, Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University; National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Vega LG, Gielincki W, Fernandes RP. Zygoma implant reconstruction of acquired maxillary bony defects. Oral Maxillofac Surg Clin North Am 2013; 25:223-39. [PMID: 23642670 DOI: 10.1016/j.coms.2013.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The reconstruction of acquired maxillary bony defects after pathologic ablation, infectious debridement, avulsive trauma, or previously failed reconstructions with zygoma implants represents a treatment alternative that is safe, predictable, and cost-effective. Still the single most important factor for treatment success of these complex reconstructions is the implementation of a team approach between the surgeon and the restorative dentist. The focus of this article is to review the surgical and prosthetic nuances to successfully reconstruct acquired maxillary defects with zygoma implants.
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Affiliation(s)
- Luis G Vega
- Oral and Maxillofacial Residency Program, Health Science Center at Jacksonville, University of Florida, Jacksonville, FL 32209, USA.
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17
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Wang M, Qu X, Cao M, Wang D, Zhang C. Biomechanical three-dimensional finite element analysis of prostheses retained with/without zygoma implants in maxillectomy patients. J Biomech 2013; 46:1155-61. [DOI: 10.1016/j.jbiomech.2013.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 12/30/2012] [Accepted: 01/02/2013] [Indexed: 11/16/2022]
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