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Testori T, Clauser T, Rapani A, Artzi Z, Avila-Ortiz G, Barootchi S, Bressan E, Chiapasco M, Cordaro L, Decker A, De Stavola L, Di Stefano DA, Felice P, Fontana F, Grusovin MG, Jensen OT, Le BT, Lombardi T, Misch C, Pikos M, Pistilli R, Ronda M, Saleh MH, Schwartz-Arad D, Simion M, Taschieri S, Toffler M, Tozum TF, Valentini P, Vinci R, Wallace SS, Wang HL, Wen SC, Yin S, Zucchelli G, Zuffetti F, Stacchi C. Indications for implant-supported rehabilitation of the posterior atrophic maxilla: A multidisciplinary consensus among experts in the field utilising the modified Delphi method. Int J Oral Implantol (Berl) 2024; 17:89-100. [PMID: 38501401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
PURPOSE To establish consensus-driven guidelines that could support the clinical decision-making process for implant-supported rehabilitation of the posterior atrophic maxilla and ultimately improve long-term treatment outcomes and patient satisfaction. MATERIALS AND METHODS A total of 33 participants were enrolled (18 active members of the Italian Academy of Osseointegration and 15 international experts). Based on the available evidence, the development group discussed and proposed an initial list of 20 statements, which were later evalu-ated by all participants. After the forms were completed, the responses were sent for blinded ana-lysis. In most cases, when a consensus was not reached, the statements were rephrased and sent to the participants for another round of evaluation. Three rounds were planned. RESULTS After the first round of voting, participants came close to reaching a consensus on six statements, but no consensus was achieved for the other fourteen. Following this, nineteen statements were rephrased and sent to participants again for the second round of voting, after which a consensus was reached for six statements and almost reached for three statements, but no consensus was achieved for the other ten. All 13 statements upon which no consensus was reached were rephrased and included in the third round. After this round, a consensus was achieved for an additional nine statements and almost achieved for three statements, but no consensus was reached for the remaining statement. CONCLUSION This Delphi consensus highlights the importance of accurate preoperative planning, taking into consideration the maxillomandibular relationship to meet the functional and aesthetic requirements of the final restoration. Emphasis is placed on the role played by the sinus bony walls and floor in providing essential elements for bone formation, and on evaluation of bucco-palatal sinus width for choosing between lateral and transcrestal sinus floor elevation. Tilted and trans-sinus implants are considered viable options, whereas caution is advised when placing pterygoid implants. Zygomatic implants are seen as a potential option in specific cases, such as for completely edentulous elderly or oncological patients, for whom conventional alternatives are unsuitable.
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Cipollina A, Ceddia M, Di Pietro N, Inchingolo F, Tumedei M, Romasco T, Piattelli A, Specchiulli A, Trentadue B. Finite Element Analysis (FEA) of a Premaxillary Device: A New Type of Subperiosteal Implant to Treat Severe Atrophy of the Maxilla. Biomimetics (Basel) 2023; 8:336. [PMID: 37622941 PMCID: PMC10452205 DOI: 10.3390/biomimetics8040336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Extreme atrophy of the maxilla still poses challenges for clinicians. Some of the techniques used to address this issue can be complex, risky, expensive, and time consuming, often requiring skilled surgeons. While many commonly used techniques have achieved very high success rates, complications may arise in certain cases. In this context, the premaxillary device (PD) technique offers a simpler approach to reconstruct severely atrophic maxillae, aiming to avoid more complicated and risky surgical procedures. Finite element analysis (FEA) enables the evaluation of different aspects of dental implant biomechanics. Our results demonstrated that using a PD allows for an optimal distribution of stresses on the basal bone, avoiding tension peaks that can lead to bone resorption or implant failure. ANSYS® was used to perform localized finite element analysis (FEA), enabling a more precise examination of the peri-crestal area and the PD through an accurate mesh element reconstruction, which facilitated the mathematical solution of FEA. The most favorable biomechanical behavior was observed for materials such as titanium alloys, which helped to reduce stress levels on bone, implants, screws, and abutments. Additionally, stress values remained within the limits of basal bone and titanium alloy strengths. In conclusion, from a biomechanical point of view, PDs appear to be viable alternatives for rehabilitating severe atrophic maxillae.
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Affiliation(s)
| | - Mario Ceddia
- Department of Mechanics, Mathematics and Management, Politecnico di Bari University, 70125 Bari, Italy; (M.C.); (B.T.)
| | - Natalia Di Pietro
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (T.R.); (A.S.)
- Center for Advanced Studies and Technologies (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Margherita Tumedei
- Department of Medical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy;
| | - Tea Romasco
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (T.R.); (A.S.)
- Center for Advanced Studies and Technologies (CAST), “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy
| | - Adriano Piattelli
- School of Dentistry, Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy;
- Facultad de Medicina, UCAM Universidad Católica San Antonio de Murcia, 30107 Murcia, Spain
| | - Alessandro Specchiulli
- Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (T.R.); (A.S.)
| | - Bartolomeo Trentadue
- Department of Mechanics, Mathematics and Management, Politecnico di Bari University, 70125 Bari, Italy; (M.C.); (B.T.)
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Bidra AS, Peña-Cardelles JF, Iverson M. Implants in the pterygoid region: An updated systematic review of modern roughened surface implants. J Prosthodont 2022; 32:285-291. [PMID: 36069239 DOI: 10.1111/jopr.13600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine the survival rates of modern roughened surface dental implants in the pterygoid region. MATERIAL AND METHODS This systematic review was an update from a previously published systematic review in 2011, which largely reported data on older machined surface dental implants. An electronic search for articles in the English language literature published from January 1, 2010 to December 8, 2021 was performed using PubMed, Scopus, and CENTRAL search engines. After applying a systematic search process in 3 stages, the final list of selected articles on roughened surface pterygoid implants was obtained. Data from the selected articles were collated with data from pertinent articles on roughened implant surface from the previous systematic review. The combined data was then used for calculating the interval survival rate (ISR) and cumulative survival rate (CSR) of pterygoid implants. RESULTS The initial electronic search resulted in 1263 titles. The systematic search process eventually resulted in 10 clinical studies reporting on modern roughened surface pterygoid implants. These 10 studies reported on a total of 911 pterygoid implants with 39 reported failures over a 6-year period. The majority of failures (37) were reported during the first year time interval and a majority of them (30) occurred before loading of the pterygoid implants. Only 2 late failures were reported after loading, during the 6th year time interval. The majority of implants were used for rehabilitation of full arch fixed implant supported prosthesis. At the maximum follow-up interval of 6 years, the cumulative survival rate of pterygoid implants with roughened surfaces was 95.5%, which was 5% higher than reported in the previous systematic review which combined machined and roughed surface pterygoid implants. CONCLUSIONS The survival rate of modern roughened surface dental implants in the pterygoid region is favorable at 95.5% over a 6 year period, and comparable to the existing evidence on survival of implants in other regions of the maxilla and mandible. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Avinash S Bidra
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, CT
| | | | - Marissa Iverson
- Research Support Librarian, L.M Stowe Library, University of Connecticut Health Center, Farmington, Connecticut
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Motiwala IA, Bathina T. A Radiographic Study on Pterygoid Implants with Hamulus as a Landmark for Engaging the Pterygoid Plate - A Retrospective Study. Ann Maxillofac Surg 2022; 12:190-196. [PMID: 36874784 PMCID: PMC9976848 DOI: 10.4103/ams.ams_132_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/17/2022] [Accepted: 10/13/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Rehabilitating the posterior maxilla with pterygoid implants can be quite challenging as the area entails many hindrances for implant placement. Although few studies have reported the three-dimensional angulations according to various planes (Frankfort horizontal (FH), sagittal plane, occlusal or maxillary planes), no anatomical landmarks have been identified to guide their placement. This study aimed at analysing the three-dimensional angulation of pterygoid implants using the hamulus as an intraoral guide. Methods Pre-operative cone-beam computed tomography scans (axial and parasagittal sections) of 150 patients rehabilitated with pterygoid implants were retrospectively analysed to determine the horizontal and vertical angulations in relation to the hamular line and FH plane, respectively. Results The results showed horizontal buccal and palatal safe angulations of 20.8° ± 7.6° and -20.7° ± 8.5° in relation to the hamular line. Maximum and minimum vertical angulations of 61.6° ± 7.0° and 37.2° ± 10.3° were observed, with a mean of 49.8 ± 8.1 in relation to FH plane. The post-operative scans showed that around 98% of the implants placed along the hamular line were successfully engaging the pterygoid plate. Discussion Comparing with the results of previous studies, this study concludes that when implants are placed along the hamular line, they are more likely to engage the centre of the pterygomaxillary junction resulting in an excellent prognosis of pterygoid implants.
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Affiliation(s)
- Irfan Ali Motiwala
- Department of Oral and Maxillofacial Surgery, Dr. Motiwala Dental Clinic and Implant Center, Hyderabad, Telangana, India
| | - Tejaswi Bathina
- Department of Oral and Maxillofacial Surgery, Dr. Motiwala Dental Clinic and Implant Center, Hyderabad, Telangana, India
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Grecchi E, Stefanelli LV, Grecchi F, Grivetto F, Franchina A, Pranno N. A novel guided zygomatic implant surgery system compared to free hand: a human cadaver study on accuracy. J Dent 2021;:103942. [PMID: 34974136 DOI: 10.1016/j.jdent.2021.103942] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 12/19/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The aim of this human cadaver study was to compare the accuracy of guided versus free-hand zygomatic implant placement. For the guided implant placement laser sintered titanium templates were used. METHODS Forty zygomatic implants were placed in ten cadavers heads. For each case two implants were inserted using the guided protocol(Ezgoma guide, Noris Medical, Israel) and the related surgical kit and the other two by using a free hand approach. Post-operative computed tomography (CT) scans were carried out to assess the deviations between planned and inserted implants. The accuracy was measured by overlaying the post-operative Ct scan (with the final position of the achieved implants)with the pre-operative CT scan (with the planned implants). RESULTS The difference of the mean between planned and placed zygomatic implants by using surgical guides or free hand were statistically significant for all the variables evaluated: angular deviation (1.19°±0.40° and 4.92°±1.71° p<0.001), linear distance deviation at coronal point (0.88 mm±0.33 mm and 2.04 mm±0.56 mm p<0.001), at apical point (0.79 mm±0.23 mm and 3.23 mm±1.43 mm p<0.001)and at apical depth (0.35 mm±0.25 mm and 1.02 mm±0.61 mm p<0.001). CONCLUSIONS The proposed surgical guided system exhibited a higher accuracy for all the investigated variables compared to the free hand technique.
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Grecchi F, Stefanelli LV, Grivetto F, Grecchi E, Siev R, Mazor Z, Del Fabbro M, Pranno N, Franchina A, Di Lucia V, De Angelis F, Goker F. A Novel Guided Zygomatic and Pterygoid Implant Surgery System: A Human Cadaver Study on Accuracy. Int J Environ Res Public Health 2021; 18:6142. [PMID: 34200143 DOI: 10.3390/ijerph18116142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022]
Abstract
The aim of this human cadaver study was to assess the accuracy of zygomatic/pterygoid implant placement using custom-made bone-supported laser sintered titanium templates. For this purpose, pre-surgical planning was done on computed tomography scans of each cadaver. Surgical guides were printed using direct metal laser sintering technology. Four zygomatic and two pterygoid implants were inserted in each case using the guided protocol and related tools. Post-operative computed tomography (CT) scans were obtained to evaluate deviations between the planned and inserted implants. Accuracy was measured by overlaying the real position in the post-operative CT on the virtual presurgical placement of the implant in a CT image. Descriptive and bivariate analyses of the data were performed. As a result, a total of 40 zygomatic and 20 pterygoid implants were inserted in 10 cadavers. The mean deviations between the planned and the placed zygomatic and pterygoid implants were respectively (mean ± SD): 1.69° ± 1.12° and 4.15° ± 3.53° for angular deviation. Linear distance deviations: 0.93 mm ± 1.23 mm and 1.35 mm ± 1.45 mm at platform depth, 1.35 mm ± 0.78 mm and 1.81 mm ± 1.47 mm at apical plane, 1.07 mm ± 1.47 mm and 1.22 mm ± 1.44 mm for apical depth. In conclusion, the surgical guide system showed accuracy for all the variables studied and allowed acceptable and accurate implant placement regardless of the case complexity.
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Stefanelli LV, Mandelaris GA, Franchina A, Di Nardo D, Galli M, Pagliarulo M, Testarelli L, Di Carlo S, Gambarini G. Accuracy Evaluation of 14 Maxillary Full Arch Implant Treatments Performed with Da Vinci Bridge: A Case Series. Materials (Basel) 2020; 13:ma13122806. [PMID: 32580340 PMCID: PMC7344455 DOI: 10.3390/ma13122806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/07/2020] [Accepted: 06/18/2020] [Indexed: 11/29/2022]
Abstract
The use of pterygoid implants can be an attractive alternative to sinus bone grafting in the treatment of posterior atrophic maxilla. This technique has not been widely used because of the difficulty of the surgical access, the presence of vital structures, and the prosthetic challenges. The use of dynamic computer aided implantology (DCAI) allows the clinician to utilize navigation dental implant surgery, which allows the surgeon to follow the osteotomy site and implant positioning in real time. A total of 14 patients (28 pterygoid implants and 56 intersinusal implants) were enrolled in the study for a full arch implant prosthetic rehabilitation (4 frontal implants and 2 pterygoids implants), using a dynamic navigation system. The reported accuracy of pterygoid implants inserted using DCAI was 0.72 mm at coronal point, 1.25 mm at apical 3D, 0.66 mm at apical depth, and 2.86° as angular deviation. The use of pterygoid implants in lieu of bone grafting represents a valid treatment opportunity to carry out a safe, accurate, and minimally invasive surgery, while reducing treatment time and avoiding cantilevers for a full implant prosthetic rehabilitation of the upper arch.
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Affiliation(s)
- Luigi V. Stefanelli
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.V.S.); (M.G.); (L.T.); (S.D.C.); (G.G.)
| | - George A. Mandelaris
- Private Practice, Periodontics and Dental Implant Surgery; Periodontal Medicine & Surgical Specialists, LTD, Chicago, IL 60601, USA;
| | - Alessio Franchina
- Private Practice, Periodontics and Dental Implant Surgery, 36100 Vicenza, Italy;
| | - Dario Di Nardo
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.V.S.); (M.G.); (L.T.); (S.D.C.); (G.G.)
- Correspondence: ; Tel.: +39-339-3935-527
| | - Massimo Galli
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.V.S.); (M.G.); (L.T.); (S.D.C.); (G.G.)
| | - Michele Pagliarulo
- Faculty of Dental Medicine, University of Plovdiv, 4002 Plovdiv, Bulgary;
| | - Luca Testarelli
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.V.S.); (M.G.); (L.T.); (S.D.C.); (G.G.)
| | - Stefano Di Carlo
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.V.S.); (M.G.); (L.T.); (S.D.C.); (G.G.)
| | - Gianluca Gambarini
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00161 Rome, Italy; (L.V.S.); (M.G.); (L.T.); (S.D.C.); (G.G.)
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