Abstract
The objective of this in vitro study was to evaluate and compare the accuracy of zygomatic dental implant (ZI) placement carried out using a dynamic navigation system. Materials and Methods: Forty (40) ZIs were randomly distributed into one of two study groups: (A) ZI placement via a computer-aided dynamic navigation system (n = 20) (navigation implant (NI)); and (B) ZI placement using a conventional free-hand technique (n = 20) (free-hand implant (FHI)). A cone-beam computed tomography (CBCT) scan of the existing situation was performed preoperatively to plan the surgical approach for the computer-aided study group. Four zygomatic dental implants were placed in anatomically based polyurethane models (n = 10) manufactured by stereolithography, and a postoperative CBCT scan was performed. Subsequently, the preoperative planning and postoperative CBCT scans were added to dental implant software to analyze the coronal entry point, apical end point, and angular deviations. Results were analyzed using the Student’s t-test. Results: The results showed statistically significant differences in the apical end-point deviations between FHI and NI (p = 0.0018); however, no statistically significant differences were shown in the coronal entry point (p = 0.2617) or in the angular deviations (p = 0.3132). Furthermore, ZIs placed in the posterior region showed more deviations than the anterior region at the coronal entry point, apical end point, and angular level. Conclusions: The conventional free-hand technique enabled more accurate placement of ZIs than the computer-assisted surgical technique. In addition, placement of ZIs in the anterior region was more accurate than that in the posterior region.
Highlights
Zygomatic implants (ZIs) have proven to be a suitable treatment option in the restoration of the extremely atrophic, totally edentulous maxillae usually caused by maxillary resection in patients with oncological pathologies, congenital deformities, or metabolic disorders—patients undergoing radiotherapy—or immunosuppressed patients [1]
ZIs are especially indicated for use in patients with compromised vascularization, which can affect the outcome of bone grafts used to regenerate maxillary defects; they are indicated in cases of incompatibility of the donor area [2]
Brief et al found that, computer-aided navigation techniques are significantly more accurate than free-hand conventional techniques, the techniques are significantly more accurate than free-hand conventional techniques, the level of accuracy provided by the free-hand conventional technique is sufficient for most level of accuracy provided by the free-hand conventional technique is sufficient for most clinical situations [22]
Summary
Zygomatic implants (ZIs) have proven to be a suitable treatment option in the restoration of the extremely atrophic, totally edentulous maxillae usually caused by maxillary resection in patients with oncological pathologies, congenital deformities, or metabolic disorders—patients undergoing radiotherapy—or immunosuppressed patients [1]. ZIs provide a predictable treatment option that prevents long waiting times before prosthetic rehabilitation when compared with alternative techniques for conventional implant placement using grafting materials [3]. In 1988, Branemark first described using an intrasinusal placement approach for ZIs; this technique can lead to sinusitis, dental implant failure, oroantral fistula, periorbital and conjunctival hematoma or edema, paresthesia, difficulty speaking, pain, and edema [5]. Preoperative planning techniques using cone-beam computed tomography (CBCT) scans [7] have been recommended to enable accurate computer-aided surgery with both static and dynamic navigation systems [8]. These increase the accuracy of dental implant placement, thereby reducing the risk of intraoperative complications and maintaining high survival rates of patients receiving dental implants [9]
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