Accuracy of digital planning in zygomatic implants

B Xing Gao,J Torres,R Ortega Aranegui,F G.F Tresguerres,J López-Quiles,I F Tresguerres,O Iglesias-Velázquez,R M López-Pintor,A Rodríguez González Cortes

doi:10.1186/s40729-021-00350-x

Abstract

BackgroundZygomatic implants have been described as a therapeutic alternative for patients with severe maxillary atrophy in order to avoid bone augmentation procedures. Taking that into account, in these treatments, the key factor is the position of the implant, the virtual surgical planning (VSP) is widespread among most clinicians before surgery on the patient. However, there are no studies which evaluate the clinical relevance of these VSP.The aim of this study is to determine whether digital planning on zygomatic implants has any influence on the implant dimensions and position, even when performing conventional surgery afterwards.ResultsFourteen zygomatic implants were placed in four patients. Pre-operative and post-operative helicoidal computed tomography were performed to each patient to allow the comparison between the digital planning and the final position of implants. Tridimensional deviation (TD), mesio-distal deviation (MDD), bucco-palatine deviation (BPD), and apico-coronal deviation (ACD) were evaluated as well as angular deviation (AD). Significative differences in apical TD were observed with a mean of 6.114 ± 4.28 mm (p < 0.05). Regarding implant position, only implants placed in the area of the first right molar reported significant differences (p < 0.05) for ACD. Also, implant length larger than 45 mm showed BPD significative differences (p < 0.05).ConclusionsZygomatic implant surgery is a complex surgical procedure, and although VSP is a useful tool which helps the clinician determine the number and the length of zygomatic implants as well as its proper position, surgical experience is still mandatory.

Highlights

Zygomatic implants have been described as a therapeutic alternative for patients with severe maxillary atrophy in order to avoid bone augmentation procedures
In 1989, Brånemark et al [6] described the use of zygomatic implants as a therapeutic alternative for patients with severe maxillary atrophy to avoid bone augmentation procedures
It is essential that the apex of the implant is placed in the areas of zygomatic bone with higher bone density and reaching the greater bone to implant contact (BIC) in all its course as far as possible

Summary

Introduction

Zygomatic implants have been described as a therapeutic alternative for patients with severe maxillary atrophy in order to avoid bone augmentation procedures. In 1989, Brånemark et al [6] described the use of zygomatic implants as a therapeutic alternative for patients with severe maxillary atrophy to avoid bone augmentation procedures. This technique consisted in placing a long dental implant through maxillary sinus, to be anchored in zygomatic bone. Authors such as Hung et al [12] have determined, by using CBCT studies, several more suitable areas for the implant apex positioning, being the upper posterior area (A3) and the central area (B1) of the zygomatic bone the most favourable, agreeing with the results of Takamaru et al [11]. One approach of zygomatic implant treatments is based in the “Quad Zygoma” concept which seeks to achieve complete upper restorations of atrophic maxilla by placing four implants [13, 14]

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