Three-Dimensional Radiographic Evaluation of the Malar Bone Engagement Available for Ideal Zygomatic Implant Placement.

Gerardo Pellegrino,Claudio Marchetti,Maria Giovanna Gandolfi,Paolo Pisi,Francesco Grande,Agnese Ferri

doi:10.3390/mps3030052

Abstract

Zygomatic implant rehabilitation is a challenging procedure that requires an accurate prosthetic and implant plan. The aim of this study was to evaluate the malar bone available for three-dimensional zygomatic implant placement on the possible trajectories exhibiting optimal occlusal emergence. After a preliminary analysis on 30 computed tomography (CT) scans of dentate patients to identify the ideal implant emergencies, we used 80 CT scans of edentulous patients to create two sagittal planes representing the possible trajectories of the anterior and posterior zygomatic implants. These planes were rotated clockwise on the ideal emergence points and three different hypothetical implant trajectories per zygoma were drawn for each slice. Then, the engageable malar bone and intra- and extra-sinus paths were measured. It was possible to identify the ideal implant emergences via anatomical landmarks with a high predictability. Significant differences were evident between males and females, between implants featuring anterior and those featuring posterior emergences, and between the different trajectories. The use of internal trajectories provided better bone engagement but required a higher intra-sinus path. A significant association was found between higher intra-sinus paths and lower crestal bone heights.

Highlights

The modern trend in implantology is to reduce surgical invasiveness [1]
Starting from the four ideal zygomatic implant emergence points, we measured the extent of malar bone engageable by zygomatic implants on the possible trajectories
The mean total lengths available for zygomatic implants, of malar bone engagements, and of the intraand extra-sinus paths for different trajectories and rotation planes are summarized in Tables 1 and 2

Summary

Introduction

The modern trend in implantology is to reduce surgical invasiveness [1]. This reduces patient morbidity, costs, and complications [2]. Zygomatic implants seem to be a valid alternative to reconstructive procedures for severely atrophic maxilla [4,5,6]. Zygomatic implant placement is a challenging procedure for oral and maxillofacial surgeons requiring the evaluation of many clinical, anatomical, and prosthetic parameters. The definition of the implant emergence position in the oral cavity, the amount of bone engagement, and the trajectory of the zygomatic fixtures are necessary for the safety of the patients and for a successful prosthetic rehabilitation

Objectives

Methods

Results

Conclusion