Atrophic Maxilla Research Articles

Eazygoma technique: a new approach for zygomatic implant placement aligned with maxillomalar anatomy

This study focused on evaluating the novel Eazygoma method for zygomatic implant placement. This approach focuses on biomechanical principles, offering direct visualization that facilitates enhanced control during implant insertion. It helps prevent malpositioning, ensuring that the apical portion remains within the zygomatic body and achieves emergence in the alveolar crest through an inverted drilling sequence. The Eazygoma system enables improved control during drilling, starting in the zygomatic area and eliminating the need for osteotomies in the maxillary sinus. This not only simplifies the procedure but also significantly reduces the operative time, allowing it to be performed under local anesthesia and sedation in approximately one hour, according to the author’s experience. The study included 34 zygomatic implants placed in 11 patients with severe maxillary atrophy, treated between 2021 and 2023 at the Maxillofacial surgery Department of the private clinic “Clínica Colsanitas” in Bogotá, Colombia. To evaluate outcomes, intraoperative torque, surgical time, and whether alveolar emergence was achieved were measured for the implants. Patients were followed up at 12 months to assess implant survival. Results showed that the Eazygoma approach eliminated postoperative sinus injuries and implant malposition, ensuring alveolar emergence and achieving a torque greater than 50 Newtons in all cases, allowing for immediate implant loading.

The Rehabilitation of Partially Edentulous Maxilla With Unilateral Zygomatic Implants: A Retrospective Study up to 23 Years Follow-Up.

This retrospective study aimed to evaluate the clinical outcomes associated with zygomatic implant (ZI) rehabilitation in partially atrophic edentulous maxillae over a mean follow-up period of more than 10.3 years. All consecutive patients underwent ZI rehabilitation between 1999 and 2020, with a minimum follow-up period of 3 years. The primary outcome was the implant survaival rate. Secondary outcomes included the prosthesis success rate, complications, and Oral Health-Related Quality of Life. Of the 21 patients, treated with 27 ZIs and 48 conventional implants (CIs), 9 (42.9%) were females. The mean follow-up was 10.3 ± 5.7 years (range 3.2-23.4). ZI and CI survival rates were 100% and 97.9%, respectively, with one CI that failed. Eleven patients received 12 CIs placed in the pterygoid and tuberosity region. Most of the implants (81.33%) were immediately loaded, with 17 patients (80.9%) receiving 21 acrylic bridges. Of the total of 26 definitive prosthesis, the success rate was 96.1%. Local inflammation (n = 2) and soft tissue recession (n = 1) were reported as complications, occurring at a mean follow-up of 4.5 and 3.2 years, respectively. The mean score of the OHIP-14 questionnaire was 1.19 ± 1.99. Unilateral ZI rehabilitation was a predictable option for patients with partially atrophic edentulous maxilla who have experienced previous graft or implant failures, or who require immediate loading. Splinting the ZI with CI for restoration appeared to be essential in unilateral ZI treatment. Complications were infrequent and could be managed effectively, with patient-reported outcomes indicating normalization in quality of life.

Pterygoid implant-based maxillary full-arch rehabilitation using an autonomous robot system: A case report.

Pterygoid implant placement has been proven to be a viable option in full-arch implant rehabilitation for extremely atrophic maxillae. Nevertheless, the utilization of pterygoid implants remains a challenge for the dentist due to the difficulties of accessing the surgical site and poor visibility. To address these difficulties, digital techniques have been used to enhance the accuracy of pterygoid implant placement. This clinical case describes the application of an autonomous robot system to enhance the precision and efficacy of pterygoid implant placement. The results demonstrated that the integration of automation and real-time imaging provided by the robot system significantly improved the safety and accuracy of the surgical procedure.

Anatomical Measurements of the Malar Bone for Safe Zygomatic Implant Placement: A Study on Donated Bodies.

Background: The malar bone provides an anchorage point for zygomatic implants, avoiding invasive reconstructive surgeries in the fixed rehabilitation of fully edentulous and severely atrophic maxillae. The limited bone volume, however, requires precise implant placement to prevent complications related to nearby anatomical structures. This observational cross-sectional study aims to measure the malar and zygomatic arch bones and their distances from critical anatomical landmarks to guide surgeons in safe zygomatic implant placement. Methods: Dissections were performed bilaterally on 29 heads from human donated bodies in a cross-sectional observational study. Key landmarks evaluated include the infraorbital foramen (IF), pyriform nasal aperture (PNA), infraorbital margin (IM), zygomaticofacial foramen (ZFF), anterior end (A), and the most protruding point of the zygomatic arch (B). Measurements included IF-PNA, IF-IM, IF-ZFF, ZFF-IM, A-B, and orbital floor depth (OFD). Results: Significant findings showed IF-PNA was greater in males (18.66 ± 2.63 mm, p = 0.001), and IF-ZFF varied between sides (26.72 ± 8.7 mm, p = 0.002). ZFF-IM was larger in males (7.43 ± 2.09 mm, p < 0.001). Heights and thicknesses were also assessed, with significant side differences observed. Conclusions: These findings underscore the importance of understanding precise anatomical distances for successful implant placement. The study provides essential data to enhance surgical planning and training, ensuring safer procedures and minimizing the risk of complications.

Using the Nasopalatine Canal for Enhanced Distribution in Severely Atrophic Maxilla With Immediate Loading of Zygomatic Implants: An 8-Year Retrospective Cohort Study.

This study presents retrospective 8-year clinical performance data from a patient cohort treated with immediately loaded maxillary full prostheses supported by zygomatic implants combined with implants placed in the nasopalatine canal, as a treatment for severely resorbed edentulous ridges. A retrospective analysis was conducted on data of maxillary edentulous patients with severe bone atrophy. All of them received zygomatic implants in combination with an implant placed in the nasopalatine foramen and an immediately loaded fixed temporary prosthesis in the first 24 hours. The frequency of major and minor adverse events was presented according to the time of occurrence. Fifteen patients were included in the study, without cases of implant loss or sensitivity in the nasopalatine region were observed up to 8 years. Only 1 major complication was observed, whereas minor complications were more frequent. In conclusion, this 8-year follow-up study demonstrated that the nasopalatine canal can be considered a viable implant site, with no major risks, to improve biomechanics by enabling a polygonal distribution in severely atrophic maxillae treated with zygomatic implants and immediate loading.

Accuracy of Zygomatic Implant Placement Using Task-Autonomous Robotic System or Dynamic Navigation: An InVitro Study.

To evaluate and compare the accuracy of task-autonomous robot-assisted implant surgery (RAIS) and dynamic computer-assisted implant surgery (dCAIS) for zygomatic implant placement. Ten atrophic edentulous maxilla models requiring zygomatic implant (ZI) placement were randomly divided into the RAIS and dCAIS groups. Osteotomies and implant placement were performed under the guidance of a task-autonomous robotic system or dynamic navigation system. A total of 20 ZIs were analyzed. The angular, coronal, lateral coronal, coronal depth, apical, lateral apical, and apical depth deviations were measured and analyzed between the two groups. The primary outcome parameters were the angular deviations between the planned and the placed ZIs. Data was subjected to descriptive and comparative statistical analysis. The significance of inter-group differences for continuous variables was assessed with Student's two-sample t-tests, Welch two-sample t-tests, and Mann-Whitney U tests according to the distribution normality and variance homogeneity. ZI placement deviations were compared between the RAIS and dCAIS groups, showing a mean angular deviation of 0.92 ± 0.40° versus 2.03 ± 0.53° (p < 0.001), a mean (±SD) coronal deviation of 0.48 ± 0.25 mm versus 1.29 ± 0.46 mm (p < 0.001), and a mean apical deviation of 0.88 ± 0.28 mm versus 1.96 ± 0.46 mm (p < 0.001). For computer-guided ZI placement, task-autonomous RAIS was superior to dCAIS in terms of accuracy.

Major clinical relevance and considerations of zygomatic implants in elderly patients: a systematic review

For decades, zygomatic implants (ZI) have been used to rehabilitate atrophic maxillae and reconstruct maxillary defects, demonstrating significant survival rates, and have emerged as an alternative to extensive bone grafting. Despite their efficacy, surgical techniques for ZI placement have consistently been associated with perioperative complications, with additional problems arising later, especially in elderly patients. Objective: The present study developed a systematic review to address the main clinical relevance and considerations of zygomatic implants in elderly patients. Methods: The present study followed a concise systematic review model. The search was carried out in the PubMed, Embase, Ovid, Cochrane Library, Web of Science, and Scopus databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 220 articles were found. In total, 77 articles were fully evaluated and 57 were included and evaluated in this study, and of the total of 57 articles, only 42 articles were developed in the item results of the systematic review. Of the initial total of articles, 108 articles were excluded because they did not meet the GRADE and AMSTAR-2 classification, and 20 were excluded because they presented a risk of bias that could compromise the credibility of the studies. The symmetric funnel plot does not suggest a risk of bias. According to the GRADE instrument, most studies presented homogeneity in their results, with X2=85.6%&gt;50%. It was concluded the ZI has a high rate of survival accumulated in 12 years, with the majority of failures occurring in the early stages of the postoperative period. The main complication observed related to zygomatic implants in elderly patients was sinusitis, which can appear several years after implantation surgery. The presence of increased maxillary sinus pneumatization with advanced resorption of the posterior alveolus may result in insufficient bone to anchor the implant. Bone augmentation is generally necessary under these conditions to allow the placement of a sufficient number and length of implants. Another more serious condition would be defects of maxillectomy, aplasia of the maxillary sinus, and cleft deformities. Zygomatic implants appear to be a consolidated therapeutic option for a significantly atrophic maxilla in elderly patients, offering a promising alternative to costly heavy bone graft techniques, fewer complications, less time for rehabilitation, less required prosthodontic work, and significantly higher survival rates.

Tomographic Analysis of the Pterygomaxillary Region in Atrophic Maxilla for the Placement of Pterygoid Implants

Tomographic Analysis of the Pterygomaxillary Region in Atrophic Maxilla for the Placement of Pterygoid Implants

Short implant versus conventional implant in the posterior atrophic maxilla: A systematic review and meta-analysis

Objective: A comparative study undertaken to measure the the marginal bone loss (MBL), implant survival rate, and prosthetic and biological complications among short implants (8 mm or shorter) and conventional implants (longer than 8 mm) in the posterior atrophic maxilla. Materials and Methods: A search in three databases PubMed (Medline), Scopus, and Cochrane was conducted. The present systematic review was registered with identification number CRD42020212805 at the International Prospective Register of Systematic Reviews. Data extraction included the publication year, patients’ number and number of implants, implant length and width, MBL, implant survival rate, and biological and mechanical complications. The Cochrane Risk of Bias 1.0 tool was used to assess the risk of bias. A meta-analysis was performed to evaluate the outcome variables. Comparisons for dichotomous variables, such as prosthetic and biological complications and implant survival rate, were done by applying the Mantel–Haenszel method. In contrast, a comparison was made by applying the inverse variance method for continuous variables like MBL. Results: Initially, 618 reports were recognized from electronic database searches. Five randomized controlled trials (RCTs) were included in the meta-analyses regarding the MBL, implant survival rate, and prosthetic complications, while three were included for biological complications. In 5 years of follow-up, no evidence of difference could be found between conventional and short implants for survival rate (risk ratio [RR]: 3.54; 95% confidence interval [CI]: 0.99–12.67; P = 0.05; I 2 = 0%). We do not find any evidence of difference for MBL between short implants and conventional implants (mean difference: −0.29; 95% CI: −0.49 to −0.08; P = 0.02; I 2 = 65%). Furthermore, no evidence of a difference exists between short and conventional implants for prosthetic complications (RR: 1.56; 95% CI: 0.68–3.55; P = 0.29; I 2 = 0%). The biological complications were seen less with short implants (RR: 0.47; 95% CI: 0.24–0.93; P = 0.03; I 2 = 0%). Conclusion: The results suggest no significant difference among conventional and short implants regarding survival rate in the posterior atrophic maxilla. The results of this systematic review and meta-analysis suggest that, for a 5-year period of follow-up, short implants are related to rarer biological complications and comparable MBL compared to conventional implants. Despite these promising findings, long-term studies with consistent study designs and clinical protocols are required to appraise the performance and durability of short implants.

Rehabilitation of an atrophic maxilla with zygomatic implants

Rehabilitation of an atrophic maxilla with zygomatic implants

Complications of zygomatic implantology: observational clinical study

Background: The rehabilitation of the atrophic maxilla with zygomatic implants appears to be a complex challenge as this surgery is not without complications. For this reason, the operator approaching it must be aware of the possible surgical complications. The aim of this study was firstly to assess the incidence of complications following zygomatic implant operations performed using the intrasinus technique and to compare the data obtained with the results already present in the literature. Materials And Methods: The methods chosen for the evaluation of implant success were those reported in the article by Chrcanovic et al which refers to factors such as implant survival rate, percentage of failed implants and,incidence of post-operative complications. A total of 174 implants were included in the study. The study comprised three phases: Phase 1 -collection of the personal, anamnestic, clinical and radiological data of each patient participating in the study -detection of the number of zygomatic implants, the number of failed implants and any post- operative complications resulting from the intrasinus technique and subsequent comparison with data reported in the literature. Phase 2 -comparison of complications arising with intrasinusal and extrasinusal technique Phase 3 -administration of the satisfaction questionnaire of patients treated with the extrasinusal technique. Results: Complications occurred in 14 patients and the most frequent complication was sinusitis, followed by soft tissue infections, 3 implants failed. Specifically, the most frequent complication related to intrasinusal technique surgery is sinusitis, caused by invasion of the Higmoro antrum by the implant. Frequency analysis of the patient questionnaire shows high satisfaction with implant-prosthetic rehabilitation with zygomatic implants. Patients appear very satisfied with the aesthetics and functionality provided by the rehabilitation. Conclusion: Zygomatic implants allow the fixed rehabilitation of patients with severe upper jaw atrophies, and although complications may occur, patient satisfaction was very high as it allows them to fully recover aesthetics and function, facilitating a rapid return to social life.

Trans-crestal dental implants in the rehabilitation of a severely atrophic maxilla: A retrospective case series.

To evaluate the mid-term clinical and radiographic results of immediate fixed full-arch prosthesis supported by two anterior axial and two posterior trans-crestally placed tilted implants in patients with severely atrophic posterior maxilla. Patients with posterior maxillary ridge less than 4 mm high and 3 mm wide were rehabilitated with an immediate fixed provisional prosthesis supported by two anterior axially placed and two trans-crestal posterior tilted implants within 3 h after implant surgery. The final prosthesis, consisting of a CAD-CAM titanium framework and composite teeth was delivered 6 months later. Patients were scheduled for follow-up visits every 6 months to assess clinical and radiological parameters. Patients' satisfaction was assessed by a questionnaire up to 5 years. From April 2008 to May 2017, 56 implants (28 axial and 28 tilted) were inserted in 14 subjects (eight female and six male). The average bone loss for the anterior axial implants was 0.99 ± 0.19 mm at 1 year (n = 28 implants), 1.37 ± 0.31 mm at 5 years (n = 28), and 2.05 ± 0.32 mm at 10 years (n = 14). Only for three implants in two subjects the marginal bone loss was higher than 2 mm after 60 months. No implant was lost, and no prosthetic failure occurred after a mean follow-up of 125 months (range 79-186 months), leading to 100% implant and prosthesis survival rates. The upper 95% confidence limit of the failure rate was 23% and 6% at patient and implant level, respectively. High level of satisfaction was reported at 5-year follow-up. Wider sample sizes will be required to determine whether the presented technique is a reliable treatment option for the immediate rehabilitation of the atrophic maxilla.

Assessment of different treatment alternatives for patients with total maxillectomy.

To assess the biomechanical advantages of combining zygoma and partial subperiosteal implants for maxillary reconstruction in severely atrophic maxillae, offering potential solutions to the challenges posed by traditional reconstruction methods. A finite element analysis used a craniofacial model simulating a totally resected maxilla. Four treatment scenarios (SCs) were evaluated: SC-1, the quad zygoma approach; SC-2, two zygoma implants (ZIs) and a one-piece subperiosteal implant (SI); SC-3, two ZI and a two-piece SI; and SC-4, four ZI and a one-piece SI. Stress distributions on bone, implants, abutments, and metal frameworks were compared under occlusal forces. For the simulated bone regions under vertical and oblique forces, SC-4 values were higher than SC-1, while SC-2 and SC-3 values were comparable for pmax and pmin. In addition, SC-2 and SC-3 values were lower than those of SC-1 and SC-4. The most balanced von Mises stress values on the ZIsand were observed in SC-3 under vertical and oblique forces. Furthermore, lower von Mises stress values on the abutments were seen in SC-3 under oblique and vertical forces. Although the lower von Mises stress values on the metal frameworks at the lateral incisor and first premolar side were seen in SC-3, lower von Mises values were observed in SC-4 in the first molar region. Overall, this study suggests that combining zygoma and partial subperiosteal implants may be a promising approach for reconstructing severely atrophic maxillae. These implants may offer improved biomechanical properties compared to ZIs alone.

Maxilla reconstruction with 100% BioOss: A clinical and tomographic follow-up study.

Tooth loss and use of a complete denture is still a reality and results in bone loss. Adequate reconstruction of an extremely atrophic edentulous maxilla is a challenge, and different treatment methods have been described for its resolution. Patients seeking implant placement in edentulous upper jaw with atrophic maxilla were selected in a private clinic in Porto Alegre, Brazil. The bone graft was performed with bilateral sinus lift and horizontal bone graft in anterior region with 0,25-1mm particles of Bio-Oss (Geistlich) covered with a collagen membrane (Bio-Gide, Geistlich). CBCTs were evaluated to verify the need for bone graft, and 6-8 months after bone graft follow-up, to plan implant placement and assess horizontal bone gain. 124 implants were placed in 19 patients, 76 of those in the sinus region. The survival rate was 95.2%, with six implants lost over a mean implants follow-up time of 47.68 months. The horizontal bone gain ranged from 0.00 to 6.86 mm, a mean gain of 2.85mm. An average of 5.5g of Bio-Oss was used per patient, and in 73.7 % of the cases, a flapless surgery was possible for implant placement, and in 92 implants an immediate loading was possible. Final rehabilitation was accomplished with fixed prosthodontics in 16 patients with a mean follow-up of 38.4 months. Within the limitations of this study, it is possible to affirm that bone graft with 100% Bio-Oss in atrophic maxilla is a reliable treatment and allow rehabilitation with implants with a high survival rate and the higher the initial bone height, the greater the gain in bone width. Key words:Bone Regeneration, Dental Implants, Prosthodontics, Dentistry.

Patient and implant-related risk factors for implant failure of one-stage lateral sinus floor elevation: A 2- to 10-year retrospective study.

This retrospective study aimed to evaluate the early and late implant failure rates of one-stage lateral sinus floor elevation (LSFE)and to identify the patient and implant-related risk factors associated with these failures. All patients treated with one-stage LSFE from January 2014 to December 2021 were evaluated for inclusion. A total of 618 patients with 936 implants met the inclusion criteria. Clinical and radiographic information about patient and implants was collected. Univariate and multivariate Cox proportional hazards frailty regression models were performed to identify risk factors for early and late implant failure. The cumulative implant survival rate was 95.62% (95% CI 93.90%-97.68%), with 16 early implant failures and 25 late implant failures. The Cox analysis indicated that ≤3 mm residual bone height (RBH) was associated with a higher early failure rate. For late implant failure, smoking habit, ≤3 mm RBH, and certain implant brand were independent risk factors. Narrow sinus ostium, long infundibulum, and flat thickening of Schneiderian membrane might be non-independent risk factors for late implant failure. No significance was found in other variables, including age, periodontitis history, implant characteristics (position, diameter, length, protrusion length, marginal bone loss), surgeon experience, healing time, opposing dentition, and prosthesis. One-stage LSFE is a predictable treatment for patients with atrophic maxilla. ≤3 mm RBH increased the risk of early implant failure, while smoking habit, ≤3 mm RBH, and certain implant brand were independent risk factors for late implant failure.

Maxillary sinus membrane perforation rate utilizing osseodensification-mediated transcrestal sinus floor elevation: A multicenter clinical study.

This multicenter cross-sectional clinical study aimed to evaluate the membrane perforation rate during transcrestal sinus floor elevation (TSFE) using osseodensification (OD) burs and assess risk factors associated with the procedure. This study was conducted in six centers, following ethical standards and approved by local committees. It included patients over 18 years old missing maxillary posterior teeth with crestal residual bone height (RBH) ≥2 and ≤6 mm. Preoperative evaluations were done, including CBCT scans, to assess bone dimensions and sinus health. All centers and surgeons followed a standardized surgical protocol for TSFE using OD burs. Surgical complications, particularly sinus membrane perforations, were recorded and analyzed. Factors such as implant site, premolars or molars, as well as, healed or fresh socket, along with initial RBH were evaluated for their impact on membrane perforation rate. Descriptive statistics, χ2, and logistic regression analysis were used to analyze the data. A total of 621 subjects with an average age of 57.9 years were included. Sinus lifting was performed at 670 sites, with 621 implants placed in the maxilla. The majority of sinus lifts were done in the molar region (76.87%) and in healed bone sites (74.33%). The average RBH was 5.1 mm (ranging from 2 to 7 mm). Sinus membrane perforation occurred in 49 cases (7.31%). RBH ≤3 mm posed a risk factor for sinus membrane perforations followed by RBH >3 and ≤5 mm. Tooth region and implant site were not associated as risk factors for sinus membrane perforation. OD drilling used for TSFE resulted in low membrane perforation rate. Challenging scenarios of severe posterior maxillary atrophy presented as risk factors for increased perforation rate.

A new classification for pterygomaxillary implants and its related surgical implications: a retrospective cohort study

BackgroundTo provide a novel classification for all implants in the maxillary retromolar region to simplify surgical design, reduce surgical risks, and guide clinicians in clinical decision-making.MethodsA total of 180 patients with bilateral partial or completely edentulous atrophic posterior maxillae who had received or were scheduled to receive pterygomaxillary implants were included in this study. Cone-beam computed tomography was performed, and the sagittal and coronal images were acquired at 110 kV and 10 mA. The exposure volume was 120 mm in diameter and 80 mm in height. The pterygomaxillary implants were divided into three different types based on the anatomical structures the implants passed through.ResultsThe average age of the 180 patients was 69 (range: 39–89) years; 99 were men and 81 were women. All the patients exhibited 360 pterygomaxillary implant sites. However, during mimic implantation, 14 implant sites were excluded due to severe resorption of the tuberosity, very small pterygoid plates, or variations in the descending palatal artery configuration. Of the 346 pterygomaxillary implant sites, 24.0% (83/346), 40.7% (141/346), 22.0% (76/346), and 13.3% (46/346) were classified as Types I, IIa, IIb, and III, respectively.ConclusionsType II pterygomaxillary implants were the most commonly used in the novel classification. Different types of pterygomaxillary implants should follow specific designs and surgical strategies to achieve optimal outcomes.

Surgical outcome of extra sinus zygomatic implants in comparison to conventional implants for the rehabilitation of atrophic maxilla: a systematic review and meta-analysis

Posterior maxillary atrophy in particular presents a challenge for implant-supported dental rehabilitation. The discovery of the zygomatic implant by Branemark and its modifications has brought a much-needed window of hope to most patients with atrophic maxilla. The conventional approach to is believed to be the intra sinus technique but the use of the extra sinus zygomatic implants has advantages like reducing surgical time, the risk of sinus adverse events and improving surgical visualization. A systematic literature search in five databases: Proquest, Google Scholar, PubMed, OVID, Cochrane and a hand search of relevant scientific journals was performed. The meta-analysis done on the included five studies, revealed that the primary outcome, i.e, implant survival rate and prosthesis failure showed no statistically significant difference between the test and the control group. The overall difference between the control (intra sinus zygomatic implants) and test group (extra sinus zygomatic implant) was statistically significant for chronic sinusitis (p=0.0002) and periimplantitis (p=0.01). The use of the extra sinus technique for the placement of zygomatic implants simplified the surgical procedure, improved the prosthetic outcome and reduced the risk of sinusitis and periimplantitis as compared to conventional or intra sinus technique of zygomatic implant placement.

Comparative Evaluation of the Accuracy of Dynamic Navigation and Free Hand Methods During Zygomatic Implant Placement: A Randomized Controlled Trial.

To assess and compare the precision and predictability of zygomatic implants in atrophic maxilla using conventional and dynamic navigation methods. This study was a randomized controlled clinical trial conducted in patients requiring zygomatic implant placements in the atrophic maxilla. Forty zygomatic implants were placed in systemically healthy individuals. Zygomatic implant placement was done using the freehand technique in the control group, and the test group involved implant placement using a dynamic navigation system, and the entry, apex, and angular deviations were evaluated. The mean deviations at the site of entry (2D) in the navigation system (2.531.42) as compared with the freehand (4.151.29) were statistically significant. The variation in the freehand group was greater than the navigation method at the apex (3D) (P < .05). The navigation method had a higher accuracy in angular deviation than the freehand method (4.02 ± 1.80 and 12.67 ± 2.11). Also, the accuracy was checked on the right and left sides in both the conventional and dynamic groups. The dynamic navigation technology had better predictability in terms of accuracy and precision, and it is the need of the hour for clinicians to master this technology and thereby aid in better prognostic level of implant placements.

Crestal Sinus Lift with the Hydrodynamic Technique: Prospective Clinical Study at 3 Years Follow-Up

Aim: This study aimed to evaluate the implant survival rate, marginal bone loss (MBL), and surgical complications in single dental implants placed in the atrophic posterior maxilla using a transcrestal sinus lift with injectable graft materials. Materials and Methods: A prospective longitudinal study was conducted at IRCCS San Raffaele, Milan, Italy. Fifty-four patients with single edentulous sites and residual bone heights &lt; 5 mm were included. A transcrestal sinus lift was performed using non-cutting drills (Cosci’s technique) and xenogenic bone graft in gel form (Gel40, Tecnoss, Italy). Follow-up visits were at 1 week, 3 and 6 months, and annually for 3 years. Results: The implant survival rate was 98.04%, with one implant lost. MBL values were 0.71 ± 0.94 mm at 6 months, 1.00 ± 0.99 mm at 1 year, 1.03 ± 1.00 mm at 2 years, and 1.02 ± 1.01 mm at 3 years. Our ANOVA showed a significant MBL increase from 6 months to 1 year (p = 0.015), with no significant changes thereafter. Minimal surgical complications were observed, each occurring in 1.85% of cases. Conclusion: Transcrestal sinus lifts with injectable graft materials demonstrate high implant survival, acceptable MBL, and minimal complications, making it a reliable option for posterior maxilla rehabilitation.