Zygomatic Implants Research Articles

Comparative evaluation of extrasinus versus intrasinus approach for zygomatic implant placement.

Edentulism, a common problem can occur either as a congenital defect or acquired later due to dental caries, periodontitis, as a consequence of aging, maxillofacial trauma or post-ablation in tumor resections. The rehabilitation of the missing teeth can be done using dental implants. To overcome the deficiency of available bone, processes like sinus augmentation with substituted bone graft and Le Fort I osteotomy with interpositional bone graft have been described in the literature. In order to overcome the associated limitations with these procedures, implants were designed that can be placed in specific anatomical areas like zygoma. This study aims to compare two different types of surgical approaches (Intrasinus vs Extrasinus) for the placement of zygomatic implants to treat atrophic maxilla. The placement of zygomatic implant through both extrasinus and intrasinus approaches were evaluated on the basis of different parameters and it was observed that postoperative pain and swelling was significantly found in intra sinus approach as compared to extra sinus approach. However, in the intranasal approach, poor patient compliance or low satisfaction rate was observed as compared to extra sinus approach. On the basis of the results of the study and post operative evaluation based on various criteria, it was concluded that extra sinus approach has got an edge over intra sinus approach.

‘Pillow technique’ to improve lip support in the context of zygoma implant rehabilitation

This study proposes a simple, off-the-shelf ancillary method for application in the dental rehabilitation of severe maxillary atrophy with zygoma implants, allowing simultaneous improvement of lip support in cases with a moderate lack of premaxillary projection. Three consecutive patients with an atrophic maxilla were evaluated retrospectively. All were treated with a fixed rehabilitation over four zygomatic implants and the pillow technique. The study variables included radiological assessment of the premaxilla volume, upper lip and perinasal soft tissue changes, clinical complications, and subjective evaluation of functional and aesthetic patient satisfaction based on a visual analogue scale. All of the zygomatic implants showed osseointegration. The survival rate was 100%. The immediate postoperative course was uneventful, and no surgical complications were noted at the follow-up visits. Radiological assessment of the premaxilla volume enhancement showed a final mean skeletal projection improvement of +9.4 mm, while the nasolabial angle decreased an average of + 0.6 mm. On the other hand, only small changes in nasal width were detected. Patient satisfaction with the functional and aesthetic outcomes at the 1-year follow-up was excellent. The pillow graft is an easy-to-handle technique that can be included in the armamentarium for moderately incrementing the maxillary sagittal dimension and enhancing lip support in the context of zygoma implant rehabilitation.

Awareness On Zygomatic Implants Among Dental Students

Introduction: Functional and aesthetic rehabilitation of maxilla or posterior maxillary defects is challenging and zygomatic implants have been an effective option in the management of atrophic edentulous maxilla and maxillectomy defects. Zygomatic implants were introduced by Branemark. Bone grafting and augmentation procedures involve two step procedures and lead to economic and financial loss for the patient, thus zygomatic implants have proved to be a good non-grafting option for the rehabilitation procedures for treating posterior maxillary and atrophic maxillary cases. Aim: This study aims to assess the awareness of zygomatic implants among undergraduate students.Materials And Method: A online questionnaire based survey was circulated among the students of Saveetha Dental college and the answers were compiled in excel sheet and tabulated and analysed using the statistical software IBM SPSS version 20.0 and the results of the survey were represented using tabulations and graphical illustrations. Results: Totally 100 participants took part in the the survey and out of which 90% of them were aware of zygomatic implants. 80% of the participants who took part in the survey were aware of the indications of zygomatic implants. 80% of the participants were aware of the most common complication being sinusitis. And the rest of the participants were aware of the other complications that can occur due to zygomatic implants. Conclusion: This survey was done to create an awareness on zygomatic implants. From the study most of them were aware of zygomatic implants, their indication, surgical procedure, contraindication and treatment protocol.

Rehabilitation of the Severely Atrophied Maxilla: Diverse Indications and Treatment Protocols Using Zygomatic Implants, Standard Implants, and Bone Grafting Techniques

The atrophic maxilla is difficult to treat using conventional implant and bone grafting techniques. Zygomatic implants have been a predictable technique to reconstruct the atrophic maxilla. There are multiple treatment combinations that include zygomatic implants, standard implants, and bone grafting; but these have seldomly been described together in the literature. A retrospective chart review was completed to identify patients who have undergone zygomatic implant placement. Variables included number of zygomatic and standard dental implants, unilateral vs bilateral placement, bone grafting status, osseointegration, hardware complications, smoking status, radiation treatment, infection, and prosthetic rehabilitation.

Unilateral Zygomatic Implants in Maxillary Reconstruction and Oral Rehabilitation: A Review of Indications

Reconstruction of the atrophic maxilla using quad zygoma implants or bilateral zygomatic implants in combination with standard implants has been discussed in the literature as a successful treatment method. However, the use of unilateral zygomatic implants as a predictable and long-standing technique has not been sufficiently studied. A retrospective chart review was completed to identify patients who have undergone unilateral zygomatic implant placement. Variables included number of zygomatic and standard dental implants, bone grafting status, osseointegration, hardware complications, smoking status, radiation treatment, infection, and prosthetic rehabilitation.

Implantes cigomáticos en abordajes intra sinusal versus extra maxilar para rehabilitación protésica en maxilaresseveramente atróficos. Análisis de elementos finitos

Objetive: To compare the stresses and deformations generated on the surrounding bone of the zygomatic implants when using an intra sinusal and extra-maxillary approach, through the finite element method. Material and Methods: Computer aided designs (CADs) were constructed using SolidWorks Software of a skull with bone resorption to be rehabilitated through a fixed hybrid prosthesis using two zygomatic and two conventional straight implants. For the boundary conditions (load conditions), symmetry in the sagittal plane was assumed and that all the materials were isotropic, homogeneous and linearly elastic. Two zygomatic implantation techniques were simulated: intra sinusal (Is) and extra maxillary (Em). Vertical and lateral loads of 150 N and 50 N were applied to the finite element models to obtain Von Mises equivalent stress and strain (displacement). Results: The average measurement of the Von Mises stress (MPa) recorded were as follows: Approach of the implant body (Is: 0.24- Em: 0.28,) effort of implant body with vertical load: Is: 0.69 - Em: 0.96; effort of peri-implant surface under horizontal load: Is: 2.11 - Em: 0.94. Average displacement under vertical load of peri-implant surface Is: 0.35 - Em: 0.40, and of implant body Is: 1.34 - Em: 2.04. Average total deformation in approach Is: 2.23 mm - Em: 0.80mm, and average total deformation in the implant body under horizontal load was Is: 0.14 - Em: 0.21. Conclusion: The results of this study indicate that despite the differences that occurred in both stress and strain (displacement) between the intra-sinus and extra-maxillary approaches, the static strength of the bone, which is approximately 150 MPa in tension and 250 MPa in compression was not exceeded. Considering the limitations of finite element analysis, there seems to be no biomechanical reason to choose one approach over the other.

Zygomatic Implants through a Face-Lift Approach: Analysis of 30 Years' Experience.

The use of zygomatic implants has been mostly replaced by fat grafting in rhytidectomy procedures. Furthermore, surgeons using implants prefer the intraoral approach. The authors aimed to describe and emphasize the usefulness of the preauricular approach as the best approach for this operation and underline the value of cheek implants as an alternative and/or as an adjunct to fat grafting during face-lift procedures for midfacial rejuvenation. A retrospective study of 350 patients who underwent face-lift procedures with silicone malar implant placement through a preauricular approach was conducted. Postoperative photographs of all patients were examined by two physicians for postoperative volume adequacy, naturalness of appearance, and improvement in asymmetry. Patient satisfaction was evaluated using a questionnaire with an ordinal scale. The large majority of patients [338 of 350 (96.5 percent)] were completely satisfied or satisfied with the aesthetic outcome. The complication rate was very low and comparable to data reported in current literature. The application of cheek implants proved to be a great tool for midfacial volume rejuvenation with or without associated fat grafting. This conclusion was drawn from the answers reported in the questionnaires completed by the two examiners. The main challenge in this operation was the choice of the type, shape, and size of the implant. The preauricular approach should be given preference during this procedure because, compared to the other approaches, it is easier, faster, and more comfortable for both the patient and the surgeon. Therapeutic, IV.

Success Rates of Zygomatic Implants for the Rehabilitation of Severely Atrophic Maxilla: A Systematic Review.

Zygomatic implants are a treatment solution for patients with severe maxillary atrophy. This treatment option allows delivering immediate fixed teeth within 24 h. Numerous peer-reviewed publications have reported different success rates, resulting in a disagreement on the topic. Therefore, the overall efficacy and predictability of this rehabilitation is still a matter of discussion. With this study, we aimed to identify the published literature on the use of zygomatic implants for the reconstruction of the severely atrophic maxilla and report the cumulative success rate (CSR) as a function of follow-up time. A systematic review of the literature on zygomatic implant for the treatment of severe maxillary atrophy was performed and 196 publications were included in the study. The cumulative success rate of zygomatic implants for the treatment of severe maxillary atrophy was 98.5% at less than 1 year, 97.5% between 1 and 3 years, 96.8% between 3 and 5 years and 96.1% after more than 5 years. The most commonly reported complications were soft tissue dehiscence, rhinosinusitis and prosthetic failures. The treatment of severe lack of bone in the upper maxilla with zygomatic implants is a safe procedure, reaching a cumulative success rate of 96.1% after more than 5 years.

Surgical and prosthetic rehabilitation of siblings with Witkop tooth and nail syndrome using zygomatic implants: a familial case series of 3 patients with up to 15-year follow-up.

Witkop tooth and nail syndrome is a rare, autosomal dominant type of ectodermal dysplasia that can have significant effects on dentition, including hypoplastic and malformed dentition and significantly atrophic maxillas. Endosseous implants have become one possible solution to replace missing teeth, although their use in areas where bone is sparse becomes challenging. Due to the severe atrophy of the maxillary alveolus, extensive preprosthetic surgeries including orthognathic surgery, extensive bone grafting, and sinus floor augmentations have been recommended prior to placement of endosseous dental implants. Although this treatment has shown favorable outcomes, it requires multiple surgical procedures, contributing to a prolonged treatment course and increased morbidity. An alternative treatment of atrophic maxillas in patients with ectodermal dysplasia includes the use of zygomatic implants. This familial case series discusses 3 siblings, all previously diagnosed with Witkop Syndrome, who underwent comprehensive preprosthetic surgery and prosthetic rehabilitation using zygomatic implants with a follow-up period up to 15years.

Biomechanical comparison of four treatment models for the totally edentulous maxilla: a finite element analysis

The aim of this study is to evaluate by finite element analysis different techniques of totally edentulous maxilla rehabilitation, considering implants, bone tissue, metallic infra-structure, and prosthetic abutments characteristics, by means of a three-dimensional model. Stress distribution on bone tissue, implants, and abutments was analyzed with four configurations (six implants axially installed, all-on-four technique, M-4 technique, and four conventional implants with two zygomatic implants). Greater tension on bone tissue were found around distal implants, in all treatment groups, but not exceeding resistance limits of cortical bone. Von Mises stress was higher on the distal region of distal implants of all-on-four and M-4 techniques. Higher stress concentration was seen on angled abutments of zygomatic implants. The highest values of minimal compression stresses were concentrated on peri implant-bone tissue, especially in the model of All-on-4. Therefore, the present finite element analysis revealed that the four configurations of treatment (six implants axially installed, all-on-four technique, M-4 technique, and four conventional implants with two zygomatic implants) for the totally edentulous maxilla are feasible and safe, from a biomechanical point of view.

Stress Distribution Pattern in Zygomatic Implants Supporting Different Superstructure Materials.

The aim of this study was to assess and compare the stress–strain pattern of zygomatic dental implants supporting different superstructures using 3D finite element analysis (FEA). A model of a tridimensional edentulous maxilla with four dental implants was designed using the computer-aided design (CAD) software. Two standard and two zygomatic implants were positioned to support the U-shaped bar superstructure. In the computer-aided engineering (CAE) software, different materials have been simulated for the superstructure: cobalt–chrome (CoCr) alloy, titanium alloy (Ti), zirconia (Zr), carbon-fiber polymers (CF) and polyetheretherketone (PEEK). An axial load of 500 N was applied in the posterior regions near the zygomatic implants. Considering the mechanical response of the bone tissue, all superstructure materials resulted in homogeneous strain and thus could reconstruct the edentulous maxilla. However, with the aim to reduce the stress in the zygomatic implants and prosthetic screws, stiffer materials, such Zr, CoCr and Ti, appeared to be a preferable option.

Major clinical outcomes for optimization of zygomatic implants: a systematic review

Introduction: In the context of implantology, the rehabilitation of an atrophic maxilla is a challenge. In case of severe resorption, zygomatic implants (ZI) are indicated and loading of the implants is advised at the end of the surgery. Also, quad zygomatic implants have been used as a treatment option for patients with severely resorbed maxilla. Objective: The present study aimed to carry out a systematic review of the main approaches and clinical outcomes of zygomatic implantation in the last ten years. Methods: The present study followed the PRISMA rules and a model of literary review presenting and publishing case series, prospective, retrospective, randomized, double-blind, placebo-controlled trials in humans with a time of the last ten years were selected and analyzed. Results and Conclusion: Under the objective proposed in this study, it was concluded that the ZI has a high 12-year cumulative survival rate, with most failures occurring in the early stages of the postoperative period. Furthermore, the zygomatic bone is a viable site for zygomatic implants and the use of specialized implant planning software is an important tool to achieve predictable results for ZI. Preliminary data one year after loading suggest that immediately loaded ZIs were associated with fewer prosthetic failures, fewer implant failures, and shorter time required for functional loading.

Autogenous bone grafting with conventional implants vs zygomatic implants for atrophic maxillae: a retrospective study of the oral health-related quality of life

IntroductionAutogenous bone grafting (ABG)–combined or not with Le Fort I osteotomy (LFIO)–and zygomatic implants (ZI) are two reliable techniques for the fixed rehabilitation of atrophic maxillae. ZI allow a reduced treatment duration with no need to graft, immediate loading and in principle less morbidity. The aim of this retrospective study was to compare these two protocols on oral health-related quality of life (OHRQoL). We also discussed implant and prosthetic survival rates, and biological complications. Material and methodsAll patients who benefited from ZI or ABG with conventional implants (CI) for a fixed maxillary rehabilitation, from November 2011 to April 2019, were included: 21 patients in the ABG group and 22 in the ZI group. OHRQoL was evaluated postoperatively by OHIP-14 questionnaire. ResultsOHIP-14 median scores were respectively 6.5 (interquartile range [IQR] 2.0–13.0) and 6.0 (IQR 3.0–10.0) without significant difference (p = 0.97). Implant/prosthetic survival rates were 97.9%/100% and 97.1%/95.5%. Biological complications rates were 33.3% and 36.4% without significant difference (p = 0.83). DiscussionThe type of surgery or prosthesis does not seem to affect final OHRQoL, implant and prosthetic survival rates or biological complications rates.

Survival of conventional dental implants in the edentulous atrophic maxilla in combination with zygomatic implants: a 20-year retrospective study

PurposeImplant-supported prosthetic rehabilitation in the resorbed maxilla is a great challenge. The aim of this study was to determine the survival rate of conventional anterior implants placed in combination with zygomatic implants according to the Brånemark technique, and to identify risk factors for implant failure.MethodsWe collected data retrospectively from 72 consecutive patients who received treatment from 1998 to 2018 at our center, according to Brånemark’s original technique. Kaplan–Meier analysis was conducted to assess survival rate, and a survival regression model was used with the patient as the random factor, applying the Weibull distribution.ResultsA total of 236 maxillary anterior implants were included, with a mean follow-up of 12.1 years. Kaplan–Meier analysis showed overall cumulative survival rates of 95.3% at 1 year, 94.8% at 2 years, 93.0% at 5 years, 90.5% at 10 years, 81.6% at 15 years, and 67.7% at 20 years. Survival regression showed an association between bruxism and implant failure as well as implants bearing an overdenture. Implants with length ≤ 10 mm had a significantly lower survival time. No significant association was found between the number of anterior implants and survival rate.ConclusionsWe found acceptable long-term anterior conventional implant survival. Significant risk factors for failure were bruxism, overdentures, and implants shorter than 10 mm.

Major clinical results of virtual zygomatic implant and assessment of the risk of bias: a systematic review

Introduction: In the context of implantology and severe resorption, zygomatic implants (ZI) are indicated and the procedures can be completed with the placement of a custom-made provisional prosthesis, reducing surgical time and optimizing results. Digital (virtual) optimizations for the ZI were developed in computerized radiology machines that allowed improvements in diagnostic and therapeutic tools. Objective: It was carried out a systematic review of the main considerations and clinical outcomes of using digital tools for the optimization of the virtual zygomatic implant. Methods: The rules of the Systematic Review-PRISMA Platform were followed. The research was carried out from January 2022 to April 2022 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. 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 94 articles were found. In total, 62 articles were fully evaluated and 41 were included and evaluated in this study, and of the total of 41 articles, only 14 articles were developed as the main clinical results of the virtual zygomatic implant. Reducing errors and complications is essential if zygomatic implants are to remain a viable treatment alternative, and further research on a guided approach to their placement is encouraged. The surgical guide system showed accuracy for all variables studied and allowed acceptable and accurate implant placement, regardless of the complexity of the case. Thus, the surgical and prosthetic plan, the position, the emergence, the shape of the implants, the position of the provisional prosthesis, the inter-arch relationships, and the surgical templates were designed in a virtual environment and previously performed by the surgeon in stereolithographic models, allowing the surgical procedure was significantly simplified.

SHORT IMPLANTS IN POSTERIOR JAWS– A LITERATURE REVIEW

One of the greatest challenges that dentists face today is to rehabilitate severe atrophied alveolar ridges in partially and completely edentulous patients with implants. Loss of bone volume at the level of the posterior maxilla and mandible can complicate rehabilitation with implants, since it leads to a reduction in the distance to the maxillary sinus and the inferior alveolar nerve, respectively. Various techniques have been used for many years to avoid damaging these structures, such as alveolar ridge augmentation procedures, bone grafting, tooth nerve transposition, or even zygomatic implants. An alternative to these surgical treatments is the use of short implants in areas where bone availability is reduced.

Design and biomechanical comparison between classic and new-generation of zygomatic implants – Experimental study

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ZYGOMATIC IMPLANTS MAY IMPROVE QUALITY OF LIFE AND SATISFACTION IN PATIENTS WITH ATROPHIED MAXILLA.

Alberto J, Mariano S, Guerrero-s Y, Pato-mourelo J. Evaluation of Quality of Life And Satisfaction in Patients with Fixed Prostheses on Zygomatic Implants Compared with the All-on-Four Concept: A Prospective Randomized Clinical Study. Int J Environ Res Public Heal. 2021; 18(3426). The Department of Oral Surgery, University of Murcia, Murcia, Spain. Prospective randomized clinical trial.

Dynamic navigation for prosthetically driven zygomatic implant placement in extensive maxillary defects: Results of a prospective case series.

Zygomatic implants (ZIs) that are anchored in remote locations can significantly improve the retention and stability of prosthetic obturation in maxillary defect sites without the need for complex surgical reconstruction. However, ZI placement without alveolar bone guidance is challenging, especially when identifying the ideal three-dimensional location of the "coronal part" of the implant fixture for further rehabilitation. To investigate the feasibility and accuracy of surgical navigation for ZI placement using prosthetically driven plans to treat extensive maxillary defects. Software was used to virtually plan the number and distribution of ZIs for maxillary defect patients according to the existing residual maxillofacial bone. The "coronal part" of the ZI was identified based on the existing maxillodental prosthetic flange, virtually planned infrastructure framework and superstructure. ZI placement was fully guided by surgical navigation. Ten patients were enrolled. One patient had loose reflective spheres, which resulted in an inaccurate back-reflection of the position during navigation. A total of 27 ZIs in the remaining 9 patients were placed uneventfully. The mean of the "coronal part" of the ZI, entry point of the zygomatic bone, apical deviation, and apical angle deviation were 1.50 mm, 1.39 mm, 1.95 mm, and 2.32°, respectively. A Computer-aided design and computer-aided manufacture milled bar and additional attachments were fabricated according to preoperative planning. No osseointegrated implant loss was detected. Six ZIs in three patients received implant surface polishing to reduce soft tissue irritation, and one ZI was submerged. Surgical navigation facilitated the accurate and feasible placement of prosthetically driven ZIs that were preoperatively planned in patients with extensive maxillary defects.

Zygomatic implants using dynamic navigation

Over the decades, surgeons innovated a myriad of methods to assist patients with the replacement of missing teeth with fewer complications and accurate placement. A review of the literature confirmed that zygomatic implants are effective in maxillary reconstruction. Recently, dynamic navigation has proven effective in guiding the insertion of dental implants through the real-time tracking of the surgical instruments during surgery in relation to the planned position on the CBCT of the patients. This method helped improve the accuracy of insertion of dental implants. A prospective randomized control trial was conducted on zygomatic implants inserted using dynamic navigation. A test group and a control group with 20 implants each group were set. In the test group, dynamic navigation guided insertion of zygomatic implants with the reflection of the mucoperiosteal flap was performed. In the control group, flapless insertion of the zygomatic implants was performed. Flapless surgery is associated with less swelling, edema, erythema, and alteration in sensation. The patient could eat and maintain oral hygiene immediately from the very next day. No infections were reported postoperatively. Dynamic navigation-guided insertion of zygomatic implants was effective in maxillary rehabilitation.