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Tezerişener HA, Özalp Ö, Altay MA, Sindel A. Comparison of stress distribution around all-on-four implants of different angulations and zygoma implants: a 7-model finite element analysis. BMC Oral Health 2024; 24:176. [PMID: 38310260 PMCID: PMC10837953 DOI: 10.1186/s12903-023-03761-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/12/2023] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND In recent years, zygomatic implants and the all-on-four treatment concept have been increasingly preferred for rehabilitation of atrophic maxillae. However, debate continues regarding the optimal configuration and angulation of the implants. The aim of this study was to analyze the biomechanical stress in implants and peri-implant bone in an edentulous maxilla with zygomatic implants and the all-on-four concept, using multiple implant configurations. METHODS A total of 7 models consisting different combinations of 4-tilted dental implants and zygomatic implants were included in the study. In each model, a total of 200 N perpendicular to the posterior teeth and 50 N with 45° to the lateral tooth were applied. A finite element analysis was performed for determination of stress distribution on implants and peri-implant bone for each model. RESULTS Higher stress values were observed in both cortical and trabecular bone around the 45°-tilted posterior implants in all-on-four models when compared to zygomatic implants. In cortical bone, the highest stress was established in an all-on-four model including 45°-tilted posterior implant with 4,346 megapascal (MPa), while the lowest stress was determined in the model including anterior dental implant combined with zygomatic implants with 0.817 MPa. In trabecular bone, the highest stress was determined in an all-on-four model including 30°-tilted posterior implant with 0.872 MPa while the lowest stress was observed in quad-zygoma model with 0.119 MPa. Regarding von Mises values, the highest stress among anterior implants was observed in an all-on-four model including 17° buccally tilted anterior implant with 38.141 MPa, while the lowest was in the including anterior dental implant combined with zygomatic implants with 20,446 MPa. Among posterior implants, the highest von Mises value was observed in the all-on-four model including 30°-tilted posterior implant with 97.002 MPa and the lowest stress was in quad zygoma model with 35.802 MPa. CONCLUSIONS Within the limits of the present study, the use of zygoma implants may provide benefit in decreasing biomechanical stress around both dental and zygoma implants. Regarding the all-on-four concept, a 17° buccal angulation of anterior implants may not cause a significant stress increase while tilting the posterior implant from 30° to 45° may cause an increase in the stress around these implants.
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Affiliation(s)
| | - Öznur Özalp
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Campus, Dumlupinar Boulevard, Antalya, 07058, Turkey
| | - Mehmet Ali Altay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Campus, Dumlupinar Boulevard, Antalya, 07058, Turkey
| | - Alper Sindel
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Campus, Dumlupinar Boulevard, Antalya, 07058, Turkey.
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Success Rates of Zygomatic Implants for the Rehabilitation of Severely Atrophic Maxilla: A Systematic Review. Dent J (Basel) 2022; 10:dj10080151. [PMID: 36005249 PMCID: PMC9406716 DOI: 10.3390/dj10080151] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/02/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
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.
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A novel guided zygomatic implant surgery system compared to free hand: a human cadaver study on accuracy. J Dent 2021; 119:103942. [PMID: 34974136 DOI: 10.1016/j.jdent.2021.103942] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 12/19/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The aim of this human cadaver study was to compare the accuracy of guided versus free-hand zygomatic implant placement. For the guided implant placement laser sintered titanium templates were used. METHODS Forty zygomatic implants were placed in ten cadavers heads. For each case two implants were inserted using the guided protocol(Ezgoma guide, Noris Medical, Israel) and the related surgical kit and the other two by using a free hand approach. Post-operative computed tomography (CT) scans were carried out to assess the deviations between planned and inserted implants. The accuracy was measured by overlaying the post-operative Ct scan (with the final position of the achieved implants)with the pre-operative CT scan (with the planned implants). RESULTS The difference of the mean between planned and placed zygomatic implants by using surgical guides or free hand were statistically significant for all the variables evaluated: angular deviation (1.19°±0.40° and 4.92°±1.71° p<0.001), linear distance deviation at coronal point (0.88 mm±0.33 mm and 2.04 mm±0.56 mm p<0.001), at apical point (0.79 mm±0.23 mm and 3.23 mm±1.43 mm p<0.001)and at apical depth (0.35 mm±0.25 mm and 1.02 mm±0.61 mm p<0.001). CONCLUSIONS The proposed surgical guided system exhibited a higher accuracy for all the investigated variables compared to the free hand technique.
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Factors influencing implant and prosthesis survival in zygomatic implant-supported fixed rehabilitation: a retrospective study. Odontology 2021; 109:965-972. [PMID: 34146176 DOI: 10.1007/s10266-021-00621-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this retrospective study was to evaluate mid-term implant and prosthesis survival in patients with edentulous atrophic maxillae submitted to zygomatic implant-supported fixed rehabilitation and to identify possible related risk factors. METHODS Data were collected from records of patients with edentulous atrophic maxillae, in good general health and who were rehabilitated by means of acrylic resin full-arch screw-retained prosthesis supported by at least one zygomatic implant, between the years of 2006-2017. Implant and prosthesis survival rates were calculated. The association between implant and prosthesis loss and quantitative and qualitative variables of interest was verified with t tests and Fisher's exact tests, respectively. For the significant variables in the latter, odds ratio and 95% confidence intervals were additionally calculated. RESULTS The sample comprised 66 patients in whom 171 zygomatic implants were placed to support maxillary screw-retained full-arch prostheses. Implant and prosthesis survival rates of 94.15% and 92.4%, respectively, were observed in a mean of 3.6 years of follow-up (up to 11.7 years). Implant loss was 4.33 more likely to occur when adverse events were recorded after the procedure of implant placement (P = 0.026) and 10.31 more likely to occur in implants that had their prosthesis repaired during follow-up visits (P = 0.004). Prosthesis loss was 22.00 times more likely to occur when implants were previously lost (P < 0.001). All prostheses that were considered as failures (i.e. were replaced) had been previously submitted to laboratory repair at some point during follow-up. CONCLUSIONS Zygomatic implant rehabilitation demonstrated to be a reliable method with good mid-term results. The occurrence of post-surgical adverse events and need for laboratory repair of the prosthesis were found to be significant risk factors for implant loss. Previous implant loss was significantly associated with prosthesis loss. These risk factors may be prevented by means of detailed planning of the rehabilitation to be carried out, including post-operative care of the patients, so that treatment success using zygomatic implants can be achieved.
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Moro SA, Thomé G, Padovan LEM, da Silva RD, Tiossi R, Fontão FNGK. A zygomatic bone study using virtual dental implant planning software. J ORAL IMPLANTOL 2021; 48:171-176. [PMID: 34091691 DOI: 10.1563/aaid-joi-d-20-00149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study evaluated the anatomical factors that influence the virtual planning of zygomatic implants by using cone beam computerized tomography (CBCT) scans. CBCT scans of 268 maxilla edentulous patients were transferred to a specialized implant planning software (Galaxis, Sirona) for the following measurements: maxillo-sinus concavity size (small, medium, and large), Zygoma width, implant insertion angle, implant length, and implant apical anchorage. Concavity sizes found were as follows: 34.95% small, 52.30% medium, and 7.35% large. The mean insertion angle was 43.2 degrees and the average implant apical anchorage was 9.1mm. The most frequent implant length was 40mm. Significant differences were found when the different types of concavities in relation to the installation angle, the distance of the apical portion of the implant in contact with the zygomatic bone and the lateral-lateral thickness of the zygomatic bone were compared (p<0.001). Medium-sized maxillary sinus concavity presented greater apical anchorage of the implant (9.7mm) and was the most frequent type (52.30%). The zygomatic bone is a viable site for zygomatic fixtures and the use of specialized implant planning software is an important tool to achieve predictable outcomes for zygomatic implants and allows good visualization of the implant-anatomical structures relation.
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Affiliation(s)
| | | | | | | | - Rodrigo Tiossi
- State University of Londrina Professor Department of Restorative Dentistry Clínica Odontológica Universitária Rua Pernambuco 540 Centro BRAZIL Londrina Paraná 86020-120 State University of Londrina
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Tobar-Reyes J, Andueza-Castro L, Jiménez-Silva A, Bustamante-Plaza R, Carvajal-Herrera J. Micromotion analysis of immediately loaded implants with Titanium and Cobalt-Chrome superstructures. 3D finite element analysis. Clin Exp Dent Res 2021; 7:581-590. [PMID: 34042328 PMCID: PMC8404496 DOI: 10.1002/cre2.365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/27/2020] [Accepted: 10/31/2020] [Indexed: 11/26/2022] Open
Abstract
Objective The aim of this study was to evaluate the amount of micromotion of dental implants under immediate loading supported by Titanium (Ti) and Cobalt‐Chrome (Co‐Cr) superstructures. Material and methods A model of tridimensional half‐edentulous maxilla with three dental implants was made using the Finite Element Analysis (FEA). Two standard and one zygomatic implants were connected to a superstructure with an elliptic section of 6x 3 mm (mm). Two study models were established. Model A: Titanium (Ti) alloy superstructure; Model B: Cobalt‐Chrome (Co‐Cr) alloy superstructure. To simulate an immediate‐loading situation, a friction coefficient of 0.71 was applied between the implant and the bone surface. An axial load of 252.04 [N] was applied on standard and zygomatic implants. Results The Micromotion of dental implants was similar in both superstructure situations. The amount of micromotion was slightly higher in B1 and B3 models (Co‐Cr alloy‐superstructure) compared with A1 and A3 models (Titanium alloy superstructure). The micromotion values in two groups were greater than 150 μm in the incisive region (standard implant) and molar region (zygomatic). In general, the micromotion was higher on the implant that received the load with respect to the other implants. The greater difference was observed when the load was applied on the standard implant A1 (Model A1 = 189.12 μm) compared with standard implant B1(Model B1 = 263.25 μm). Conclusions Within the limits of present study, all implants on different load application points showed micromotion; in general, the amount of micromotion was slightly higher in the implants connected with Co‐Cr alloy superstructure.
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Affiliation(s)
- Julio Tobar-Reyes
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Chile, Santiago, Chile
| | - Luis Andueza-Castro
- Facultad de Diseño, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonio Jiménez-Silva
- Orthodontic and Orthopaedic Department, Faculty of Dentistry, Universidad Andrés Bello, Santiago, Chile
| | | | - Juan Carvajal-Herrera
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Chile, Santiago, Chile
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Lorusso F, Conte R, Inchingolo F, Festa F, Scarano A. Survival Rate of Zygomatic Implants for Fixed Oral Maxillary Rehabilitations: A Systematic Review and Meta-Analysis Comparing Outcomes between Zygomatic and Regular Implants. Dent J (Basel) 2021; 9:dj9040038. [PMID: 33915748 PMCID: PMC8065623 DOI: 10.3390/dj9040038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Zygomatic implants have been proposed alone or in combination with premaxillary conventional implants for severe resorbed maxillary atrophy rehabilitation. The aim of the present investigation was to evaluate through a qualitative systematic review and meta-analysis the survival rate of zygomatic implants in conjunction with regular fixtures for maxillary rehabilitation. Methods: The article screening was conducted on the PubMed/Medline and EMBASE electronic databases according to the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines. The scientific papers were included for qualitative analysis and risk-of-bias evaluation. Only the papers that included rehabilitation with zygomatic implants in combination with regular implants were considered for the meta-analysis comparative evaluation of the implant survival rate. Results: The paper search screened a total of 137 papers. After the initial screening, a total of 32 articles were considered for the qualitative analysis. There was a similar implant survival rate between zygomatic and premaxilla regular implants (p = 0.02; Z: 2.26). Conclusions: Zygomatic and conventional implants showed a high long-term survival rate for fixed maxillary rehabilitations, but few included studies reported the marginal bone loss after loading. Further studies are necessary to evaluate the pattern of marginal bone loss between zygomatic and conventional implants after long-term functional loading.
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Affiliation(s)
- Felice Lorusso
- Department of Innovative Technologies in Medicine & Dentistry and CAST, University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (F.L.); (F.F.)
| | | | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy;
| | - Felice Festa
- Department of Innovative Technologies in Medicine & Dentistry and CAST, University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (F.L.); (F.F.)
| | - Antonio Scarano
- Department of Innovative Technologies in Medicine & Dentistry and CAST, University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; (F.L.); (F.F.)
- Correspondence: ; Tel.: +39-0871-355-4084; Fax: +39-0871-355-4099
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Combined bone- and mucosa-supported 3D-printed guide for sinus slot preparation and prosthetically driven zygomatic implant placement. J Prosthet Dent 2021; 128:1165-1170. [PMID: 33795160 DOI: 10.1016/j.prosdent.2021.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/24/2022]
Abstract
The use of zygomatic implants to rehabilitate the severely atrophic maxilla has been well documented since first being introduced by Brånemark. Placement of zygomatic implants is technically complex, with catastrophic complications and numerous prosthetic challenges resulting from imprecise placement. The purpose of this report was to demonstrate a technique that allows transfer of the preoperatively planned sinus slot position to the surgical field by using cone beam computed tomography (CBCT) and an implant planning software program to fabricate a combined bone- and mucosa-supported 3D-printed surgical guide. This facilitates optimal zygomatic implant positioning and promotes favorable biomechanics with a predictable prosthetic outcome.
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Choi Y, Kim IB. Distribution of the Laterally Supplying Facial Nerve to the Orbicularis Oculi Muscle. Aesthet Surg J 2021; 41:161-169. [PMID: 32652025 DOI: 10.1093/asj/sjaa202] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The facial nerve that traverses the lateral border of the orbicularis oculi muscle is considered the primary motor for the muscle. Nevertheless, the lateral motor supply to the orbicularis oculi muscle has not yet been fully described. OBJECTIVES The aim of this study was to report detailed anatomic information about the lateral motor supply route to the orbicularis oculi. METHODS Facial nerve branches that cross the lateral orbicularis oculi border were fully traced from the parotid border to the nerve destinations in 43 fresh hemifaces by microscopic surgical dissection and time-lapse photography. RESULTS Through the lateral route, the anterior temporal and upper zygomatic branches supply the superior orbital and superior preseptal orbicularis oculi of the upper eyelid, as well as the lateral pretarsal and malar orbicularis oculi, excluding the upper medial pretarsal portion of the upper eyelid and most of the lower eyelid. The nerve supplying the lateral pretarsal orbicularis oculi muscle crosses the anterior area of the zygomatic arch. It then traverses an area 6 mm above and 4 mm below the lateral canthal crease. CONCLUSIONS The anterior area of the zygomatic arch and an area 6 mm above and 4 mm below the lateral canthal crease are the facial nerve danger zones. The present anatomic findings provide surgeons with further insights for performing blepharoplasty, midface lift, facelift, and facial nerve reconstructive surgery.
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Affiliation(s)
- Yeop Choi
- Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In-Beom Kim
- Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Bryanskaya EO, Novikova IN, Dremin VV, Gneushev RY, Bibikova OA, Dunaev AV, Artyushenko VG. Optical Diagnostics of the Maxillary Sinuses by Digital Diaphanoscopy Technology. Diagnostics (Basel) 2021; 11:diagnostics11010077. [PMID: 33418891 PMCID: PMC7825049 DOI: 10.3390/diagnostics11010077] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 02/03/2023] Open
Abstract
The work is devoted to the development of a scientific and technical basis for instrument implementation of a digital diaphanoscopy technology for the diagnosis of maxillary sinus inflammatory diseases taking into account the anatomical features of patients (differences in skin structure, skull bone thickness, and sinus size), the optical properties of exercised tissues, and the age and gender characteristics of patients. The technology is based on visualization and analysis of scattering patterns of low-intensity radiation as it passes through the maxillary sinuses. The article presents the experimental data obtained using the digital diaphanoscopy method and the results of numerical simulation of the optical radiation passage through the study area. The experimental setup has been modernized through the installation of a a device for controlling the LED applicator brightness. The approach proposed may have considerable promise for creating diagnostic criteria for various pathological changes and can be used to assess the differences in the optical and anatomical features of males and females.
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Affiliation(s)
- Ekaterina O. Bryanskaya
- R&D Center of Biomedical Photonics, Orel State University, Orel 302026, Russia; (I.N.N.); (V.V.D.); (R.Y.G.); (A.V.D.)
- Correspondence: ; Tel.: +7-980-366-29-12
| | - Irina N. Novikova
- R&D Center of Biomedical Photonics, Orel State University, Orel 302026, Russia; (I.N.N.); (V.V.D.); (R.Y.G.); (A.V.D.)
| | - Viktor V. Dremin
- R&D Center of Biomedical Photonics, Orel State University, Orel 302026, Russia; (I.N.N.); (V.V.D.); (R.Y.G.); (A.V.D.)
- College of Engineering and Physical Sciences, Aston University, Birmingham B4 7ET, UK
| | - Roman Yu. Gneushev
- R&D Center of Biomedical Photonics, Orel State University, Orel 302026, Russia; (I.N.N.); (V.V.D.); (R.Y.G.); (A.V.D.)
| | | | - Andrey V. Dunaev
- R&D Center of Biomedical Photonics, Orel State University, Orel 302026, Russia; (I.N.N.); (V.V.D.); (R.Y.G.); (A.V.D.)
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Abstract
Restoring the dentition of an edentulous patient is often challenging. Endosseous dental implants have allowed for far more versatility in this area but still require adequate maxillary and mandibular alveolar bone. Often, unless significant bone grafting techniques are used, true restoration of the dentition can be impossible with traditional endosseous implants. The advent of zygomatic implants, however, may provide a viable, predictable, and stable alternative for the restoration of the dentition in patients with severe maxillary alveolar bone loss.
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Affiliation(s)
- Jonathan Rosenstein
- Department of Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, USA
| | - Harry Dym
- Department of Dentistry/Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 121 DeKalb Avenue, Brooklyn, NY 11201, USA.
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Pellegrino G, Grande F, Ferri A, Pisi P, Gandolfi MG, Marchetti C. Three-Dimensional Radiographic Evaluation of the Malar Bone Engagement Available for Ideal Zygomatic Implant Placement. Methods Protoc 2020; 3:mps3030052. [PMID: 32707931 PMCID: PMC7564428 DOI: 10.3390/mps3030052] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/11/2020] [Accepted: 07/21/2020] [Indexed: 12/27/2022] Open
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.
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Affiliation(s)
- Gerardo Pellegrino
- Oral and Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy; (A.F.); (C.M.)
- Correspondence: ; Tel.: +39-051-208-8157
| | - Francesco Grande
- Oral Surgery Unit, Dental School, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy;
| | - Agnese Ferri
- Oral and Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy; (A.F.); (C.M.)
| | - Paolo Pisi
- Dental Radiology Unit, Dental School, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy;
| | - Maria Giovanna Gandolfi
- Medical-technical Science, Dental School, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy;
| | - Claudio Marchetti
- Oral and Maxillofacial Surgery Unit, Department of Biomedical and Neuromotor Sciences, University of Bologna, 40125 Bologna, Italy; (A.F.); (C.M.)
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Abstract
Even with the great strides made in the techniques for placement of traditional endosseous dental implants, restoration of the dentition in patients with a severely resorbed or resected maxilla can prove challenging. For many decades, significant bone grafting was the mainstay of treatment for these patients. However, zygomatic implants have been shown to provide a stable and predictable alternative for the restoration of the dentition for patients with severe bone loss of the maxilla.
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Affiliation(s)
- Jonathan Rosenstein
- Department of Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, USA
| | - Harry Dym
- Department of Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 121 Dekalb Avenue, Brooklyn, NY 11201, USA.
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Wang CI, Cho S, Cho D, Ducote C, Reddy LV, Sinada N. A 3D‐Printed Guide to Assist in Sinus Slot Preparation for the Optimization of Zygomatic Implant Axis Trajectory. J Prosthodont 2020; 29:179-184. [DOI: 10.1111/jopr.13139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Christina I. Wang
- Department of Comprehensive DentistryTexas A&M University College of Dentistry Dallas TX
| | - Seok‐Hwan Cho
- Department of Comprehensive DentistryTexas A&M University College of Dentistry Dallas TX
| | - David Cho
- Department of Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry Dallas TX
| | - Colten Ducote
- Department of Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry Dallas TX
| | - Likith V. Reddy
- Department of Oral and Maxillofacial Surgery, Texas A&M University College of Dentistry Dallas TX
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An Anatomical Study of Maxillary-Zygomatic Complex Using Three-Dimensional Computerized Tomography-Based Zygomatic Implantation. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8027307. [PMID: 29376077 PMCID: PMC5742432 DOI: 10.1155/2017/8027307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 10/12/2017] [Indexed: 12/03/2022]
Abstract
Objective To obtain anatomical data of maxillary-zygomatic complex based on simulating the zygomatic implantation using cadaver heads and three-dimensional computerized tomography (3D-CT). Methods Simulating zygomatic implantation was performed using seven cadaver heads and 3D-CT images from forty-eight adults. After measuring the maxillary-zygomatic complex, we analyzed the position between the implantation path and the maxillary sinus cavity as well as the distance between the implantation path and the zygomatic nerve. Results The distance from the starting point to the endpoint of the implant was 56.85 ± 5.35 mm in cadaver heads and 58.15 ± 7.37 mm in 3D-CT images. For the most common implantation path (80.20%), the implant went through the maxillary sinus cavity completely. The projecting points of the implant axis (IA) on the surface of zygoma were mainly located in the region of frontal process of zygomatic bone close to the lateral orbital wall. The distances between IA and zygomatic nerve in 53 sides were shorter than 2 mm. Conclusion The simulating zygomatic implantation on cadaver skulls and 3D-CT imaging provided useful anatomical data of the maxillary-zygomatic complex. It is necessary to take care to avoid the zygomatic nerve injury during implantation, because it frequently appears on the route of implantation.
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Hung KF, Ai QY, Fan SC, Wang F, Huang W, Wu YQ. Measurement of the zygomatic region for the optimal placement of quad zygomatic implants. Clin Implant Dent Relat Res 2017; 19:841-848. [PMID: 28766912 DOI: 10.1111/cid.12524] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/01/2017] [Accepted: 07/09/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The zygomatic implant is suggested to be placed in zygomatic areas with the largest thickness, but regions to obtain the largest bone-to-implant contact (BIC) were unknown. PURPOSE To identify the zygomatic regions for placing quad zygomatic implants that obtain the largest BIC. MATERIALS AND METHODS The zygomatic thicknesses of 300 zygomata were measured at total 12 points on the superior, middle, and inferior areas on the 3-dimensional reconstruction images. In 50 edentulous maxillae, the zygomatic BICs of virtually placed implants were measured and the incidence of the intrusion into the infratemporal fossa calculated at each point. RESULTS The largest thickness in the superior, middle, and inferior regions were at Point A1 (8.01 ± 2.10 mm), Point B1 (7.02 ± 1.73 mm), and Point C0 (6.65 ± 1.66 mm), respectively. The virtually placed implants at Point A3 (16.70 ± 4.18 mm) and Point B1 (12.07 ± 3.84 mm) had the highest BICs while retaining the minimum incidence of the intrusion complications. CONCLUSION To obtain the largest BICs and avoid the intrusion complications, results suggested that the postero-superior region (Point A3 ) and the center of zygoma (Point B1 ) were the optimal places for the placement of quad zygomatic implants.
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Affiliation(s)
- Kuo-Feng Hung
- Department of Oral-Maxillofacial Implantology, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200011, China
| | - Qi-Yong Ai
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, S.A.R. China
| | - Sheng-Chi Fan
- Department of Oral-Maxillofacial Implantology, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200011, China
| | - Feng Wang
- Department of Oral-Maxillofacial Implantology, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200011, China
| | - Wei Huang
- Department of Oral-Maxillofacial Implantology, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200011, China
| | - Yi-Qun Wu
- Department of Oral-Maxillofacial Implantology, Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200011, China
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Kamburoğlu K, Kirşan Büyükkoçak B, Acar B, Paksoy CS. Assessment of zygomatic bone using cone beam computed tomography in a Turkish population. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:257-264. [DOI: 10.1016/j.oooo.2016.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/30/2016] [Accepted: 10/24/2016] [Indexed: 11/28/2022]
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18
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Takamaru N, Nagai H, Ohe G, Tamatani T, Sumida K, Kitamura S, Miyamoto Y. Measurement of the zygomatic bone and pilot hole technique for safer insertion of zygomaticus implants. Int J Oral Maxillofac Surg 2015; 45:104-9. [PMID: 26395065 DOI: 10.1016/j.ijom.2015.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 06/01/2015] [Accepted: 07/16/2015] [Indexed: 12/01/2022]
Abstract
The zygomaticus implant was developed for patients with severe bone resorption of the posterior maxilla. These may eliminate or minimize the need for bone grafting. Although the zygomaticus implant has shown a remarkable success rate in this difficult-to-treat patient population, the method requires an advanced surgical technique and carries an increased risk of complications. There have been few anatomical studies on the zygomatic bone in relation to the insertion of zygomaticus implants. The height and thickness of the zygomatic bone for the insertion were measured in this study. The thickness at the 90° angle point, where the upper margin of the zygomatic arch and the temporal margin of the frontal process of the zygomatic bone intersect and where the apex of the implant penetrates, was found to be 1.8±0.4 mm; this gradually increased inferiorly and anteriorly. Thus, the penetration point of the apex of the zygomaticus implant should be located more inferoanterior to the 90° angle point, as the thickness in this region is thinner than the diameter of the implant. Based on the results of this study, a newer and safer insertion method for the zygomaticus implant using a drill guide is proposed.
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Affiliation(s)
- N Takamaru
- Department of Oral Surgery, Subdivision of Molecular Oral Medicine, Division of Integrated Sciences of Translational Research, Institute of Health Biosciences, University of Tokushima, Tokushima, Japan.
| | - H Nagai
- Department of Oral Surgery, Subdivision of Molecular Oral Medicine, Division of Integrated Sciences of Translational Research, Institute of Health Biosciences, University of Tokushima, Tokushima, Japan
| | - G Ohe
- Department of Oral Surgery, Subdivision of Molecular Oral Medicine, Division of Integrated Sciences of Translational Research, Institute of Health Biosciences, University of Tokushima, Tokushima, Japan
| | - T Tamatani
- Department of Oral Surgery, Subdivision of Molecular Oral Medicine, Division of Integrated Sciences of Translational Research, Institute of Health Biosciences, University of Tokushima, Tokushima, Japan
| | - K Sumida
- Department of Oral and Maxillofacial Anatomy, Subdivision of Medical Science for Oral and Maxillofacial Regeneration, Division of Medico-Dental Dynamics and Reconstruction, Institute of Health Biosciences, University of Tokushima, Tokushima, Japan
| | - S Kitamura
- Department of Oral and Maxillofacial Anatomy, Subdivision of Medical Science for Oral and Maxillofacial Regeneration, Division of Medico-Dental Dynamics and Reconstruction, Institute of Health Biosciences, University of Tokushima, Tokushima, Japan
| | - Y Miyamoto
- Department of Oral Surgery, Subdivision of Molecular Oral Medicine, Division of Integrated Sciences of Translational Research, Institute of Health Biosciences, University of Tokushima, Tokushima, Japan
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Bertl K, Heimel P, Rökl-Riegler M, Hirtler L, Ulm C, Zechner W. MicroCT-based evaluation of the trabecular bone quality of different implant anchorage sites for masticatory rehabilitation of the maxilla. J Craniomaxillofac Surg 2015; 43:961-8. [DOI: 10.1016/j.jcms.2015.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 11/16/2022] Open
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20
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Age-related changes in anatomic bases for the insertion of zygomatic implants. Int J Oral Maxillofac Surg 2014; 43:1367-72. [DOI: 10.1016/j.ijom.2014.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 04/24/2014] [Accepted: 05/14/2014] [Indexed: 11/18/2022]
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21
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Romeed SA, Malik R, Dunne SM. Zygomatic Implants: The Impact of Zygoma Bone Support on Biomechanics. J ORAL IMPLANTOL 2014; 40:231-7. [DOI: 10.1563/aaid-joi-d-11-00245] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Maxillectomy and severely resorbed maxilla are challenging to restore with provision of removable prostheses. Dental implants are essential to restore esthetics and function and subsequently quality of life in such group of patients. Zygomatic implants reduce the complications associated with bone grafting procedures and simplify the rehabilitation of atrophic maxilla and maxillectomy. The purpose of this study was to compare, by means of 3-dimensional finite element analysis, the impact of different zygomatic bone support (10, 15, and 20 mm) on the biomechanics of zygomatic implants. Results indicated that maximum stresses within the fixture were increased by 3 times when bone support decreased from 20 to 10 mm and were concentrated at the fixture/bone interface. However, stresses within the abutment screw and the abutment itself were not significantly different regardless of the bone support level. Supporting bone at 10 mm sustained double the stresses of 15 and 20 mm. Fixture's deflection was decreased by 2 to 3 times when bone support level increased to 15 mm and 20 mm, respectively. It was concluded that zygomatic bone support should not be less than 15 mm, and abutment screw is not at risk of fracture regardless of the zygomatic bone support.
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Affiliation(s)
- Shihab A. Romeed
- Deptartment Restorative Dentistry, King's College London Dental Institute, London, UK
| | | | - Stephen M. Dunne
- Deptartment Restorative Dentistry, King's College London Dental Institute, London, UK
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22
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Huang B, Takahashi K, Jennings EA, Pumtang-On P, Kiso H, Togo Y, Saito K, Sugai M, Akira S, Shimizu A, Bessho K. Prospective signs of cleidocranial dysplasia in Cebpb deficiency. J Biomed Sci 2014; 21:44. [PMID: 24885110 PMCID: PMC4039338 DOI: 10.1186/1423-0127-21-44] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/08/2014] [Indexed: 11/10/2022] Open
Abstract
Background Although runt-related transcription factor 2 (RUNX2) has been considered a determinant of cleidocranial dysplasia (CCD), some CCD patients were free of RUNX2 mutations. CCAAT/enhancer-binding protein beta (Cebpb) is a key factor of Runx2 expression and our previous study has reported two CCD signs including hyperdontia and elongated coronoid process of the mandible in Cebpb deficient mice. Following that, this work aimed to conduct a case-control study of thoracic, zygomatic and masticatory muscular morphology to propose an association between musculoskeletal phenotypes and deficiency of Cebpb, using a sample of Cebpb-/-, Cebpb+/- and Cebpb+/+ adult mice. Somatic skeletons and skulls of mice were inspected with soft x-rays and micro-computed tomography (μCT), respectively. Zygomatic inclination was assessed using methods of coordinate geometry and trigonometric function on anatomic landmarks identified with μCT. Masseter and temporal muscles were collected and weighed. Expression of Cebpb was examined with a reverse transcriptase polymerase chain reaction (RT-PCR) technique. Results Cebpb-/- mice displayed hypoplastic clavicles, a narrow thoracic cage, and a downward tilted zygomatic arch (p < 0.001). Although Cebpb+/- mice did not show the phenotypes above (p = 0.357), a larger mass percentage of temporal muscles over masseter muscles was seen in Cebpb+/- littermates (p = 0.012). The mRNA expression of Cebpb was detected in the clavicle, the zygoma, the temporal muscle and the masseter muscle, respectively. Conclusions Prospective signs of CCD were identified in mice with Cebpb deficiency. These could provide an additional aetiological factor of CCD. Succeeding investigation into interactions among Cebpb, Runx2 and musculoskeletal development is indicated.
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Affiliation(s)
| | - Katsu Takahashi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto 606-8507, Japan.
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23
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Wen H, Guo W, Liang R, Xiang L, Long G, Wang T, Deng M, Tian W. Finite element analysis of three zygomatic implant techniques for the severely atrophic edentulous maxilla. J Prosthet Dent 2014; 111:203-15. [PMID: 24314571 DOI: 10.1016/j.prosdent.2013.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 05/10/2013] [Accepted: 05/16/2013] [Indexed: 01/13/2023]
Abstract
STATEMENT OF PROBLEM A variety of zygomatic implantation techniques currently exist; however, a consensus regarding the most suitable method has not yet been reached. PURPOSE The purpose of this study was to evaluate and compare 3 zygomatic implantation techniques and to clarify the optimal number and position of zygomatic and dental implants for the reconstruction of the severely atrophied edentulous maxilla. MATERIAL AND METHODS A 3-dimensional finite element analysis craniofacial model was constructed from the computed tomography data of a selected patient with a severely atrophic edentulous maxilla. Modeled zygomatic implants were inserted into the craniofacial model with 3 surgical techniques (classic Brånemark, exteriorized, and extramaxillary), and with 3 model variations that involved the number and position of zygomatic and dental implants. The zygomatic implants were loaded with a vertical force of 150 N and a lateral force of 50 N. The stresses on and deformations of the bones and implants were then observed and compared. RESULTS No obvious differences in the amount and distribution of stress on the external craniofacial bones were detected in the models. The lowest stresses on the zygomatic implants were observed in the exteriorized technique group. The lowest deformations of the bone that surrounds zygomatic implants and dental implants were observed in the exteriorized technique and classic Brånemark technique groups. For the exteriorized technique group, the model with 1 dental implant in the site of the maxillary lateral incisor exhibited the lowest stress on the zygomatic implants and the least deformation of the bone surrounding the zygomatic and dental implants. CONCLUSIONS All 3 zygomatic implant techniques resulted in more or less homogeneous transference of force and thus could reconstruct the edentulous maxilla; however, the exteriorized technique with 1 dental implant in the lateral incisor appeared to be the most appropriate reconstruction method for the severely atrophied edentulous maxilla.
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Affiliation(s)
- Hailin Wen
- Postgraduate student, Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University; National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Weihua Guo
- Associate Professor, Department of Pedodontics, West China College of Stomatology, Sichuan University; National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Rui Liang
- Postgraduate student, College of Architecture and Environment, Sichuan University; National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lin Xiang
- Postgraduate student, Department of Implantology, West China College of Stomatology, Sichuan University; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Gang Long
- Postgraduate student, Department of Implantology, West China College of Stomatology, Sichuan University; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tingting Wang
- Postgraduate student, Department of Endodontics, West China College of Stomatology, Sichuan University; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Meng Deng
- Postgraduate student, Department of Endodontics, West China College of Stomatology, Sichuan University; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Weidong Tian
- Professor and Director, Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University; National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University; State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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24
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Vega LG, Gielincki W, Fernandes RP. Zygoma implant reconstruction of acquired maxillary bony defects. Oral Maxillofac Surg Clin North Am 2013; 25:223-39. [PMID: 23642670 DOI: 10.1016/j.coms.2013.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The reconstruction of acquired maxillary bony defects after pathologic ablation, infectious debridement, avulsive trauma, or previously failed reconstructions with zygoma implants represents a treatment alternative that is safe, predictable, and cost-effective. Still the single most important factor for treatment success of these complex reconstructions is the implementation of a team approach between the surgeon and the restorative dentist. The focus of this article is to review the surgical and prosthetic nuances to successfully reconstruct acquired maxillary defects with zygoma implants.
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Affiliation(s)
- Luis G Vega
- Oral and Maxillofacial Residency Program, Health Science Center at Jacksonville, University of Florida, Jacksonville, FL 32209, USA.
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25
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Rehabilitation of posterior maxilla with zygomatic and dental implant after tumor resection: a case report. Case Rep Dent 2013; 2013:930345. [PMID: 23533833 PMCID: PMC3600263 DOI: 10.1155/2013/930345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 02/05/2013] [Indexed: 11/18/2022] Open
Abstract
Zygomatic implants have been used for dental rehabilitation in patients with insufficient bone in the posterior upper jaw, due to, for example, tumor resection, trauma, or atrophy. Zygomatic implants are an alternative to complex free or vascularized bone grafting and distraction osteogenesis. A 42-year-old male patient with a severe defect in the right posterior maxilla, starting from the first canine region, which had occurred after tumor resection 3 years earlier, was referred to our department. One zygomatic implant (Brenemark System, Nobel Biocare, Goteborg, Sweden) to the zygoma and one dental implant to the canine region were placed. After a 5-month osseointegration period, a fixed denture was fabricated and adapted to the implants. Although the surgical and prosthetic procedures for zygoma implants are not easy, the final outcomes can be successful with appropriate planning.
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Korkmaz FM, Korkmaz YT, Yaluğ S, Korkmaz T. Impact of Dental and Zygomatic Implants on Stress Distribution in Maxillary Defects: A 3-Dimensional Finite Element Analysis Study. J ORAL IMPLANTOL 2012; 38:557-67. [DOI: 10.1563/aaid-joi-d-10-00111] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to evaluate the stress distribution in the bone around dental and zygomatic implants for 4 different implant-supported obturator prostheses designs in a unilaterally maxillary defect using a 3-dimensional finite element stress analysis. A 3-dimensional finite element model of the human unilateral maxillary defect was constructed. Four different implant-supported obturator prostheses were modeled; model 1 with 2 zygomatic implants and 1 dental implant, model 2 with 2 zygomatic implants and 2 dental implants, model 3 with 2 zygomatic implants and 3 dental implants, and model 4 with 1 zygomatic implant and 3 dental implants. Bar attachments were used as superstructure. A 150-N vertical load was applied in 3 different ways, and von Mises stresses in the cortical bone around implants were evaluated. When the models (model 1–3) were compared in terms of number of implants, all of the models showed similar highest stress values under the first loading condition, and these values were less than under model 4 conditions. The highest stress values of models 1–4 under the first loading condition were 8.56, 8.59, 8.32, and 11.55 Mpa, respectively. The same trend was also observed under the other loading conditions. It may be concluded that the use of a zygomatic implant on the nondefective side decreased the highest stress values, and increasing the number of dental implants between the most distal and most mesial implants on the nondefective side did not decrease the highest stress values.
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Affiliation(s)
- Fatih Mehmet Korkmaz
- Department of Prosthodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey
| | - Yavuz Tolga Korkmaz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Suat Yaluğ
- Department of Prosthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | - Turan Korkmaz
- Department of Prosthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
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Abstract
Patients with moderate to severe atrophy challenge the surgeon to discover alternative ways to use existing bone or resort to augmenting the patient with autogenous or alloplastic bone materials. Many procedures have been suggested for these atrophied maxillae before implant placement, which include Le Fort I maxillary downfracture, onlay bone grafts and maxillary sinus graft procedures. A zygomatic implant can be an effective device for rehabilitation of the severely resorbed maxilla. If zygomatic implants are used, onlay bone grafting or sinus augmentation would likely not be necessary. The purpose of this article is to review the developments that have taken place in zygomatic implant treatment over years, including anatomic information for installing the zygomatic implants, implant placement techniques, stabilization, and prosthodontic procedures.
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Affiliation(s)
- Ashu Sharma
- Department of Prosthodontics, Bangalore Institute of Dental Sciences and Research Center, Bangalore, Karnataka, India.
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Chrcanovic BR, Oliveira DR, Custódio AL. Accuracy evaluation of computed tomography-derived stereolithographic surgical guides in zygomatic implant placement in human cadavers. J ORAL IMPLANTOL 2010; 36:345-355. [PMID: 20545538 DOI: 10.1563/aaid-joi-d-09-00074] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Presurgical planning is essential to achieve esthetic and functional implants. For implant planning and placement, the association of computer-aided design (CAD) and computer-aided manufacturing (CAM) techniques furnishes some advantages regarding tridimensional determination of the patient's anatomy and fabrication of both anatomic models and surgical guides. The goal of this clinical study was to determine the angular deviations between planned and placed zygomatic implants using stereolithographic surgical guides in human cadavers. A total of 16 zygomatic implants were placed, 4 in each cadaver, with the use of stereolithographic (SLA) surgical guides generated by computed tomography (CT). A new CT scan was made after implant insertion. The angle between the long axis of the planned and actual implants was calculated. The mean angular deviation of the long axis between the planned and placed implants was 8.06 ± 6.40 (mean ± SD) for the anterior-posterior view, and 11.20 ± 9.75 (mean ± SD) for the caudal-cranial view. Use of the zygomatic implant, in the context of this protocol, should probably be reevaluated because some large deviations were noted. An implant insertion guiding system is needed because this last step is carried out manually. It is recommended that the sinus slot technique should be used together with the CT-based drilling guide to enhance final results. Further research to enhance the precision of zygomatic implant placement should be undertaken.
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29
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Trindade-Suedam IK, de Morais JAND, Faeda RS, Leite FRM, Tosoni GM, Neto CB, Marcantonio E, Scaf G. Bioglass associated with leukocyte-poor platelet-rich plasma in the rabbit maxillary sinus: histomorphometric, densitometric, and fractal analysis. J ORAL IMPLANTOL 2010; 36:333-43. [PMID: 20545539 DOI: 10.1563/aaid-joi-d-09-00072] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The objective of the present study was to evaluate the outcomes of autogenous bone graft (AB) and bioglass (BG) associated or not with leukocyte-poor platelet-rich plasma (LP-PRP) in the rabbit maxillary sinus (MS) by histomorphometric and radiographic analysis. Twenty rabbits divided into 2 groups (G1, G2) were submitted to sinus lift surgery. In G1, 10 MS were grafted with AB and 10 MS were grafted with BG. In G2, 10 MS were grafted with AB + LP-PRP and 10 MS were grafted with BG + LP-PRP. After 90 days, the animals were killed and specimens were obtained, x-rayed, and submitted to histomorphometric, radiographic bone density (RD) and fractal dimension analysis. Radiographic bone density mean values (SD), expressed as aluminum equivalent in mm, of AB, BG, AB + LP-PRP, and BG + LP-PRP groups were 1.79 (0.31), 2.04 (0.39), 1.61 (0.28), and 1.53 (0.30), respectively. Significant differences (P < 0.05) were observed between BG and AB, and BG + PRP and BG. Fractal dimension mean values were 1.48 (0.04), 1.35 (0.08), 1.44 (0.04), and 1.44 (0.06), respectively. Significant differences were observed between BG and AB, and AB + LP-PRP and BG. Mean values for the percentage of bone inside MS were 63.30 (8.60), 52.65 (10.41), 55.25 (7.01), and 51.07 (10.25), respectively. No differences were found. No correlations were observed among percentage of bone, RD and FD. Histological analysis showed that MS treated with AB presented mature and new bone formation. The other groups showed minor bone formation. Within the limitations of this study, the results indicated that at a 90-day time end point, AB yielded better results than AB + LP-PRP, BG, and BG + LP-PRP and should be considered the primary material for MS augmentation.
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Affiliation(s)
- Ivy Kiemle Trindade-Suedam
- Department of Diagnosis and Surgery, Division of Periodontics, Araraquara School of Dentistry, São Paulo State University-UNESP, São Paulo, Brazil.
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Pena N, Campos PSF, de Almeida SM, Bóscolo FN. Determination of the length of zygomatic implants through computed tomography: establishing a protocol. Dentomaxillofac Radiol 2009; 37:453-7. [PMID: 19033430 DOI: 10.1259/dmfr/16676031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to establish and verify an examination protocol using CT to estimate the length of zygomatic implants, thus rendering the surgical process safer and more predictable, and exposing the patient to a minimal level of radiation. METHODS Paracoronal CT scan was carried out on ten dry human crania (n = 20) and the zygomatic implant sites were measured (L(CT)) bilaterally. A standard surgical zygomatic implant placement procedure was carried out and the actual lengths (L(Real)) and clinical lengths (L(Clin)) determined. RESULTS The averages of the L(CT), L(Clin) and L(Real) were 45.73 +/- 4.82 mm, 42.63 +/- 4.33 mm, and 44.73 +/- 4.53 mm, respectively. Student's t-test revealed no statistically significant differences between the L(Real) and L(CT) averages (P = 0.1532), whereas the L(Real) and L(Clin) averages were statistically different (P < 0.0001). CONCLUSIONS The proposed protocol proved to be precise and efficacious in the determination of zygomatic implant length, with the advantage to the patient of a relatively low level of exposure to radiation due to the small quantity of tomographic slices used. Although there were no major repercussions, the clinical probe in the zygomatic implant kit commonly used in this surgical procedure proved to be a rather imprecise tool.
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Affiliation(s)
- N Pena
- FAPESB (Fundação de Amparo a Pesquisa do Estado da Bahia, Bahia, Brazil.
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Xiaojun C, Ming Y, Yanping L, Yiqun W, Chengtao W. Image guided oral implantology and its application in the placement of zygoma implants. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2009; 93:162-173. [PMID: 18951648 DOI: 10.1016/j.cmpb.2008.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2007] [Revised: 07/23/2008] [Accepted: 09/04/2008] [Indexed: 05/27/2023]
Abstract
The application of zygoma implants proposes a successful treatment for functional reconstruction of maxillary defects. However, the placement of zygoma implants is not without risk due to anatomically complex operation sites. Aiming at minimizing the risks and improving the precision of the surgery, an image guided oral implantology system (IGOIS) is presented in this study to transfer the preoperative plan accurately to the operating theatre. The principle of IGOIS is introduced in detail, including the framework, 3D-reconstruction, preoperative planning, registration, and the motion tracking algorithm. The phantom experiment shows that fiducial registration error (FRE) and TRE (target registration error) of IGOIS are, respectively, 1.12mm and 1.35mm. With respect to the overall accuracy, the average distance deviations at the coronal and apical point of the implant are, respectively, 1.36+/-0.59mm and 1.57+/-0.59mm, while average angle deviation between the axes of the planned and the actual implant is 4.1 degrees +/-0.9 degrees . A clinical report for a patient with a severely atrophic maxilla demonstrates that the major advantage of this computer-aided navigation technology lies in its accuracy, reliability, and flexibility.
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Affiliation(s)
- Chen Xiaojun
- Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China.
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32
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Aparicio C, Ouazzani W, Hatano N. The use of zygomatic implants for prosthetic rehabilitation of the severely resorbed maxilla. Periodontol 2000 2008; 47:162-71. [DOI: 10.1111/j.1600-0757.2008.00259.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rossi M, Duarte LR, Mendonça R, Fernandes A. Anatomical bases for the insertion of zygomatic implants. Clin Implant Dent Relat Res 2008; 10:271-5. [PMID: 18384404 DOI: 10.1111/j.1708-8208.2008.00091.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to obtain anatomical information for installing four zygomatic implants, by measurements of maxillae and zygomata. MATERIALS AND METHODS Linear and angular measurements were obtained from the maxillae and zygomata of 40 dry skulls. RESULTS Based on mean and standard deviation values, the installation angle of the additional implant in the four zygoma technique was between 25 degrees and 47 degrees , and that of the conventional zygomatic implant was between 39 degrees and 62 degrees . The distance between the alveolar crest in the canine region and the lateral margin of the orbital socket was 53.42 mm, and between the alveolar crest in the premolar region and the area closest to the lateral margin of the orbital socket was 42.47 mm. CONCLUSIONS When the angle of installation of the additional implant is less than 25 degrees and that of the conventional zygomatic implant is less than 39 degrees , perforation of the maxilla, zygoma, or the infratemporal fossa must be avoided. When the angle of installation of an additional implant is greater than 47 degrees and that of the conventional zygomatic implant is greater than 62 degrees , perforation of the orbital floor must be avoided. The length of an additional implant was greater than the length of a conventional zygomatic implant, and should be measured prior to drilling, because the greatest value found for this distance was 61.94 mm, while the maximum length of the zygomatic implants currently available on the market is 52.5 mm.
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Affiliation(s)
- Marcelle Rossi
- Bahia School of Medicine and Public Health, Bahia, Brazil.
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Ujigawa K, Kato Y, Kizu Y, Tonogi M, Yamane GY. Three-dimensional finite elemental analysis of zygomatic implants in craniofacial structures. Int J Oral Maxillofac Surg 2007; 36:620-5. [PMID: 17517497 DOI: 10.1016/j.ijom.2007.03.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Revised: 01/19/2007] [Accepted: 03/14/2007] [Indexed: 11/18/2022]
Abstract
The objective of this study was to analyse stress distribution in craniofacial structures around zygomatic osseointegrated implants. An integrated system for Digital Imaging and Communications in Medicine (DICOM) data were utilized to create a three-dimensional model of craniofacial structures. The amount and distribution of the main stresses were compared using three-dimensional finite elemental analysis. The system allowed visual confirmation and analysis of stress distribution as well as the convenient and simple construction of a digital biomechanical model that provided details of anatomical structures in the regions of interest. Zygomatic implants with or without connected implants supporting the superstructure were compared. Stresses in severely resorbed maxillae with connected implants were not concentrated around the alveolar bone supporting the zygomatic implants. Stresses where there were no connected implants tended to be generated in the zygomatic bone, at the middle part of the zygomatic implant and at the joint of the fixture-abutment. Stress due to occlusal forces is mainly supported by the zygomatic bone, is transferred predominantly through the infrazygomatic crest, and is divided between the frontal and temporal processes of the zygomatic bone in different directions.
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Affiliation(s)
- K Ujigawa
- Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College, Chiba, Japan.
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Kreissl ME, Heydecke G, Metzger MC, Schoen R. Zygoma implant-supported prosthetic rehabilitation after partial maxillectomy using surgical navigation: A clinical report. J Prosthet Dent 2007; 97:121-8. [PMID: 17394908 DOI: 10.1016/j.prosdent.2007.01.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The rehabilitation of patients with acquired defects of the maxilla is a challenge in terms of reestablishing oronasal separation. In most patients these goals are met by means of prosthetic rehabilitation with an obturator prosthesis. If the remaining dentition does not offer sufficient retention and support, the placement of zygoma implants can enhance the stability of the prosthesis. Due to the anatomic intricacies of the zygomatic bone and the implant length, computer-supported navigated implant placement can be advantageous. In the following clinical report, a diabetic patient with a status of posthemimaxillectomy secondary to aspergillusis infection is presented, in whom a zygoma implant was placed using a CT scan-based navigation system. A special retentive anchoring abutment was used to integrate the zygoma implant into a telescopic crown-retained denture on the residual dentition. This tooth-implant-supported obturator prosthesis restored function and phonetics, as well as esthetics, for this young patient.
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Affiliation(s)
- Marion E Kreissl
- Department of Prosthodontics, School of Dentistry, University Hospital, Freiburg, Germany.
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36
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Koser LR, Campos PSF, Mendes CMC. Length determination of zygomatic implants using tridimensional computed tomography. Braz Oral Res 2006; 20:331-6. [PMID: 17242794 DOI: 10.1590/s1806-83242006000400009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Accepted: 07/17/2006] [Indexed: 11/22/2022] Open
Abstract
Considering the potential of tridimensional computed tomography (3D-CT) as a predictor of real bone dimensions, nine dried human skulls with maxillary edentulism were evaluated using images obtained by 3D-CT, prior to the installation of zygomatic implants, in order to obtain the measurements of the implants. In the analysis of correlation between the two 3D-CT examiners, a 75% agreement was found, and no correlation was found between them and the surgical measurement. The worst result was the surgical one, possibly because an inaccurate probe was used. Based on the obtained data, we concluded that the probe used is inaccurate, suggesting that the surgical probe be changed in its measurement scale. Agreement between surgeon and radiologist could possibly be obtained by using insertion guides, since what might have possibly caused the discrepancy in the results is the fact that the 3D-CT examiners and the surgeon used different implant insertion points. It is also possible that a larger sample might produce a more accurate evaluation, thus improving the results.
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37
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Alpha C. Immediate Loading of Zygomatic Implants. J Oral Maxillofac Surg 2005. [DOI: 10.1016/j.joms.2005.05.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Landes CA. Zygoma implant-supported midfacial prosthetic rehabilitation: a 4-year follow-up study including assessment of quality of life. Clin Oral Implants Res 2005; 16:313-25. [PMID: 15877752 DOI: 10.1111/j.1600-0501.2005.01096.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Successful prosthetic rehabilitation is crucial for quality of life in cases of large maxillary defects when surgical reconstruction is not advisable because of general health or patient refusal. For this purpose, the extended indications for Zygomaticus fixtures in different defect types were evaluated. PATIENTS AND METHODS Twelve patients received 28 zygoma implants and 23 dental implants (if a segment of alveolar process was available) and were followed-up 14-53 months. Zygoma implants were positioned classically in the maxillary molar region and to reduce leverage, a premolar and a canine position was developed. The quality of life was assessed by a validated questionnaire after complete rehabilitation. RESULTS Cumulative zygoma implant survival was 82%. Three losses occurred because of persistent infection and gradual loosening. Lost implants were immediately replaced in adjacent bone. Insufficient implant length within soft tissue reconstructions was prone to chronic infection by pocketing and recurrent overgrowth of granulating tissue. Longer implants were free of soft tissue inhibition, yet prone to overloading and high leverage in cases when no anterior alveolar process and dental implants were present. Zygoma implant success was therefore 71%, including the new premolar and canine Zygomaticus fixture-position. Periotest values increased from 0 to +7 to the fourth year, peri-implant bleeding and plaque index were decreasing from 56% to 0% and 33% to 0%, respectively, and good general quality of life with the priorities on chewing and activity was noted. CONCLUSION Zygoma implants can reliably anchor the midfacial maxillary prostheses and enable a quality of life comparable with autologous maxillary reconstruction. They can be replaced immediately if local infection or loosening should occur. A premolar and canine position reduce leverage when no anterior alveolar process is present. The patient can alternatively be provided with dental implants.
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Affiliation(s)
- Constantin Alexander Landes
- Maxillofacial and Plastic Facial Surgery, The J.-W. Goethe University Medical Centre Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany.
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Uckan S, Oguz Y, Uyar Y, Ozyesil A. Reconstruction of a Total Maxillectomy Defect With a Zygomatic Implant-Retained Obturator. J Craniofac Surg 2005; 16:485-9. [PMID: 15915122 DOI: 10.1097/01.scs.0000157306.54667.68] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Treatment options of maxillary fibrous dysplasia are surgical recontouring or total or partial maxillectomy depending on the site and behavior of the lesion. Among the reconstruction procedures, which include many surgical options, reconstruction using a maxillary obturator is the least invasive one. This report describes a case of aggressive maxillary fibrous dysplasia that was treated with a total maxillectomy and reconstructed with a malar implant-retained maxillary obturator.
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Affiliation(s)
- Sina Uckan
- Department of Oral and Maxillofacial Surgery, Baskent University Faculty of Dentistry, Ankara, Turkey.
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Al-Nawas B, Wegener J, Bender C, Wagner W. Critical soft tissue parameters of the zygomatic implant. J Clin Periodontol 2004; 31:497-500. [PMID: 15191582 DOI: 10.1111/j.1600-051x.2004.00505.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Zygomatic implants have been introduced for the rehabilitation of patients with severe bone defects of the maxilla. The soft tissue aspects of the palatal emergence situation have not been described yet. The aim of this study was to evaluate the incidence and clinical impact of possible periimplant alterations of zygomatic implants. MATERIALS AND METHODS From 1998 to 2001 all patients with zygomatic implants were included into this study (24 patients, 37 zygomatic implants). One implant was lost in the loading phase giving a survival rate of 97%. Fourteen patients with 20 zygomatic implants fulfilled the inclusion criteria and were all available for the recall examination. Thirteen zygomatic implants were inserted in cases of severe maxillary atrophy, seven in cases of tumour-resection of the maxilla. Clinical examination and microbial analysis using a DNA probe was performed. The implants had a mean time in situ of 598 days (min: 326, max: 914). RESULTS Colonisation with periodontal pathogens was found at four of the 20 implants. A positive microbiologic result of the periimplant pocket and the maximum pocket probing depth were not statistically related. Nine of the 20 implants showed bleeding on probing, four of these had positive microbiologic results. At sites without bleeding on probing only negative microbiologic samples were found (p=0.026). The mean palatal and mesial probing depth was 1 mm deeper than at the vestibular and distal aspect. Thus at nine out of the 20 implants both, bleeding on probing and pocket probing depth >/=5 mm indicated soft tissue problems resulting in a success rate of only 55%. The patient's history (tumor versus atrophy) or smoking habits seemed not to have influence the situation. CONCLUSION These soft tissue problems should be taken into account if zygomatic implants are considered as an alternative therapy option in the maxilla.
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Affiliation(s)
- B Al-Nawas
- Oral and Maxillofacial Surgery, University Mainz, Augustusplatz 2, Mainz, Germany.
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Malevez C, Abarca M, Durdu F, Daelemans P. Clinical outcome of 103 consecutive zygomatic implants: a 6-48 months follow-up study. Clin Oral Implants Res 2004; 15:18-22. [PMID: 15005100 DOI: 10.1046/j.1600-0501.2003.00985.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to evaluate retrospectively, after a period of 6-48 months follow-up of prosthetic loading, the survival rate of 103 zygomatic implants inserted in 55 totally edentulous severely resorbed upper jaws. Fifty-five consecutive patients, 41 females and 14 males, with severe maxillary bone resorption were rehabilitated by means of a fixed prosthesis supported by either 1 or 2 zygomatic implants, and 2-6 maxillary implants. This retrospective study calculated the success and survival rates at both the prosthetic and implant levels. Out of 55 prostheses, 52 were screwed on top of the implants, while 3 were modified due to loss of standard additional implants and transformed in semimovable prosthesis. Although osseointegration in the zygomatic region is difficult to evaluate, no zygomatic implant was considered fibrously encapsulated and they are still in function. This study confirms that zygoma bone can offer a predictable anchorage and support function for a fixed prosthesis in severely resorbed maxillae.
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Affiliation(s)
- Chantal Malevez
- Department of Maxillofacial Surgery and Dentistry, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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Malevez C, Daelemans P, Adriaenssens P, Durdu F. Use of zygomatic implants to deal with resorbed posterior maxillae. Periodontol 2000 2003; 33:82-9. [PMID: 12950843 DOI: 10.1046/j.0906-6713.2002.03307.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Chantal Malevez
- Department of Maxillo-facial Surgery and Dentistry, Academic Erasme Hospital, Brussels, Belgium
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Vrielinck L, Politis C, Schepers S, Pauwels M, Naert I. Image-based planning and clinical validation of zygoma and pterygoid implant placement in patients with severe bone atrophy using customized drill guides. Preliminary results from a prospective clinical follow-up study. Int J Oral Maxillofac Surg 2003; 32:7-14. [PMID: 12653226 DOI: 10.1054/ijom.2002.0337] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The zygoma implant has been designed for those situations where there is insufficient bone in the upper jaw, which would otherwise require onlay or inlay (sinus) bonegrafts. The aim of the study was to present and validate a planning system for implant insertion based on preoperative CT imaging. It allows the surgeon to determine the desired position of different kinds of implants. Finally a customized drill guide is produced by stereolithography. In this study, zygoma, pterygoid and regular platform implants were used. The treatment protocol is validated through 12 case studies, selected at random from the total patient group (n=29 patients). From postoperative images, the exact implant location is determined and the deviation of axes between planned and inserted implants is calculated. In this in vivo study, displacements, varying according to the type of implant and the location of the implants, were observed. From a clinical standpoint, most of the inserted implants were judged to be adequately sited. A prospective clinical follow-up study was performed on all 29 patients. Although all patients presented with severe maxillary atrophy, excellent cumulative survival rates (92%) for the zygoma implants and 93% for regular platform implants have been obtained.
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Affiliation(s)
- L Vrielinck
- Department Oral and Maxillofacial Surgery, Ziekenhuis Oost-Limburg, Schiepse bos 6, B-3600 Genk, Belgium.
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