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Traboulsi-Garet B, Jorba-García A, Bara-Casaus J, Camps-Font O, Valmaseda-Castellón E, Figueiredo R, Sánchez-Garcés MÀ. Accuracy of freehand surgery, static and dynamic computer assisted surgery on zygomatic implant placement: A systematic review and meta-analyses. J Craniomaxillofac Surg 2025; 53:301-311. [PMID: 39709308 DOI: 10.1016/j.jcms.2024.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 10/17/2024] [Accepted: 12/03/2024] [Indexed: 12/23/2024] Open
Abstract
Real-time surgical navigation systems (dynamic computer-aided surgery, d-CAIS) and static guided surgery (static computer-aided surgery, s-CAIS) have been shown to enhance the accuracy of zygomatic implant (ZI) placement. The objective of this systematic review was to evaluate and compare the accuracy and risk of complications associated with d-CAIS and s-CAIS in ZI placement. A systematic review of published studies involving more than 4 patients was conducted to assess and compare the accuracy of d-CAIS and s-CAIS in zygomatic implant placement. Only one study included freehand ZI placement as a control. The primary outcomes measured were the accuracy of implant placement relative to preoperative planning, with a secondary focus on evaluating any potential complications. Out of 903 screened studies, 14 met the inclusion criteria. Freehand zygomatic implant placement was used as a control in only 1 study. The results revealed a mean apex deviation of 2.07 mm (95% CI: 2.01 to 2.13; I2 = 83.14%) for d-CAIS, 1.29 mm (95% CI: 1.15 to 1.43; I2 = 94.5%) for s-CAIS, and 4.98 mm (95% CI: 3.59 to 6.37; I2 = not assessable) for freehand placement. Reported complications included mucositis, reversible bilateral sinusitis, oroantral fistula, unspecified reversible postoperative complications, and fracture of the anterior wall of the zygoma. Both CAIS systems demonstrated high accuracy and safety in ZI placement, with a nearly 99% success rate at 6 months of follow-up. These findings suggest that both d-CAIS and s-CAIS are reliable methods for improving the precision and reducing the risks associated with ZI procedures.
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Affiliation(s)
| | - Adrià Jorba-García
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; IDIBELL Institute, Barcelona, Spain
| | - Javier Bara-Casaus
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; Dental and Maxillofacial Institute. Hospital Universitari Sagrat Cor, Grupo Quironsalud, Barcelona, Spain; Department of Oral and Maxillofacial Surgery, University Hospital of Mutua Terrassa, University of Barcelona, Terrassa, Spain
| | - Octavi Camps-Font
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; IDIBELL Institute, Barcelona, Spain.
| | - Eduard Valmaseda-Castellón
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; IDIBELL Institute, Barcelona, Spain
| | - Rui Figueiredo
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; IDIBELL Institute, Barcelona, Spain
| | - Ma Àngels Sánchez-Garcés
- School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; IDIBELL Institute, Barcelona, Spain
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Du C, Peng P, Guo X, Wu Y, Zhang Z, Hao L, Zhang Z, Xiong J. Combined static and dynamic computer-guided surgery for prosthetically driven zygomatic implant placement. J Dent 2025; 152:105453. [PMID: 39537011 DOI: 10.1016/j.jdent.2024.105453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 10/26/2024] [Accepted: 11/05/2024] [Indexed: 11/16/2024] Open
Abstract
OBJECTIVES To propose and validate a minimally invasive combined static and dynamic computer assisted implant surgery (CAIS) workflow for zygomatic implant (ZI) placement. METHODS A combined approach leveraging static CAIS for initial positioning, complemented by dynamic CAIS for real-time control of the angle, depth and width was proposed. Fourteen consecutive patients (age: 60.3±9.8 years; 8 females) seeking ZI-supported restoration were enrolled. A single anatomically and prosthetically driven ZI on either the unilateral zygoma or bilateral zygomata was planned and placed using the proposed approach. The zygomatic anatomy-guided approach (ZAGA) type and the ZI length were recorded. The angular, coronal global, and apical global deviation between the planned and placed positions were measured by overlapping post- and pre-operative cone beam computer tomography. Comparisons were made between the left and right sides across the ZAGA type and ZI length. Statistical significance was set at P<0.05. RESULTS 22 ZIs were placed using the combined approach and 13 immediate loading prostheses were delivered, with one patient restored 6 months after surgery. The angular deviations and coronal global deviations were 1.99±0.17° and 1.21±0.45 mm, respectively. The median apical global deviation was 1.67 mm (interquartile range [IQR]: 1.11-1.93 mm). No significant differences were found between the left and right sides across the ZAGA type or ZI length. All ZIs remained stable over a median follow-up of 14.5 months (IQR: 7-20 months). CONCLUSIONS The proposed combination of static and dynamic CAIS is safe, reliable, accurate, and robust for ZI placement. CLINICAL SIGNIFICANCE This pilot study proposed a minimally invasive ZI placement method that combined static and dynamic computer-guided surgery. The implant positioning accuracy achieved using this approach validated its safety, reliability, accuracy, and robustness. The combined approach may reduce the technique sensitivity of ZI placement, facilitating future rehabilitation of severely atrophic or defective maxillae.
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Affiliation(s)
- Chenlin Du
- School of Biomedical Engineering, Tsinghua University, Beijing, China.
| | - Pei Peng
- One Stop Dental, Beijing, China.
| | - Xiaodong Guo
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China; Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Disease, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China.
| | - Yunshu Wu
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Zeyu Zhang
- Institute for Hospital Management, Tsinghua Medicine, Tsinghua University, Beijing, China.
| | | | - Zongjiu Zhang
- Institute for Hospital Management, Tsinghua Medicine, Tsinghua University, Beijing, China.
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Tabernée Heijtmeijer S, Glas H, Janssen N, Vosselman N, de Visscher S, Spijkervet F, Raghoebar G, de Bree R, Rosenberg A, Witjes M, Kraeima J. Accuracy of augmented reality navigated surgery for placement of zygomatic implants: a human cadaver study. PeerJ 2024; 12:e18468. [PMID: 39670105 PMCID: PMC11636531 DOI: 10.7717/peerj.18468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 10/15/2024] [Indexed: 12/14/2024] Open
Abstract
Purpose Placement of zygomatic implants in the most optimal prosthetic position is considered challenging due to limited bone mass of the zygoma, limited visibility, length of the drilling path and proximity to critical anatomical structures. Augmented reality (AR) navigation can eliminate some of the disadvantages of surgical guides and conventional surgical navigation, while potentially improving accuracy. In this human cadaver study, we evaluated a developed AR navigation approach for placement of zygomatic implants after total maxillectomy. Methods The developed AR navigation interface connects a commercial navigation system with the Microsoft HoloLens. AR navigated surgery was performed to place 20 zygomatic implants using five human cadaver skulls after total maxillectomy. To determine accuracy, postoperative scans were virtually matched with preoperative three-dimensional virtual surgical planning, and distances in mm from entry-exit points and angular deviations were calculated as outcome measures. Results were compared with a previously conducted study in which zygomatic implants were positioned with 3D printed surgical guides. Results The mean entry point deviation was 2.43 ± 1.33 mm and a 3D angle deviation of 5.80 ± 4.12° (range 1.39-19.16°). The mean exit point deviation was 3.28 mm (±2.17). The abutment height deviation was on average 2.20 ± 1.35 mm. The accuracy of the abutment in the occlusal plane was 4.13 ± 2.53 mm. Surgical guides perform significantly better for the entry-point (P = 0.012) and 3D angle (P = 0.05); however, there is no significant difference in accuracy for the exit-point (P = 0.143) when using 3D printed drill guides or AR navigated surgery. Conclusion Despite the higher precision of surgical guides, AR navigation demonstrated acceptable accuracy, with potential for improvement and specialized applications. The study highlights the feasibility of AR navigation for zygomatic implant placement, offering an alternative to conventional methods.
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Affiliation(s)
- Sander Tabernée Heijtmeijer
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, Netherlands
- 3D-Lab, University Medical Center Groningen, Groningen, Netherlands
| | - Haye Glas
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Nard Janssen
- Department of Oral and Maxillofacial Surgery & Special Dental Care, Utrecht University Medical Center, Utrecht, Netherlands
| | - Nathalie Vosselman
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Sebastiaan de Visscher
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Fred Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Gerry Raghoebar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Antoine Rosenberg
- Department of Oral and Maxillofacial Surgery & Special Dental Care, Utrecht University Medical Center, Utrecht, Netherlands
| | - Max Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Joep Kraeima
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, Netherlands
- 3D-Lab, University Medical Center Groningen, Groningen, Netherlands
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Guo H, Jiang X, Lin Y. Comparison of robotic system and dynamic navigation for zygomatic implant placement: An in vitro study. J Dent 2024; 150:105329. [PMID: 39243803 DOI: 10.1016/j.jdent.2024.105329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 08/09/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024] Open
Abstract
OBJECTIVES To compare the accuracy of robotic and dynamic navigation systems in assisting zygomatic implant (ZI) using an in vitro model experiment. METHODS Preoperative cone-beam computed tomography (CBCT) images of patients who underwent ZI treatment between 2011 and 2023 were collected from local databases. Corresponding three-dimensional resin models were printed and assigned to two groups: the robotic and dynamic navigation system groups. Following preoperative plans, ZIs were placed in the models with the assistance of either a robotic or dynamic navigation system. Deviations in the in vitro navigation surgery were measured and compared between the groups. RESULTS A total of 110 ZIs were placed in 56 models, with 55 ZIs in each group. No significant differences were observed in entry and angle deviations between the groups (p>0.05). However, the exit deviation in the robotic system group (2.39±1.24 mm) was larger than that in the dynamic navigation group (1.83±1.25 mm) (p<0.05). On the exit side, the Z-axis deviation in the robotic group (left: -0.28±1.43 mm, right: -0.21±1.30 mm) was smaller than that in the dynamic navigation group (left: 0.76±1.11 mm, right: 0.85±1.52 mm) (p<0.05), while no significant differences were found in X- and Y-axis deviations (p>0.05). CONCLUSIONS Compared with the dynamic navigation system, the robotic system can effectively prevent ZI overextension. However, its accuracy on the exit side is slightly lower than that of the dynamic navigation system. CLINICAL SIGNIFICANCE This preliminary in vitro study showed that the accuracy of the robotic system was slightly inferior to that of the dynamic navigation system in terms of exit deviation when used in ZI placement. Further clinical studies are required to confirm these findings.
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Affiliation(s)
- Houzuo Guo
- Department of Oral Implantology, Peking University School and Hospital of Stomatology, #22 Zhongguancun South Street, Haidian District, Beijing 10081, PR China
| | - Xi Jiang
- Department of Oral Implantology, Peking University School and Hospital of Stomatology, #22 Zhongguancun South Street, Haidian District, Beijing 10081, PR China
| | - Ye Lin
- Department of Oral Implantology, Peking University School and Hospital of Stomatology, #22 Zhongguancun South Street, Haidian District, Beijing 10081, PR China.
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Abouzeid OEM, Gaber RM, Maergy HA, Hany HED, Abdelmohsen KM, Elkassaby MA, Taha MM. A modified protocol merging two published techniques for computer guided zygomatic implants surgery: a technical note. BMC Oral Health 2024; 24:1273. [PMID: 39449100 PMCID: PMC11515538 DOI: 10.1186/s12903-024-05010-1] [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: 07/24/2024] [Accepted: 10/03/2024] [Indexed: 10/26/2024] Open
Abstract
OBJECTIVES Zygomatic implant surgery can be difficult due to the limited intraoperative visibility of the surgical field and the complex anatomy of the zygomatic bone, which could lead to serious complications. This study aims to assess the accuracy of zygomatic implants placement using computer-guided surgical templates. MATERIALS AND METHODS A total of 13 zygomatic implants were placed in four participants. Double-sleeve drill guides were used with the help of computer-guided surgical templates designed with a lateral window. The accuracy was evaluated by measuring the linear deviations regarding the implants' platforms and apices' positions in addition to the angular deviations. Moreover, deviations of both implants from three fixed planes of space were measured. RESULTS The mean linear deviation at platforms was 2.44 mm ± 1.57 and at the apices 2.32 mm ± 1 while the mean angular deviation was 3.6˚ ± 1.92. Differences at the entry points were 0.43 ± 1.79 mm, 0.39 ± 1.12 mm, and - 0.54 ± 2.00 mm from the mid-sagittal, horizontal, and coronal planes respectively. Differences at the exit points were - 0.75 ± 1.25 mm, -0.06 ± 1.09 mm, and 0.63 ± 1.24 mm from the same planes respectively. Within all planes, there was no statistically significant difference. CONCLUSION Given the limitations of this study, the use of the computer-guided surgical templates augmented by the double sleeve drill guides allowed favorable control over the tip of the long surgical drill away from vital structures during the zygomatic implant osteotomy. It also allowed control over alveolar crest osteotomy and its placement in a favorable prosthetic position. Overall, this protocol should be considered for further research and improvement to allow more predictable surgical outcomes while preventing the occurrence of complications. Before conducting this study, the protocol was reviewed and approved by the Research Ethical Committee of Faculty of Dentistry, Ain Shams University in meeting no. (105), on 15th of July 2020 with the application no.: (FDASU-RecD072029).
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Affiliation(s)
| | - Ramy M Gaber
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | | | - Hossam El-Dien Hany
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Karim M Abdelmohsen
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Marwa A Elkassaby
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Moustafa M Taha
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Raouf K, Chrcanovic BR. Clinical Outcomes of Pterygoid and Maxillary Tuberosity Implants: A Systematic Review. J Clin Med 2024; 13:4544. [PMID: 39124809 PMCID: PMC11312960 DOI: 10.3390/jcm13154544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
Background: This study aimed to assess the survival of implants placed in the maxillary tuberosity or in the pterygomaxillary region of the maxilla, based on a systematic review of the literature. Methods: An electronic search was undertaken in three databases. The cumulative survival rate (CSR) was calculated. The log-rank (Mantel-Cox) test was used to compare the survival distributions between some groups. Results: Thirty-eight studies were included, reporting 3446 implants (3053 pterygoid, 393 tuberosity) in 2245 patients, followed up for a mean ± SD of 61.0 ± 36.3 months (min-max, 1-144). A total of 208 pterygoid and 12 tuber implants failed, with a clear concentration of failures in the first year of follow-up and a 10-year CSR of 92.5% and 96.9%, respectively. The survival of pterygoid implants was lower than that of implants in the maxillary tuberosity (p = 0.006; log-rank test), and the survival of implants submitted to early/delayed loading was lower than that of immediately loaded implants (p < 0.001; log-rank test). Non-splinted implants presented higher failure rates. Few cases of intra- or postoperative complications were reported. Conclusions: Implants placed in the pterygoid process/maxillary tuberosity present a high 10-year CSR, although with lower survival for pterygoid in comparison to tuber implants. Pterygoid/tuber implants that are splinted with other implants may present higher survival rates than those that are not splinted.
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Affiliation(s)
- Kami Raouf
- Faculty of Odontology, Malmö University, 214 21 Malmö, Sweden;
| | - Bruno Ramos Chrcanovic
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, 214 21 Malmö, Sweden
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Chen J, Bu L, Xu G. Identifying an optimal approach for the placement of pterygoid implants: A 3D finite element analysis. J Prosthet Dent 2024; 131:917.e1-917.e13. [PMID: 38443244 DOI: 10.1016/j.prosdent.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
STATEMENT OF PROBLEM A consensus on the optimal approach to the placement of pterygoid implants is lacking. PURPOSE The purpose of this finite element analysis study was to determine the optimal approach to the placement of pterygoid implants by comparing biomechanical behavior. MATERIAL AND METHODS An edentulous and moderately atrophic maxilla with the anatomic structure of the pterygomaxillary region was constructed. Complete arch restorations with 4 standard anterior implants and pterygoid implants in 3 approaches were simulated: L70, long pterygoid implants (4.1×18 mm) inclined at 70 degrees relative to the Frankfort horizontal plane with anchorage in the pterygoid process; L45, long pterygoid implants (4.1×20 mm) inclined at 45 degrees with anchorage in the pterygoid process; and S45, shorter pterygoid implants (4.1×13 mm) inclined 45 degrees without apical anchorage. The L70, L45, and S45 groups were classified as D or S depending on the bone quality: D3 (dense trabecular bone) or D4 (sparse trabecular bone). A total of 6 finite element models were built. The bone failure theory, based on the von Mises theory, was used to judge yielding of the trabecular bone. The von Mises stress (σVM) distribution was measured in the cortical bone, the trabecular bone, and on the implant surface. Deformation (DF) distribution was obtained for the entire bone (DFB) and bone surrounding the pterygoid implant (DFP). RESULTS L70 showed a lower maximum σVM value (maxσVM), more uniform σVM distribution in the cortical bone, trabecular bone, and on the implant surface and a lower maximum DFp value (maxDFp), especially in the D4 bone. The biomechanical behaviors were similar in L45 and S45 with no stress distribution in the pterygoid process. In the D4 bone, L70, L45, and S45 exceeded the limited stress of the bone failure theory by 50%, 130%, and 130%, while all values were under the limit in D3 bone. CONCLUSIONS The approach of pterygoid implants inclined at 70 degrees relative to the Frankfort plane with anchorage in the pterygoid process was optimal, providing improved biomechanical behavior. Clinically, in the case of D4 bone, the inclined angulation of pterygoid implants should be 70 degrees to minimize the risk of failure.
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Affiliation(s)
- Jun Chen
- Postgraduate student, College of Stomatology, Shanghai Jiao Tong University, Shanghai, PR China
| | - Lingtong Bu
- Doctoral student, College of Stomatology, Shanghai Jiao Tong University, Shanghai, PR China
| | - Guangzhou Xu
- Professor, Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
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Shruthi D, Saravanan M, Reddy V, Balasubramanium M. Comparative evaluation on wear resistance of metal sleeve, sleeve-free resin, and reinforced sleeve-free resin implant guide: An in vitro study. J Indian Prosthodont Soc 2024; 24:196-200. [PMID: 38650345 PMCID: PMC11129808 DOI: 10.4103/jips.jips_535_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND In-office three-dimensional (3D) printers and metal sleeveless surgical guides are becoming a major trend recently. However, metal sleeve-free designs are reported to be more prone to distortion which might lead to variation in the inner diameter of the drill hole and cause deviation and inaccuracy in the placement of the implant. Carbon fiber nanoparticles are reported to improve the properties of 3D printing resin material in industrial application. AIM The purpose of the study is to evaluate and compare the wear resistance of 3D-printed implant guides with metal sleeve, sleeve-free, and reinforced sleeve-free resin to the guide drill. MATERIALS AND METHODS A total of 66 samples with 22 samples in each group. Three groups including 3D-printed surgical guide with metal sleeve (Group A), without metal sleeve (Group B), an carbon fiber reinforced without metal sleeve (Group C) were included in the study. All samples were evaluated before sequential drilling and after sequential drilling using Vision Measuring Machine. The data were tabulated and statistically evaluated. RESULTS The data obtained were statistically analyzed with one-way analysis of variance and posthoc test. The data obtained for wear observed in the samples showed that the wear was highest in Group B with a mean of 0.5036 ± 0.1118 and the least was observed in Group A with a mean of 0.0228 ± 0.0154 and Group C was almost similar to Group A with mean of 0.0710 ± 0.0381. The results showed there was a significant difference between Group B with Group A and C, respectively (P < 0.05). The results showed that there was no significant difference regarding the wear observed between Groups A and C (P > 0.05). CONCLUSION The wear observed in the guide with a metal sleeve and carbon fiber reinforced without a metal sleeve was almost similar. The carbon fiber-reinforced guide showed better tolerance to guide drill equivalent to metal sleeve. Thus, carbon fiber nanoparticles reinforced in 3D printing resin have shown improved strength and can be used as a good replacement for a metal sleeve for an accurate placement of the implant.
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Affiliation(s)
- D Shruthi
- Department of Prosthodontics, SRM Dental College, Chennai, Tamil Nadu, India
| | - M. Saravanan
- Department of Prosthodontics, SRM Dental College, Chennai, Tamil Nadu, India
| | - Vishal Reddy
- Department of Prosthodontics, SRM Dental College, Chennai, Tamil Nadu, India
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Venkatachalam V, Pandiarajan R, Meyappan A, Anbukkarasu H. Evaluation of Surgical Outcomes of Zygomatic Implant-Supported Rehabilitation of Atrophic Maxillary Arches - A Prospective Study. Ann Maxillofac Surg 2024; 14:27-32. [PMID: 39184428 PMCID: PMC11340836 DOI: 10.4103/ams.ams_32_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 01/20/2024] [Accepted: 02/02/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction Prosthetic rehabilitation with implants in the atrophic edentulous maxilla often requires a bone augmentation procedure to enable implant placement and integration. However, rigid anchorage can also be achieved using long zygomatic implants. The aim of this study was to evaluate the surgical outcomes of rehabilitation of atrophic posterior maxillary ridges with zygomatic implants using the zygomatic success code (ZSC) and derive the success grade for the procedure based on the observed results. Materials and Methods A total of eight implants were placed in an extrasinus technique based on the zygomatic anatomy-guided approach. The following were evaluated postoperatively - primary stability, maxillary sinus pathology, soft-tissue healing and prosthetic offset. The ZSC score was calculated, and success grading was given with ZSC based on Aparacio et al.,'s guidelines. Results One implant had Grade 1 mobility and partial maxillary sinus opacification, 25% (n = 2) revealed a mild recession exposing the implant head and 12.5% (n = 1) showed significant recession up to 7 mm. The prosthetic offset of zygomatic implants was scored -1 for all eight implants. Five implants were given a success code of 1/1/1/1 and a success grade of Grade I, two implants were given code 1/1/2/1 with Grade II and one implant 2/2/3/1 and grade III. The results imply that zygomatic implants can be a successful option in maxillary rehabilitation. Discussion The zygomatic implants, as a graft less and promising solution to the rehabilitation of atrophied maxillary arches, have excellent surgical outcomes with varied advantages.
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Affiliation(s)
- Vaishali Venkatachalam
- Department of Oral and Maxillofacial Surgery, Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India
| | - Rajesh Pandiarajan
- Department of Oral and Maxillofacial Surgery, Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India
| | - Alagappan Meyappan
- Department of Oral and Maxillofacial Surgery, Chettinad Dental College and Research Institute, Chennai, Tamil Nadu, India
| | - Harushi Anbukkarasu
- Department of Oral and Maxillofacial Surgery, A.S Dentistry, Salem, Tamil Nadu, India
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Wang W, Yu X, Wang F, Wu Y. Clinical efficacy of computer-assisted zygomatic implant surgery: A systematic scoping review. J Prosthet Dent 2023:S0022-3913(23)00717-5. [PMID: 38007293 DOI: 10.1016/j.prosdent.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/27/2023]
Abstract
STATEMENT OF PROBLEM Digital technology can improve the success of zygomatic implant (ZI) surgery. However, the reliability and efficacy of computer-assisted zygomatic implant surgery (CAZIS) need further analysis. PURPOSE The purpose of this scoping review was to provide an overview of the placement accuracy, implant survival, and complications of CAZIS. MATERIAL AND METHODS A systematic search of English and Mandarin Chinese publications up to May 2023 was conducted in PubMed, Web of Science, Embase, and Wanfang database. The nonpeer-reviewed literature was searched in the trial register (clinicaltrials.gov). Clinical studies and cadaver studies on CAZIS were included. After data extraction and collection, the findings were critically reviewed, analyzed, interpreted, and discussed. RESULTS Forty-one studies met the inclusion criteria. After excluding publications with duplicate data, retaining the most recent, 28 articles were included in this scoping review. Of these, 18 were on static computer-assisted zygomatic implant surgery (sCAZIS), 8 on dynamic computer-assisted zygomatic implant surgery (dCAZIS), and 2 on robot-assisted zygomatic implant surgery (rAZIS). Excluding the outliers, the mean deviations of ZIs in the sCAZIS group (with 8 articles reporting implant placement accuracy, 183 ZIs involved) were: 1.15 ±1.37 mm (coronal deviation), 2.29 ±1.95 mm (apical deviation), and 3.32 ±3.36 degrees (angular deviation). The mean deviations of dCAZIS (3 articles, 251 ZIs) were: 1.60 ±0.74 mm (coronal), 2.27 ±1.05 mm (apical), and 2.89 ±1.69 degrees (angular). The mean deviations of rAZIS (2 articles, 5 ZIs) were: 0.82 ±0.21 mm (coronal), 1.25 ±0.52 mm (apical), and 1.46 ±0.35 degrees (angular). Among the CAZIS reported in the literature, the implant survival rate was high (96.3% for sCAZIS, 98.2% for dCAZIS, and 100% for rAZIS, specified in 14 of 21 clinical studies). The incidence of complications was low, but, because of the few relevant studies (4/21 specified), valid conclusions regarding complications could not be drawn. CONCLUSIONS CAZIS has demonstrated clinical efficacy with high implant survival rates and placement accuracy. Of the 3 guided approaches, rAZIS showed the smallest 3-dimensional deviation.
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Affiliation(s)
- Wenying Wang
- Graduate student, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Xinbo Yu
- Undergraduate student, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Feng Wang
- Professor, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Yiqun Wu
- Professor, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China.
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Konstantinović VS, Abd-Ul-Salam H, Jelovac D, Ivanjac F, Miličić B. Pterygoid and tuberosity implants in the atrophic posterior maxilla: A retrospective cohort study. J Prosthet Dent 2023; 130:219.e1-219.e10. [PMID: 37481400 DOI: 10.1016/j.prosdent.2023.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 07/24/2023]
Abstract
STATEMENT OF PROBLEM Rehabilitation of the partially or completely edentulous posterior maxilla using dental implants is a clinical challenge because of the presence of the maxillary sinus, as well as the low quality and quantity of bone in that region. In addition to bone augmentation procedures, posterior maxillary rehabilitation using implants includes their anchoring in bones such as the zygoma, pterygoid, and maxillary tuberosity, as well as in short implants. However, the performance of pterygoid and tuberosity implants in the atrophic posterior maxilla is unclear. PURPOSE The purpose of this retrospective cohort study was to evaluate the survival of tuberosity and pterygoid implants in patients with posterior maxillary atrophy. MATERIAL AND METHODS A nonprobability convenient sample of patients who had received fixed prostheses on implants placed in the maxillary tuberosity or pterygoid regions was analyzed retrospectively. Demographic variables included sex (male, female) and age. Implant-related variables included surface characteristics, site of placement, implant design, length, diameter, and anteroposterior insertion angle. Prosthetic-related variables included the type of reconstruction for rehabilitation and loading protocols. Implant survival, complications, crestal bone loss, and follow-up intervals were also documented. Collected data were analyzed at both patient and implant levels. The demographics and implant characteristics of patients receiving pterygoid or tuberosity implants were analyzed with a statistical software program (α=.05). Survival analysis was estimated by using the nonparametric Kaplan-Meier curve. RESULTS A total of 119 patients had 183 pterygoid or tuberosity implants inserted. Most implants in the pterygoid region (71.5%) were Ø4.1 mm (87.4%) and 15 mm in length (60.1%). The most common prostheses were complete maxillary reconstructions (49.2%) with late loading (74.3%). The average implant anteroposterior insertion angle was 60.8 degrees. The cumulative survival rate was 97.3% (n=178) during the mean follow-up period of 57 months (range 1 to 168 months). Among all implants placed, 2.7% failed (n=5) within 2 months of their placement. The statistically significant differences noted between tuberosity and pterygoid implants were related to design, surface characteristics, and loading. The average crestal bone loss was 1.5 mm. CONCLUSIONS The survival of the implants placed in the maxillary tuberosity and pterygoid regions was high in patients with posterior maxillary atrophy.
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Affiliation(s)
- Vitomir S Konstantinović
- Professor, Clinic of Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Hani Abd-Ul-Salam
- Adjunct Professor, Department of Population Oral Health, Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada; and Professor, Department of Diagnostic and Oral Surgical Dental Sciences, Faculty of Dentistry, Gulf Medical University, College of Dentistry, Ajman, Ajman, United Arab Emirates.
| | - Drago Jelovac
- Associate Professor, Clinic of Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Filip Ivanjac
- Research Associate, Clinic of Maxillofacial Surgery, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Biljana Miličić
- Professor, Department of Medical Statistics and Informatics, School of Dental Medicine, University of Belgrade, Belgrade, Serbia
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González Rueda JR, Galparsoro Catalán A, de Paz Hermoso VM, Riad Deglow E, Zubizarreta-Macho Á, Pato Mourelo J, Montero Martín J, Hernández Montero S. Accuracy of computer-aided static and dynamic navigation systems in the placement of zygomatic dental implants. BMC Oral Health 2023; 23:150. [PMID: 36918837 PMCID: PMC10015906 DOI: 10.1186/s12903-023-02856-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/04/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Zygomatic implants are widely used in the rehabilitation of severely atrophic maxillae, but implant placement is not without risks, and it can potentially cause damage to related anatomical structures. The aim of this study was to perform a comparative analysis of the accuracy of static navigation systems in placing zygomatic dental implants in comparison to dynamic navigation systems. METHODS Sixty zygomatic dental implants were randomly allocated to one of three study groups, categorized by which implant placement strategy was used: A: computer-aided static navigation system (n = 20) (GI); B: computer-aided dynamic navigation system (n = 20) (NI); or C: free-hand technique (n = 20) (FHI). For the computer-aided study groups, a preoperative cone-beam computed tomography (CBCT) scan of the existing situation was performed in order to plan the approach to be used during surgery. Four zygomatic dental implants were inserted in each of fifteen polyurethane stereolithographic models (n = 15), with a postoperative CBCT scan taken after the intervention. The pre- and postoperative CBCT scans were then uploaded to a software program used in dental implantology to analyze the angular deviations, apical end point, and coronal entry point. Student's t-test was used to analyze the results. RESULTS The results found statistically significant differences in apical end-point deviations between the FHI and NI (p = 0.0053) and FHI and GI (p = 0.0004) groups. There were also statistically significant differences between the angular deviations of the FHI and GI groups (p = 0.0043). CONCLUSIONS The manual free-hand technique may enable more accurate placement of zygomatic dental implants than computer-assisted surgical techniques due to the different learning curves required for each zygomatic dental implant placement techniques.
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Affiliation(s)
- Juan Ramón González Rueda
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
| | - Agustín Galparsoro Catalán
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
| | | | - Elena Riad Deglow
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
| | - Álvaro Zubizarreta-Macho
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
- grid.11762.330000 0001 2180 1817Department of Surgery, Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain
| | - Jesús Pato Mourelo
- grid.5924.a0000000419370271Department of Surgery, Faculty of Dentistry, University of Navarra, 31009 Pamplona, Navarra Spain
| | - Javier Montero Martín
- grid.11762.330000 0001 2180 1817Department of Surgery, Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain
| | - Sofía Hernández Montero
- grid.464699.00000 0001 2323 8386Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, Avda. Universidad, 1, Villanueva de la Cañada, 28691 Madrid, Spain
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Dynamic navigation for zygomatic implant placement: A randomized clinical study comparing the flapless versus the conventional approach. J Dent 2023; 130:104436. [PMID: 36736529 DOI: 10.1016/j.jdent.2023.104436] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/22/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The assessment of the accuracy of flapless placement of zygomatic implants in edentulous maxilla using dynamic navigation. METHODS A randomized controlled trial was carried out on 20 patients. Patients were randomized into two groups, the flapless (Group 1; n=10) and the conventional (Group 2; n=10). In each case two zygomatic implants were inserted under local anaesthesia, one on the right and one on the left side guided by a dynamic navigation system. The surgical procedure was identical in the two groups except for the reflection of the mucoperiosteal flap which was eliminated in the flapless cases. Postoperative CBCT scans were used to assess the accuracy of the placement of zygomatic implants. RESULTS Osseointegration was achieved for all the implants, except one case in the flapless group. Statistically significant differences in the accuracy of the position of the zygomatic implants was found between the flapless and the conventional groups, measured at the apex and the entry points of the implants (p < 0.01). The average apical and coronal deviations were 5 mm and 3 mm, respectively; the angular deviation was 6°, and 2 mm vertical apical disparity was detected between the planned and the achieved surgical position. Perforation of the Schneiderian membrane was noted in three cases, one in flapless group and two in the conventional group. CONCLUSIONS Flapless placement of zygomatic implants guided by dynamic navigation offered satisfactory safety and accuracy. CLINICAL SIGNIFICANCE This is the first clinical trial to prove the feasibility and accuracy of flapless placement of zygomatic implant with minimal morbidity. The study highlights the innovative reflection of the Schneiderian membrane under guided surgical navigation. The procedure can be performed under local anaesthesia, which offers clinical advantages. Adequate training on the use of dynamic navigation is mandatory before its use in clinical cases.
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Feng Y, Su Z, Mo A, Yang X. Comparison of the accuracy of immediate implant placement using static and dynamic computer-assisted implant system in the esthetic zone of the maxilla: a prospective study. Int J Implant Dent 2022; 8:65. [PMID: 36512162 PMCID: PMC9747989 DOI: 10.1186/s40729-022-00464-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This study aimed to compare the accuracy of fully guided between dynamic and static computer-assisted implant surgery (CAIS) systems for immediate implant placement in the esthetic zone. METHODS A total of 40 qualified patients requiring immediate implant placement in the esthetic zone were randomly and equally assigned to either static CAIS group (n = 20) or dynamic CAIS groups (n = 20). Global deviations at entry, apex, and angular deviation between placed and planned implant position were measured and compared as primary outcomes. Secondary outcomes were the deviation of implant placement at mesial-distal, labial-palatal, and coronal-apical directions. RESULTS For the immediate implant placement, the mean global entry deviations in static and dynamic CAIS groups were 0.99 ± 0.63 mm and 1.06 ± 0.55 mm (p = 0.659), while the mean global apex deviations were 1.50 ± 0.75 mm and 1.18 ± 0.53 mm (p = 0.231), respectively. The angular deviation in the static and dynamic CAIS group was 3.07 ± 2.18 degrees and 3.23 ± 1.67 degrees (p = 0.547). No significant differences were observed for the accuracy parameters of immediate implant placement between static and dynamic CAIS systems, except the deviation of the implant at entry in the labial-palatal direction in the dynamic CAIS group was significantly more labial than of the static CAIS (p = 0.005). CONCLUSIONS This study demonstrated that clinically acceptable accuracy of immediate implant placement could be achieved using static and dynamic CAIS systems. Trial registration ChiCTR, ChiCTR2200056321. Registered 3 February 2022, http://www.chictr.org.cn/showproj.aspx?proj=151348.
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Affiliation(s)
- Yuzhang Feng
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section, Renmin Nan Road, Chengdu, Sichuan People’s Republic of China
| | - Zhenya Su
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section, Renmin Nan Road, Chengdu, Sichuan People’s Republic of China
| | - Anchun Mo
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section, Renmin Nan Road, Chengdu, Sichuan People’s Republic of China
| | - Xingmei Yang
- grid.13291.380000 0001 0807 1581State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section, Renmin Nan Road, Chengdu, Sichuan People’s Republic of China
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Kumar Pandey A, Akkara F, Dhupar V. Efficacy of implant placement with surgical guides in the rehabilitation of the edentulous areas: An observational study and review of literature. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Bidra AS, Peña-Cardelles JF, Iverson M. Implants in the pterygoid region: An updated systematic review of modern roughened surface implants. J Prosthodont 2022; 32:285-291. [PMID: 36069239 DOI: 10.1111/jopr.13600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine the survival rates of modern roughened surface dental implants in the pterygoid region. MATERIAL AND METHODS This systematic review was an update from a previously published systematic review in 2011, which largely reported data on older machined surface dental implants. An electronic search for articles in the English language literature published from January 1, 2010 to December 8, 2021 was performed using PubMed, Scopus, and CENTRAL search engines. After applying a systematic search process in 3 stages, the final list of selected articles on roughened surface pterygoid implants was obtained. Data from the selected articles were collated with data from pertinent articles on roughened implant surface from the previous systematic review. The combined data was then used for calculating the interval survival rate (ISR) and cumulative survival rate (CSR) of pterygoid implants. RESULTS The initial electronic search resulted in 1263 titles. The systematic search process eventually resulted in 10 clinical studies reporting on modern roughened surface pterygoid implants. These 10 studies reported on a total of 911 pterygoid implants with 39 reported failures over a 6-year period. The majority of failures (37) were reported during the first year time interval and a majority of them (30) occurred before loading of the pterygoid implants. Only 2 late failures were reported after loading, during the 6th year time interval. The majority of implants were used for rehabilitation of full arch fixed implant supported prosthesis. At the maximum follow-up interval of 6 years, the cumulative survival rate of pterygoid implants with roughened surfaces was 95.5%, which was 5% higher than reported in the previous systematic review which combined machined and roughed surface pterygoid implants. CONCLUSIONS The survival rate of modern roughened surface dental implants in the pterygoid region is favorable at 95.5% over a 6 year period, and comparable to the existing evidence on survival of implants in other regions of the maxilla and mandible. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Avinash S Bidra
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, CT
| | | | - Marissa Iverson
- Research Support Librarian, L.M Stowe Library, University of Connecticut Health Center, Farmington, Connecticut
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Vrielinck L, Blok J, Politis C. Survival of conventional dental implants in the edentulous atrophic maxilla in combination with zygomatic implants: a 20-year retrospective study. Int J Implant Dent 2022; 8:27. [PMID: 35704150 PMCID: PMC9200924 DOI: 10.1186/s40729-022-00425-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Implant-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. METHODS We 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. RESULTS A 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. CONCLUSIONS We found acceptable long-term anterior conventional implant survival. Significant risk factors for failure were bruxism, overdentures, and implants shorter than 10 mm.
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Affiliation(s)
- Luc Vrielinck
- Department of Oral and Maxillofacial Surgery, East-Limburg Hospital, Genk, Belgium
| | - Jorden Blok
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium. .,OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium.
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Vosselman N, Glas HH, Merema BJ, Kraeima J, Reintsema H, Raghoebar GM, Witjes MJH, de Visscher SAHJ. Three-Dimensional Guided Zygomatic Implant Placement after Maxillectomy. J Pers Med 2022; 12:jpm12040588. [PMID: 35455704 PMCID: PMC9027393 DOI: 10.3390/jpm12040588] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 12/27/2022] Open
Abstract
Zygomatic implants are used in patients with maxillary defects to improve the retention and stability of obturator prostheses, thereby securing good oral function. Prosthetic-driven placement of zygomatic implants is even difficult for experienced surgeons, and with a free-hand approach, deviation from the preplanned implant positions is inevitable, thereby impeding immediate implant-retained obturation. A novel, digitalized workflow of surgical planning was used in 10 patients. Maxillectomy was performed with 3D-printed cutting, and drill guides were used for subsequent placement of zygomatic implants with immediate placement of implant-retained obturator prosthesis. The outcome parameters were the accuracy of implant positioning and the prosthetic fit of the obturator prosthesis in this one-stage procedure. Zygomatic implants (n = 28) were placed with good accuracy (mean deviation 1.73 ± 0.57 mm and 2.97 ± 1.38° 3D angle deviation), and in all cases, the obturator prosthesis fitted as pre-operatively planned. The 3D accuracy of the abutment positions was 1.58 ± 1.66 mm. The accuracy of the abutment position in the occlusal plane was 2.21 ± 1.33 mm, with a height accuracy of 1.32 ± 1.57 mm. This feasibility study shows that the application of these novel designed 3D-printed surgical guides results in predictable zygomatic implant placement and provides the possibility of immediate prosthetic rehabilitation in head and neck oncology patients after maxillectomy.
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González Rueda JR, García Ávila I, de Paz Hermoso VM, Riad Deglow E, Zubizarreta-Macho Á, Pato Mourelo J, Montero Martín J, Hernández Montero S. Accuracy of a Computer-Aided Dynamic Navigation System in the Placement of Zygomatic Dental Implants: An In Vitro Study. J Clin Med 2022; 11:jcm11051436. [PMID: 35268527 PMCID: PMC8910948 DOI: 10.3390/jcm11051436] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of this in vitro study was to evaluate and compare the accuracy of zygomatic dental implant (ZI) placement carried out using a dynamic navigation system. Materials and Methods: Forty (40) ZIs were randomly distributed into one of two study groups: (A) ZI placement via a computer-aided dynamic navigation system (n = 20) (navigation implant (NI)); and (B) ZI placement using a conventional free-hand technique (n = 20) (free-hand implant (FHI)). A cone-beam computed tomography (CBCT) scan of the existing situation was performed preoperatively to plan the surgical approach for the computer-aided study group. Four zygomatic dental implants were placed in anatomically based polyurethane models (n = 10) manufactured by stereolithography, and a postoperative CBCT scan was performed. Subsequently, the preoperative planning and postoperative CBCT scans were added to dental implant software to analyze the coronal entry point, apical end point, and angular deviations. Results were analyzed using the Student’s t-test. Results: The results showed statistically significant differences in the apical end-point deviations between FHI and NI (p = 0.0018); however, no statistically significant differences were shown in the coronal entry point (p = 0.2617) or in the angular deviations (p = 0.3132). Furthermore, ZIs placed in the posterior region showed more deviations than the anterior region at the coronal entry point, apical end point, and angular level. Conclusions: The conventional free-hand technique enabled more accurate placement of ZIs than the computer-assisted surgical technique. In addition, placement of ZIs in the anterior region was more accurate than that in the posterior region.
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Affiliation(s)
- Juan Ramón González Rueda
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.R.G.R.); (I.G.Á.); (E.R.D.); (S.H.M.)
| | - Irene García Ávila
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.R.G.R.); (I.G.Á.); (E.R.D.); (S.H.M.)
| | | | - Elena Riad Deglow
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.R.G.R.); (I.G.Á.); (E.R.D.); (S.H.M.)
| | - Álvaro Zubizarreta-Macho
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.R.G.R.); (I.G.Á.); (E.R.D.); (S.H.M.)
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain;
- Correspondence:
| | - Jesús Pato Mourelo
- Department of Surgery, Faculty of Dentistry, University of Navarra, 31009 Pamplona, Spain;
| | - Javier Montero Martín
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37008 Salamanca, Spain;
| | - Sofía Hernández Montero
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain; (J.R.G.R.); (I.G.Á.); (E.R.D.); (S.H.M.)
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Vrielinck L, Moreno‐Rabie C, Schepers S, Van Eyken P, Coucke W, Politis C. Peri‐zygomatic Infection Associated to Zygomatic Implants: a retrospective longitudinal cohort study. Clin Oral Implants Res 2022; 33:405-412. [DOI: 10.1111/clr.13900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/23/2021] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Luc Vrielinck
- Department of Oral and Maxillofacial Surgery Saint John´s Hospital Genk Belgium
| | - Catalina Moreno‐Rabie
- OMFS‐IMPATH Research Group Department of Imaging and Pathology Faculty of Medicine University of Leuven Leuven Belgium
- Department of Oral and Maxillofacial Surgery University Hospitals Leuven Leuven Belgium
| | - Serge Schepers
- Department of Oral and Maxillofacial Surgery Saint John´s Hospital Genk Belgium
| | | | - Wim Coucke
- Certified Freelance Statistician Heverlee Belgium
| | - Constantinus Politis
- OMFS‐IMPATH Research Group Department of Imaging and Pathology Faculty of Medicine University of Leuven Leuven Belgium
- Department of Oral and Maxillofacial Surgery University Hospitals Leuven Leuven Belgium
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Wu Y, Tao B, Lan K, Shen Y, Huang W, Wang F. Reliability and accuracy of dynamic navigation for zygomatic implant placement. Clin Oral Implants Res 2022; 33:362-376. [PMID: 35113463 PMCID: PMC9305866 DOI: 10.1111/clr.13897] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/19/2021] [Accepted: 01/24/2022] [Indexed: 11/29/2022]
Abstract
Objectives To assess the accuracy of a real‐time dynamic navigation system applied in zygomatic implant (ZI) surgery and summarize device‐related negative events and their management. Material and methods Patients who presented with severely maxillary atrophy or maxillary defects and received dynamic navigation‐supported ZI surgery were included. The deviations of entry, exit, and angle were measured after image data fusion. A linear mixed‐effects model was used. Statistical significance was defined as p < .05. Device‐related negative events and their management were also recorded and analyzed. Results Two hundred and thirty‐one zygomatic implants (ZIs) with navigation‐guided placement were planned in 74 consecutive patients between Jan 2015 and Aug 2020. Among them, 71 patients with 221 ZIs received navigation‐guided surgery finally. The deviations in entry, exit, and angle were 1.57 ± 0.71 mm, 2.1 ± 0.94 mm and 2.68 ± 1.25 degrees, respectively. Significant differences were found in entry and exit deviation according to the number of ZIs in the zygomata (p = .03 and .00, respectively). Patients with atrophic maxillary or maxillary defects showed a significant difference in exit deviation (p = .01). A total of 28 device‐related negative events occurred, and one resulted in 2 ZI failures due to implant malposition. The overall survival rate of ZIs was 98.64%, and the mean follow‐up time was 24.11 months (Standard Deviation [SD]: 12.62). Conclusions The navigation‐supported ZI implantation is an accurate and reliable surgical approach. However, relevant technical negative events in the navigation process are worthy of attention.
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Affiliation(s)
- Yiqun Wu
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Baoxin Tao
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Kengliang Lan
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yihan Shen
- Department of Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Wei Huang
- Department of Oral Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Feng Wang
- Department of Oral Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology; Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
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22
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Parihar A, Sahoo P, Awinashe V, Bali Y, Gupta N, Jagadeesh K, Babaji P. A cone-beam computed tomography evaluation of bone density for insertion of pterygoid implants in dentulous and edentulous patients. Tzu Chi Med J 2022; 34:82-87. [PMID: 35233361 PMCID: PMC8830540 DOI: 10.4103/tcmj.tcmj_241_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/11/2020] [Accepted: 12/29/2020] [Indexed: 11/04/2022] Open
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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: 14] [Impact Index Per Article: 3.5] [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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Jayanetti J, Shah K, Chao D, Drago C. Double sleeve guided placement of quadruple zygomatic implants for rehabilitation of a patient with ectodermal dysplasia: A clinical report. J Prosthet Dent 2021:S0022-3913(21)00503-5. [PMID: 34656306 DOI: 10.1016/j.prosdent.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
Abstract
The surgical and prosthodontic treatment for a 22-year-old man with ectodermal dysplasia is described and illustrated. He had never managed to wear complete dentures, and implant-retained or implant-supported prostheses were indicated. However, the placement of conventional maxillary endosseous implants was contraindicated. A novel surgical template with double sleeves was used to guide osteotomies for 4 zygomatic implants used with an unloaded, one-stage approach. After confirming osseointegration, prosthetic rehabilitation began with an interim implant-supported fixed prosthesis to evaluate esthetics, phonetics, and hygiene maintenance. Clinical challenges included lip biting and speech articulation.
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Affiliation(s)
- Jay Jayanetti
- Assistant Professor, Division of Advanced Prosthodontics, University of California Los Angeles School of Dentistry, Los Angeles, Calif
| | - Krina Shah
- Preceptor, Division of Oral and Maxillofacial Surgery, University of California Los Angeles School of Dentistry, Los Angeles, Calif
| | - Denny Chao
- Assistant Professor, Division of Advanced Prosthodontics, University of California Los Angeles School of Dentistry, Los Angeles, Calif
| | - Carl Drago
- Adjunct Associate Professor, Graduate Prosthodontics, Marquette University School of Dentistry, Milwaukee, Wis.
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Abstract
INTRODUCTION Rehabilitating a severely atrophic maxilla is a complex procedure. In case of severe resorption, zygomatic implants are indicated and loading of the implants at the end of the surgery is desirable. We present a new method by means of guided surgery for the placement of zygomatic implants, using specially designed metal templates that should be supported by bone. METHODS The treatment planning for completely guided prosthetic rehabilitation of the maxilla with zygomatic implants was digitally performed. A radiographic template was designed for the prosthetic treatment planning. A surgical template was used to replicate the digitally planned steps in vivo. RESULTS The procedure ended with the positioning of a custom-made temporary prosthesis. This method can reduce the surgery duration, simplify the procedure, and optimize the outcome. It requires equal cooperation among technicians, prosthodontists, and surgeons. Nineteen out of twenty patients included in the study presented successful implants and prosthesis at the moment of analysis. CONCLUSIONS The present approach addressed the needs for zygomatic-implant surgery. The surgical and prosthetic plan, position, emergence, the shape of the implants, the position of the temporary prosthesis, the inter-arch relationships, and surgical templates were designed in a completely virtual environment and performed by the surgeon on stereolithographic models beforehand. Consequently, the surgical procedure was considerably simplified.
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Gutiérrez Muñoz D, Obrador Aldover C, Zubizarreta-Macho Á, González Menéndez H, Lorrio Castro J, Peñarrocha-Oltra D, Montiel-Company JM, Hernández Montero S. Survival Rate and Prosthetic and Sinus Complications of Zygomatic Dental Implants for the Rehabilitation of the Atrophic Edentulous Maxilla: A Systematic Review and Meta-Analysis. BIOLOGY 2021; 10:biology10070601. [PMID: 34209770 PMCID: PMC8301194 DOI: 10.3390/biology10070601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/18/2021] [Accepted: 06/24/2021] [Indexed: 12/26/2022]
Abstract
Simple Summary Zygomatic dental implants have been proposed as an alternative to atrophic total edentulous maxillae rehabilitation with the necessity of bone grafting procedures. However, surgical, prosthetic, and maxillary sinus complications have been associated with this surgical procedure. Therefore, it is necessary to produce a systematic review and meta-analysis that provides evidence associated with the prognosis when using zygomatic dental implants as an alternative to atrophic total edentulous maxillae rehabilitation. Abstract The aim of this systematic review and meta-analysis was to analyze and compare the survival rate and prosthetic and sinus complications of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla. Materials and methods: We conducted a systematic literature review and meta-analysis, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations, of clinical studies that evaluated the survival rate and prosthetic and sinus complications of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla. Four databases were consulted during the literature search: Pubmed–Medline, Scopus, Embase, and Web of Science. After eliminating duplicate articles and applying the inclusion criteria, 46 articles were selected for the qualitative analysis and 32 for the quantitative analysis. Results: Four randomized controlled trials, 19 prospective clinical studies, 20 retrospective studies, and 3 case series were included in the meta-analysis. Conventional dental implants failure (n = 3549) were seen in 2.89% (IC-95% 1.83–3.96%), while zygomatic dental implants failure (n = 1895) were seen in 0.69% (IC-95% 0.21–1.16%). The measure of the effect size used was the Odds Ratio, which was estimated at 2.05 with a confidence interval of 95% between 1.22 and 3.44 (z test = 2.73; p-value = 0.006). The failure risk of conventional dental implants is 2.1 times higher than that of zygomatic dental implants. Slight heterogeneity was determined in the meta-analysis between 23 combined studies (Q test = 32.4; p-value = 0.070; I2 = 32.1%). Prosthetic complications were recorded in 4.9% (IC-95% 2.7–7.3%) and mild heterogeneity was observed in a meta-analysis of 28 combined studies (Q test = 88.2; p-value = 0.001; I2 = 69.4%). Sinus complications were seen in 4.7% (IC-95% 2.8–6.5%) and mild heterogeneity was observed in a meta-analysis of 32 combined studies (Q test = 75.3; p-value = 0.001; I2 = 58.8%). Conclusions: The high survival rate and low prosthetic and sinus complications related to zygomatic dental implants suggest the use of zygomatic dental implants for the rehabilitation of the atrophic edentulous maxilla.
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Affiliation(s)
- David Gutiérrez Muñoz
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (D.G.M.); (C.O.A.); (H.G.M.); (J.L.C.); (S.H.M.)
| | - Caterina Obrador Aldover
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (D.G.M.); (C.O.A.); (H.G.M.); (J.L.C.); (S.H.M.)
| | - Álvaro Zubizarreta-Macho
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (D.G.M.); (C.O.A.); (H.G.M.); (J.L.C.); (S.H.M.)
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain
- Correspondence:
| | - Héctor González Menéndez
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (D.G.M.); (C.O.A.); (H.G.M.); (J.L.C.); (S.H.M.)
| | - Juan Lorrio Castro
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (D.G.M.); (C.O.A.); (H.G.M.); (J.L.C.); (S.H.M.)
| | - David Peñarrocha-Oltra
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (D.P.-O.); (J.M.M.-C.)
| | - José María Montiel-Company
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain; (D.P.-O.); (J.M.M.-C.)
| | - Sofía Hernández Montero
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain; (D.G.M.); (C.O.A.); (H.G.M.); (J.L.C.); (S.H.M.)
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Ramezanzade S, Keyhan SO, Tuminelli FJ, Fallahi HR, Yousefi P, Lopez-Lopez J. Dynamic-Assisted Navigational System in Zygomatic Implant Surgery: A Qualitative and Quantitative Systematic Review of Current Clinical and Cadaver Studies. J Oral Maxillofac Surg 2021; 79:799-812. [PMID: 33176128 DOI: 10.1016/j.joms.2020.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The goal of this systematic review is to assess the accuracy and complications (including failure) of dynamic navigation in placing zygomatic implants. METHODS PubMed, Cochrane Library (CENTRAL), trial register (clinicaltrial.gov), and Google Scholar were searched systematically up to May 2020. In addition, the reference lists of included systematic reviews were hand searched. The New Castle Ottawa and Joanna Briggs Institute Critical Appraisal Checklist for Case Reports were used for quality assessment. RESULTS Ninety-four studies were assessed, and finally, 12 articles were included. According to Joanna Briggs Institute tool, the mean score of case reports (±standard deviation) was 6.4 (range, 5/9 to 8/9) and the mean score of observational studies (±standard deviation) was 5.66 (range, 5/9 to 7/9) as measured by New Castle Ottawa tool. Included materials pointed out that higher accuracy and drastic cut down on the risk of perioperative/postoperative complications were reported by using the dynamic navigation system compared with freehand implant placement. CONCLUSIONS Application of dynamic navigation systems is a reliable technology for zygomatic implant placement, especially in difficult cases with a history of maxillary deficiency. Evidence of reliability and accuracy of dynamic navigation technique in multicenter large randomized and prospective controlled studies is still lacking.
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Affiliation(s)
- Shaqayeq Ramezanzade
- Private Dental Practice, Isfahan University of Medical Science, Faculty of Dentistry, Isfahan, Iran.
| | - Seied Omid Keyhan
- Delegate Researcher in CMFRC, National Advance for Craniomaxillofacial Reconstruction, Tehran, Iran; and Craniomaxillofacial Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Frank J Tuminelli
- Clinical Assistant Professor, Department of Dental Medicine, Hofstra Northwell School of Medicine, New York
| | - Hamid Reza Fallahi
- Private Practitioner, Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Yousefi
- Resident, Department of Prosthodontics, Dental College, Isfahan University of Medical Science, Isfahan, Iran
| | - Jose Lopez-Lopez
- Professor, Department of Odonto-Stomatology, School of Dentistry & Dental Hospital Barcelona University, University of Barcelona, Barcelona, Spain
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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: 11] [Impact Index Per Article: 2.8] [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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Implant placement in the pterygoid region with dynamically navigated surgery: A clinical report. J Prosthet Dent 2021; 128:125-129. [PMID: 33640090 DOI: 10.1016/j.prosdent.2020.12.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 02/05/2023]
Abstract
Implant placement in the pterygoid region is a reliable treatment for posterior maxillary tooth loss. However, the surgery is not widely applied because the implant placement region is hard to access and the direct visual access is limited. This clinical report describes the use of a dynamic navigation system to improve the pterygoid implant placement surgery. Real-time imaging of the surgery area and full-time guidance are provided by the system to alleviate the problem of lack of visibility and to reduce the complexity of placement.
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30
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Saravi B, Lang G, Steger R, Vollmer A, Zwingmann J. Corrective Osteotomy of Upper Extremity Malunions Using Three-Dimensional Planning and Patient-Specific Surgical Guides: Recent Advances and Perspectives. Front Surg 2021; 8:615026. [PMID: 33614702 PMCID: PMC7887308 DOI: 10.3389/fsurg.2021.615026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/13/2021] [Indexed: 11/23/2022] Open
Abstract
Malunions of the upper extremity can result in severe functional problems and increase the risk of osteoarthritis. The surgical reconstruction of complex malunions can be technically challenging. Recent advances in computer-assisted orthopedic surgery provide an innovative solution for complex three-dimensional (3-D) reconstructions. This study aims to evaluate the clinical applicability of 3-D computer-assisted planning and surgery for upper extremity malunions. Hence, we provide a summary of evidence on this topic and highlight recent advances in this field. Further, we provide a practical implementation of this therapeutic approach based on three cases of malunited forearm fractures treated with corrective osteotomy using preoperative three-dimensional simulation and patient-specific surgical guides. All three cases, one female (56 years old) and two males (18 and 26 years old), had painful restrictions in range of motion (ROM) due to forearm malunions and took part in clinical and radiologic assessments. Postoperative evaluation of patient outcomes showed a substantial increase in range of motion, reduction of preoperatively reported pain, and an overall improvement of patients' satisfaction. The therapeutic approach used in these cases resulted in an excellent anatomical and functional reconstruction and was assessed as precise, safe, and reliable. Based on current evidence and our results, the 3-D preoperative planning technique could be the new gold standard in the treatment of complex upper extremity malunions in the future.
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Affiliation(s)
- Babak Saravi
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Gernot Lang
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Rebecca Steger
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Centre, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Andreas Vollmer
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Medical Centre, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Jörn Zwingmann
- Department of Orthopedics and Trauma Surgery, St. Elisabeth Hospital Ravensburg, Ravensburg, Germany
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Digital Approach for the Rehabilitation of the Edentulous Maxilla with Pterygoid and Standard Implants: The Static and Dynamic Computer-Aided Protocols. Methods Protoc 2020; 3:mps3040084. [PMID: 33371232 PMCID: PMC7768480 DOI: 10.3390/mps3040084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022] Open
Abstract
A full-arch rehabilitation of the edentulous upper jaw without grafting procedures exploits the residual alveolar or the basal bone, with the necessity of long implants placed with a particular orientation. The precision in planning and placing the fixtures is fundamental to avoid clinical problems and to allow an acceptable connection with the prosthesis. The computer-aided implantology resulted in more accuracy than the traditional one, with a high standard of correspondence between the virtual project and the real outcome. This paper reports about the two different digital protocols, static and dynamic, as support to implant-borne prosthetic rehabilitation of edentulous maxillae. Two pterygoid and two/four anterior standard implants were seated in both cases by two different operators, without flap raising, and immediately loaded. This approach avoided the posterior cantilever by-passing the maxillary sinus and was adequately planned and realized without any surgical or prosthetic error. The two digital flow-charts were described step by step, underlining each other’s advantages and drawbacks compared to a free-hand approach.
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32
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Zhou M, Zhou H, Li SY, Zhu YB, Geng YM. Comparison of the accuracy of dental implant placement using static and dynamic computer-assisted systems: an in vitro study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:343-348. [PMID: 33307210 DOI: 10.1016/j.jormas.2020.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/26/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The study aimed to compare the accuracy of implant placement between static and dynamic computer-assisted systems (CAS) in a partially edentulous mandible model. MATERIALS & METHODS A total of 80 implants was placed in mandible models. The implants were placed using either static or dynamic computer-assisted system. Deviations of implant hex, apex and angulation were measured between preoperative planning and postoperative CBCT in planning software. RESULTS The mean deviations of implant hex, apex and angulation in static CAS group were 1.15 ± 0.34 mm, 1.37 ± 0.38 mm and 2.60 ± 1.11 degree, while in dynamic CAS group were 0.40 ± 0.41 mm, 0.34 ± 0.33 mm and 0.97 ± 1.21 degree, respectively. Implant placement with dynamic CAS showed less deviations of shoulder, apex and angulation than with static CAS significantly. CONCLUSIONS The implant accuracy using CAS system could be influenced by the guiding technique.
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Affiliation(s)
- Miao Zhou
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Huangshadadao Road 39, 510182, Guangzhou, China
| | - Hui Zhou
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Huangshadadao Road 39, 510182, Guangzhou, China; Department of Stomatology, the Eighth People Hospital of Guangzhou, Huayinglu Road 8, 510060, Guangzhou, China
| | - Shu-Yi Li
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Huangshadadao Road 39, 510182, Guangzhou, China
| | - Yi-Bo Zhu
- 4th Dental Center of School and Hospital of Stomatology, Peking University, Dongsihuanzhonglu Road 41, 100025, Beijing, China
| | - Yuan-Ming Geng
- Department of Stomatology, Zhujiang Hospital, Southern Medical University, Gongyedadaozhong Road 253, 510282, Guangzhou, China.
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Mitov G, Alevizakos V, Bryk C, Draenert F, Vassileva Z, von See C. Use of interactive instructional tools in virtual 3D planning. J Dent Educ 2020; 84:1275-1283. [PMID: 33161581 DOI: 10.1002/jdd.12306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/18/2020] [Accepted: 06/26/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The aim of this study is to analyze the effectiveness of screencast training videos for users from different professional backgrounds on the basis of the quality and quantity of virtual 3D implant planning as evaluated using assessment software. METHODS Participants in the study were dental students (n = 21), dental technicians (n = 16), or practicing dentists (n = 16) with no knowledge of the implant planning software CoDiagnostiX or any experience in virtual implant planning. They were randomly divided into 2 groups: The participants of the control group were presented training videos on CBCT (cone beam computed tomography) and implant planning, additional to the traditional software manual. The participants of the experimental group received, additionally, a training video on the planning software, produced in the form of a screencast. Then 3 implant planning procedures were performed by all participants. The quality of implant planning was assessed using the Treatment Evaluation Tool software, and time for planning was measured. RESULTS Paired sample tests showed significantly shorter planning times for the experimental groups consisting of dentists and students (P < 0.001). A comparison of the results of the individual groups reveals that students and dental technicians who had not received prior screencast training were significantly less precise in their planning (P < 0.001). CONCLUSION This study suggests a promising outcome for the future use of screencasts in the acquisition of software skills for dental software. There is a need for tools for objective self-assessment of effectiveness in software training.
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Affiliation(s)
- Gergo Mitov
- Centre for Prosthetic Dentistry and Dental Biomaterials, Danube Private University, Krems, Austria
| | - Vasilios Alevizakos
- Centre for CAD/CAM and Digital Dentistry, Danube Private University, Krems, Austria
| | - Christoph Bryk
- Centre for CAD/CAM and Digital Dentistry, Danube Private University, Krems, Austria
| | - Florian Draenert
- Department for Maxillofacial Surgery, University Marburg, Marburg, Germany
| | | | - Constantin von See
- Centre for CAD/CAM and Digital Dentistry, Danube Private University, Krems, Austria
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Dynamic Navigation for Zygomatic Implants: A Case Report about a Protocol with Intraoral Anchored Reference Tool and an Up-To-Date Review of the Available Protocols. Methods Protoc 2020; 3:mps3040075. [PMID: 33167345 PMCID: PMC7711909 DOI: 10.3390/mps3040075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023] Open
Abstract
Dynamic Navigation is a computer-aided technology that allows the surgeon to track the grip instruments while preparing the implant site in real time based on radiological anatomy and accurate pre-operative planning. The support of this technology to the zygoma implant placement aims to reduce the risks and the errors associated with this complex surgical and prosthetic treatment. Various navigation systems are available to clinicians currently, distinguished by handling, reliability, and the associated economic and biological benefits and disadvantages. The present paper reports on the different protocols of dynamic navigations following a standard workflow in correlation with zygomatic implant supported rehabilitations and describes a case of maxillary atrophy successfully resolved with this technology. An innovative and minimally invasive dynamic navigation system, with the use of an intraoral anchored trust marker plate and a patient reference tool, has been adopted to support the accurate insertion of four zygomatic implants, which rapidly resolved maxillary atrophy from a 75-year-old male system. This approach provided an optimal implant placement accuracy reducing surgical invasiveness.
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Tao B, Shen Y, Sun Y, Huang W, Wang F, Wu Y. Comparative accuracy of cone-beam CT and conventional multislice computed tomography for real-time navigation in zygomatic implant surgery. Clin Implant Dent Relat Res 2020; 22:747-755. [PMID: 33112508 DOI: 10.1111/cid.12958] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/04/2020] [Accepted: 10/04/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cone-beam computed tomography (CBCT) and conventional multislice CT (MSCT) are both used in zygomatic implant navigation surgery but the superiority of one technique versus the other remains unclear. PURPOSE This study compared the accuracy of CBCT and MSCT in zygomatic implant navigation surgery by calculating the deviations of implants. MATERIAL AND METHODS Patients with severely atrophic maxillae were classified into two groups according to the use of CBCT- or MSCT-guided navigation system. The entry and apical distance deviation, and the angle deviation of zygomatic implants were measured on fused operation images. A linear effect model was used for analysis, with statistical significance set at P < .05. RESULTS A total of 72 zygomatic implants were inserted as planned in 23 patients. The comparison of deviations in CBCT and MSCT groups showed a mean (± SD) entry deviation of 1.69 ± 0.59 mm vs 2.04 ± 0.78 mm (P = .146), apical deviation of 2 ± 0.68 mm vs 2.55 ± 0.85 (P < .001), and angle deviation of 2.32 ± 1.02° vs 3.23 ± 1.21° (P = .038). CONCLUSION Real-time zygomatic implant navigation surgery with CBCT may result in higher values for accuracy than MSCT.
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Affiliation(s)
- Baoxin Tao
- Department of Second Dental Center, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yihan Shen
- Department of Second Dental Center, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yuanyuan Sun
- Department of Second Dental Center, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Wei Huang
- Department of Oral Implantology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Feng Wang
- Department of Oral Implantology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yiqun Wu
- Department of Second Dental Center, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
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Pellegrino G, Basile F, Relics D, Ferri A, Grande F, Tarsitano A, Marchetti C. Computer-Aided Rehabilitation Supported by Zygomatic Implants: A Cohort Study Comparing Atrophic with Oncologic Patients after Five Years of Follow-Up. J Clin Med 2020; 9:jcm9103254. [PMID: 33053696 PMCID: PMC7600816 DOI: 10.3390/jcm9103254] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/03/2020] [Accepted: 10/07/2020] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to evaluate the survival and clinical success rate, complications, and patients’ quality of life after computer-aided rehabilitation supported by zygomatic implants in cases of severe maxillary atrophy (ten patients) and in bone defects in oncologic patients (ten patients). All patients underwent computer-aided planning and surgery. Seventy-three zygomatic implants were placed. The mean follow-up period was 39.9 months. Implant survival and clinical success rate, the effectiveness of planning the implant length, biological and prosthetic complications, and the quality of life were evaluated. The five-year implant survival rate for patients with maxillary atrophy and oncologic patients was 97.4% and 96.7%, respectively. The prosthetic survival rate was 100%. Two implant failures occurred in the first year. One implant failure was observed in each group. Minor biological and prosthetic complications occurred in both groups without significant differences. All complications were managed without affecting the treatment. The quality of life increased by 71.3% in the atrophic group and by 82.9% in the oncologic group. Zygomatic implant rehabilitation seems to be a reliable technique for patients with maxillary atrophy and for oncologic patients. The three-dimensional computer-aided approach allows the surgeon to plan the surgery and increase its predictability. Early prosthesis loading certainly allows for better functional outcomes.
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Affiliation(s)
- Gerardo Pellegrino
- Oral and Maxillofacial Surgery Unit, DIBINEM, University of Bologna, 40100 Bologna, Italy; (G.P.); (F.B.); (D.R.); (A.F.); (F.G.)
| | - Francesco Basile
- Oral and Maxillofacial Surgery Unit, DIBINEM, University of Bologna, 40100 Bologna, Italy; (G.P.); (F.B.); (D.R.); (A.F.); (F.G.)
| | - Daniela Relics
- Oral and Maxillofacial Surgery Unit, DIBINEM, University of Bologna, 40100 Bologna, Italy; (G.P.); (F.B.); (D.R.); (A.F.); (F.G.)
| | - Agnese Ferri
- Oral and Maxillofacial Surgery Unit, DIBINEM, University of Bologna, 40100 Bologna, Italy; (G.P.); (F.B.); (D.R.); (A.F.); (F.G.)
| | - Francesco Grande
- Oral and Maxillofacial Surgery Unit, DIBINEM, University of Bologna, 40100 Bologna, Italy; (G.P.); (F.B.); (D.R.); (A.F.); (F.G.)
| | - Achille Tarsitano
- Oral and Maxillofacial Surgery Unit, Azienda Ospedaliero-Universitaria di Bologna, DIBINEM, University of Bologna, 40100 Bologna, Italy;
- Correspondence: ; Tel.: +39-051-214-2463
| | - Claudio Marchetti
- Oral and Maxillofacial Surgery Unit, Azienda Ospedaliero-Universitaria di Bologna, DIBINEM, University of Bologna, 40100 Bologna, Italy;
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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: 1.4] [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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Wu Y, Wang F, Huang W, Fan S. Real-Time Navigation in Zygomatic Implant Placement. Oral Maxillofac Surg Clin North Am 2019; 31:357-367. [DOI: 10.1016/j.coms.2019.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Orentlicher G, Horowitz A, Kobren L. Computer-Guided Dental Implant Treatment of Complete Arch Restoration of Edentulous and Terminal Dentition Patients. Oral Maxillofac Surg Clin North Am 2019; 31:399-426. [PMID: 31253346 DOI: 10.1016/j.coms.2019.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The treatment of completely edentulous or soon-to-be completely edentulous dental arches with complete-arch fixed denture restorations, supported by dental implants, are some of the more complicated patient cases in oral and maxillofacial surgery and prosthodontics. This article discusses the use of digital technologies, computerized tomographic (CT) guided planning software applications, and surgical guides in treating these complex dental implant patient cases. A discussion of the nuances and workflows of different types of treatments are provided. The importance of experience and a multi-disciplinary team approach is emphasized.
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Affiliation(s)
- Gary Orentlicher
- Private Practice, New York Oral, Maxillofacial, and Implant Surgery, 495 Central Park Avenue, Scarsdale, NY 10583, USA; Oral and Maxillofacial Surgery, White Plains Hospital, White Plains, NY, USA.
| | - Andrew Horowitz
- Private Practice, New York Oral, Maxillofacial, and Implant Surgery, 495 Central Park Avenue, Scarsdale, NY 10583, USA; Oral and Maxillofacial Surgery, White Plains Hospital, White Plains, NY, USA
| | - Leonard Kobren
- Private Practice, Westchester Prosthodontics, 12 Old Mamaroneck Road, White Plains, NY 10605, USA
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Dings JPJ, Verhamme L, Maal TJJ, Merkx MAW, Meijer GJ. Reliability and accuracy of skin-supported surgical templates for computer-planned craniofacial implant placement, a comparison between surgical templates: With and without bony fixation. J Craniomaxillofac Surg 2019; 47:977-983. [PMID: 30905534 DOI: 10.1016/j.jcms.2019.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 12/17/2018] [Accepted: 01/23/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The purpose is to determine the accuracy of guided implant placement in the orbital, nasal, and auricular region using computer-aided designed stereolithographic skin-supported surgical templates with and without bone fixation pins. MATERIALS AND METHODS Preoperatively, cone-beam CT (CBCT) and multiple detector computed tomography (MDCT) scans were acquired from 10 cadaver heads, followed by virtual planning of implants in the orbital margin, auricular region and nasal floor. Surgical skin-supported templates were digitally designed to allow flapless implant placement. Fixation pins were used for stabilization comprising half of all templates in predetermined bone areas. The accuracy of the surgical templates was validated by comparing the achieved implant location to its virtual planned implant position by calculating the linear and angular deviations. RESULTS Surgical templates with the use of bone fixation pins produced statistically significant greater implant deviations as compared to the non-fixated surgical templates. CONCLUSION The results of this study indicate that significant deviation has to be taken into account when placing cranio-maxillofacial implants using skin-supported surgical templates. Surprisingly, the use of bone-fixated pins worsened the accuracy.
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Affiliation(s)
- J P J Dings
- Dept of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
| | - L Verhamme
- 3D Lab, Dept of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - T J J Maal
- 3D Lab, Dept of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - M A W Merkx
- Dept of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - G J Meijer
- Dept of Implantology and Periodontology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
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Araujo RZ, Santiago Júnior JF, Cardoso CL, Benites Condezo AF, Moreira Júnior R, Curi MM. Clinical outcomes of pterygoid implants: Systematic review and meta-analysis. J Craniomaxillofac Surg 2019; 47:651-660. [PMID: 30799134 DOI: 10.1016/j.jcms.2019.01.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/21/2018] [Accepted: 01/23/2019] [Indexed: 10/27/2022] Open
Abstract
The aim of this systematic literature review was to analyze clinical outcomes of pterygoid implant for the treatment of patients with atrophic posterior maxillae and to provide clinical recommendations for this dental implant technique. An extensive search of electronic databases (PubMed/Medline, Science Direct, Lilacs, Embase, and Cochrane Library) was conducted, for articles published between January 1995 and January 2018, to identify literature presenting clinical outcomes of pterygoid implants in the treatment of patients with atrophic posterior maxillae. The systematic review was performed in accordance with PRISMA/PICO statement guidelines, and the risk of bias was assessed (Australian National Health and Medical Research Council scale). The relative risk of implant failure was analyzed within a 95% confidence interval (95% CI). After screening 331 abstracts from the electronic databases, 36 full-text articles were accessed for eligibility, and a total of 6 studies were included in this systematic review (after applying the inclusion and exclusion criteria). All studies were retrospective in nature and were classified with a poor level of evidence. A total of 634 patients received 1.893 pterygoid implants, with a mean implant survival rate of 94.87%. The mean prevalence of implant failure was 0.056 with a 95% CI of 0.04-0.077. This study demonstrates that pterygoid implants can be successfully used in patients with atrophic posterior maxilla. However, the results should be interpreted with caution, given the presence of uncontrolled confounding factors in the included studies.
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Affiliation(s)
- Rafael Zetehaku Araujo
- Department of Oral Implantology and Dental Prosthesis, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais, Brazil.
| | | | - Camila Lopes Cardoso
- Department of Oral Implantology, Universidade do Sagrado Coração, Bauru, São Paulo, Brazil
| | | | - Rosenvaldo Moreira Júnior
- Department of Oral and Maxillofacial Surgery, Universidade do Sagrado Coração, Bauru, São Paulo, Brazil
| | - Marcos Martins Curi
- Department of Oral and Maxillofacial Surgery, Hospital Santa Catarina, São Paulo, Brazil
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The smiling scan technique: Facially driven guided surgery and prosthetics. J Prosthodont Res 2018; 62:514-517. [DOI: 10.1016/j.jpor.2018.03.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 02/24/2018] [Accepted: 03/01/2018] [Indexed: 11/23/2022]
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Rehabilitation of Posterior Maxilla with Obturator Supported by Zygomatic Implants. Case Rep Dent 2018; 2018:3437417. [PMID: 29850277 PMCID: PMC5937606 DOI: 10.1155/2018/3437417] [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: 01/05/2018] [Accepted: 04/03/2018] [Indexed: 11/18/2022] Open
Abstract
Prosthetic rehabilitation of atrophic maxilla and large maxillary defects can be done successfully by zygomatic implant-supported prosthesis. Zygomatic implants are an avant-garde to complex and invasive-free vascularised osteocutaneous flaps, distraction osteogenesis, and the solution to flap failures. A treated case of tuberculous osteomyelitis, with a class II (Aramany's classification) maxillary defect, reported to oral maxillofacial department, Government Dental College (RUHS-CODS). The defect in this group was unilateral, retaining the anterior teeth. The patient was previously rehabilitated with a removable maxillary obturator. Inadequate retention affected essential functions like speaking, mastication, swallowing, esthetics, and so on due to lack of sufficient supporting tissues. A fixed prosthetic rehabilitation of posterior maxillary defect was done with obturator supported with two single-piece zygomatic implants. At 1-year follow-up, the patient was comfortable with the prosthesis, and no further complaints were recorded.
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Minimally Invasive Approach Based on Pterygoid and Short Implants for Rehabilitation of an Extremely Atrophic Maxilla: Case Report. IMPLANT DENT 2018; 26:639-644. [PMID: 28486354 DOI: 10.1097/id.0000000000000603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Extremely atrophic maxillae can be considered the most important indication for three-dimensional maxillary reconstruction. Different bone-augmentation techniques have been suggested to accomplish this. This article illustrates a minimally invasive approach to rehabilitation of the extremely atrophic maxilla. MATERIAL AND METHODS A 63-year-old male patient was referred for restoration of his totally edentulous maxilla with a fixed full-arch implant-prosthetic rehabilitation. Four short implants in the premaxillary region and 2 longer implants in the pterygomaxillary regions were inserted with piezoelectric implant site preparation. DISCUSSION At the 1-year follow-up appointment, no clinical or radiographic changes in the soft-tissue contours or crestal bone levels were observed. CONCLUSION This surgical approach, based on the combination of short implants in the premaxillary regions and pterygoid implants in the pterygomaxillary regions, represents a way to shorten treatment timing, minimize the risk of surgical complications, and reduce patient discomfort and costs.
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Kim K, Choi HS, Pang NS. Clinical application of 3D technology for tooth autotransplantation: A case report. AUST ENDOD J 2018; 45:122-128. [PMID: 29450945 DOI: 10.1111/aej.12260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This report presents two cases of tooth autotransplantation using cone-beam computed tomography (CBCT), the three-dimensional (3D) simulation dental planning software and a computer-aided rapid prototyping (CARP) model. Two hopeless teeth of adult patients were replaced as their third molar teeth. Before deciding the autotransplantation, diagnostic CBCT images were acquired and imported to SimPlant software. The SimPlant dental program was used for surgical simulation prior to autotransplantation, which created 3D images of the available donor teeth and recipient site tooth and superimposed the images to display their morphological similarity. Efficient modification of the recipient socket was designed preoperatively. The CARP model of the donor tooth was prepared as a substitute for the donor tooth that would be fit into the new recipient socket during bone preparation. Autotransplantation was favourably performed in 5-6 min. Transplanted teeth healed up without clinical abnormality. The postoperative follow-up time was up to 6 years.
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Affiliation(s)
- Keunhee Kim
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hee-Seung Choi
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
| | - Nan-Sim Pang
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
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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: 0.9] [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, Wang F, Wang HW, Zhou WJ, Huang W, Wu YQ. Accuracy of a real-time surgical navigation system for the placement of quad zygomatic implants in the severe atrophic maxilla: A pilot clinical study. Clin Implant Dent Relat Res 2017; 19:458-465. [PMID: 28219120 DOI: 10.1111/cid.12475] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/30/2016] [Accepted: 01/08/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Kuo-feng Hung
- Department of Oral-Maxillofacial Implantology; Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai 200011 China
| | - Feng Wang
- Department of Oral-Maxillofacial Implantology; Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai 200011 China
| | - Hao-wei Wang
- Department of Oral-Maxillofacial Implantology; Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai 200011 China
| | - Wen-jie Zhou
- Department of Oral-Maxillofacial Implantology; Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai 200011 China
| | - Wei Huang
- Department of Oral-Maxillofacial Implantology; Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai 200011 China
| | - Yi-qun Wu
- Department of Oral-Maxillofacial Implantology; Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai 200011 China
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Peel S, Bhatia S, Eggbeer D, Morris DS, Hayhurst C. Evolution of design considerations in complex craniofacial reconstruction using patient-specific implants. Proc Inst Mech Eng H 2016; 231:509-524. [DOI: 10.1177/0954411916681346] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Previously published evidence has established major clinical benefits from using computer-aided design, computer-aided manufacturing, and additive manufacturing to produce patient-specific devices. These include cutting guides, drilling guides, positioning guides, and implants. However, custom devices produced using these methods are still not in routine use, particularly by the UK National Health Service. Oft-cited reasons for this slow uptake include the following: a higher up-front cost than conventionally fabricated devices, material-choice uncertainty, and a lack of long-term follow-up due to their relatively recent introduction. This article identifies a further gap in current knowledge – that of design rules, or key specification considerations for complex computer-aided design/computer-aided manufacturing/additive manufacturing devices. This research begins to address the gap by combining a detailed review of the literature with first-hand experience of interdisciplinary collaboration on five craniofacial patient case studies. In each patient case, bony lesions in the orbito-temporal region were segmented, excised, and reconstructed in the virtual environment. Three cases translated these digital plans into theatre via polymer surgical guides. Four cases utilised additive manufacturing to fabricate titanium implants. One implant was machined from polyether ether ketone. From the literature, articles with relevant abstracts were analysed to extract design considerations. In all, 19 frequently recurring design considerations were extracted from previous publications. Nine new design considerations were extracted from the case studies – on the basis of subjective clinical evaluation. These were synthesised to produce a design considerations framework to assist clinicians with prescribing and design engineers with modelling. Promising avenues for further research are proposed.
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Affiliation(s)
- Sean Peel
- PDR – International Centre for Design & Research, Cardiff Metropolitan University, Cardiff, UK
| | - Satyajeet Bhatia
- University Hospital of Wales, Cardiff & Vale University Health Board, Cardiff, UK
| | - Dominic Eggbeer
- PDR – International Centre for Design & Research, Cardiff Metropolitan University, Cardiff, UK
| | - Daniel S Morris
- University Hospital of Wales, Cardiff & Vale University Health Board, Cardiff, UK
| | - Caroline Hayhurst
- University Hospital of Wales, Cardiff & Vale University Health Board, Cardiff, UK
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Chrcanovic BR, Albrektsson T, Wennerberg A. Survival and Complications of Zygomatic Implants: An Updated Systematic Review. J Oral Maxillofac Surg 2016; 74:1949-1964. [PMID: 27422530 DOI: 10.1016/j.joms.2016.06.166] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/01/2016] [Accepted: 06/08/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE To assess the survival rate of zygomatic implants (ZIs) and the prevalence of complications based on previously published studies. MATERIALS AND METHODS An electronic search of 3 databases was performed in December 2015 and was supplemented by manual searching. Clinical series of ZIs were included. Interval survival rate and cumulative survival rate (CSR) were calculated. The untransformed proportion of complications (sinusitis, soft tissue infection, paresthesia, oroantral fistulas) was calculated by considering the prevalence reported in the studies. RESULTS Sixty-eight studies were included, comprising 4,556 ZIs in 2,161 patients with 103 failures. The 12-year CSR was 95.21%. Most failures were detected within the 6-month postsurgical period. Studies (n = 26) that exclusively evaluated immediate loading showed a statistically lower ZI failure rate than studies (n = 34) evaluating delayed loading protocols (P = .003). Studies (n = 5) evaluating ZIs for the rehabilitation of patients after maxillary resections presented lower survival rates. The probability of presenting postoperative complications with ZIs was as follows: sinusitis, 2.4% (95% confidence interval [CI], 1.8-3.0); soft tissue infection, 2.0% (95% CI, 1.2-2.8); paresthesia, 1.0% (95% CI, 0.5-1.4); and oroantral fistulas, 0.4% (95% CI, 0.1-0.6). However, these numbers might be underestimated, because many studies failed to mention the prevalence of these complications. CONCLUSION ZIs present a high 12-year CSR, with most failures occurring at the early stages postoperatively. The main observed complication related to ZIs was sinusitis, which can appear several years after ZI installation surgery.
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Affiliation(s)
- Bruno Ramos Chrcanovic
- PhD student, Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
| | - Tomas Albrektsson
- Retired Professor and former Department Head, Department of Biomaterials, Göteborg University, Göteborg; Guest Professor, Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Ann Wennerberg
- Professor and Department Head, Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
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Chow J. A novel device for template-guided surgery of the zygomatic implants. Int J Oral Maxillofac Surg 2016; 45:1253-5. [DOI: 10.1016/j.ijom.2016.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/26/2016] [Accepted: 06/09/2016] [Indexed: 11/25/2022]
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