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ORIGINAL ARTICLE
Purpose: Patients with moderate to severe atrophy challenge the surgeon to discover alternative ways
to use existing bone or resort to augmenting the patient with autogenous or alloplastic bone materials.
The objective of the following study was to review the published literature to evaluate treatment
success with zygomatic implants in patients with atrophic posterior maxilla.
Study Selection: Medline/PubMed searches were conducted using the terms atrophic maxilla,
zygomatic implant, zygomatic bone, grafts, maxillary sinus, as well as combinations of these and
related terms. The few articles judged to be relevant were reviewed.
Results: Based on the current literature review, zygomatic implants show excellent survival rates (>90%)
and a low incidence of complications.
Conclusion: With proper case selection, correct indication and knowledge of the surgical technique, the
use of zygomatic implants associated with standard implants offers advantages in the rehabilitation
of severely resorbed maxillae, especially in areas with inadequate bone quality and volume, without
needing an additional bone grafting surgery, wherefore shortening or avoiding hospital stay and
reducing surgical morbidity.
KEY WORDS: Atrophic maxilla, grafts, maxillary sinus, zygomatic bone, zygomatic implant
INTRODUCTION
Dental implants are now commonly used for replacing
missing teeth in various clinical situations. Dental
implants are surgically inserted in the jawbones.
Unfortunately, restrictions have appeared in the use of
oral implants. One of them is the lack of sufficient bone
volume, especially in the posterior maxilla.[1]
During the last three decades, several surgical procedures
have been developed to increase local bone volume in
Department of Prosthodontics, Government Dental College and
Research Institute, Victoria Hospital Campus, Fort, Bengaluru,
Karnataka, India
Address for correspondence: Dr. Richa Vashisht,
Government Dental College and Research Institute, Victoria Hospital Campus,
Fort, Bengaluru - 560 002, Karnataka, India.
E-mail: dr.richavashisht@gmail.com
Website:
www.jdionline.org
DOI:
10.4103/0974-6781.130973
44
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PRESURGICAL EVALUATION
Clinical examination is not sufficient for this evaluation
and radiologic assessment has to be considered. Bedrossian
et al. in their study on zygomatic and premaxillary implants
used panoramic radiographs, which generally depict the
size and configuration of the maxillary sinuses, the height
of the residual ridge and the position of the nasal floor. The
body of the zygoma can usually be visualized.[9] However,
orthopantomography can give distorted information
and therefore, the examination of choice is the spiral
or helicoid computed tomography (CT) scan, which
makes two- and three-dimensional imaging possible
with axial cuts every 2 mm parallel to the palatal arch
and conventional tomography with frontal tomograms
perpendicular to the hard palate every 3-4 mm. The CT
scan also gives the opportunity to visualize the health
of the maxilla and the sinus. Sinusitis, polyps or any
sinusal pathology can be excluded. The density, length
and volume of the zygoma can be evaluated and special
templates for inserting the zygomatic implants can be
constructed on stereolithographic models to facilitate
the orientation of the zygomatic implants during the
surgery with minimal errors in angulation and position.[10]
Vrielinck et al., presented a planning system for zygomatic
implant insertion based on the pre-operative CT imaging;
they calculated the position of the implants and fabricated
a surgical guide. Using this system they obtained a success
rate of 92% in 29 patients with zygomatic implants (two
implants did not reach the zygomatic arch when using
this surgical guide).[11]
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SURGICAL PROCEDURE
COMPLICATIONS
The reported complications associated with zygomatic
implants include postoperative sinusitis, oroantral fistula
formation, periorbital and subconjunctival hematoma
or edema, lip lacerations, pain, facial edema, temporary
paresthesia, epistaxis, gingival inflammation and orbital
penetration/injury [Table 1]. Post-operative concerns
regarding difficulty with speech articulation and hygiene
caused by the palatal emergence of the zygomatic
implant and its effect on the prosthesis suprastructure
have been reported.
CONCLUSION
The zygomatic implant is an alternative procedure to
bone augmentation, maxillary sinus lift and to bone
No. of No. of
patients zygomatic
implants
Follow-up
Success Complication
rate %
69
131
6 months-5 years
99
14
21
42
28
40
81
12 months
29 months
12-42 months
100
100
100
54
56
25
20
75
101
110
47
80
150
1-72 months
9 months-5 years
2-5 years
6-40 months
12 months
96
96
100
96
98.7
42
81
5 years
98.5
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13.
14.
15.
16.
REFERENCES
1.
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zygomatic implants: A treatment option for the atrophic edentulous
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