ORAL IMPLANTOLOGY
tissues, nor being negatively influenced by it. The
main disadvantage of the anterolateral thigh flap
in males is the hair growth on the flap.24
When zygomatic implants and free flaps are
considered to close a maxillary defect, three timing
options exist for placement of the zygomatic
implants: after, simultaneous or before the free
flap reconstruction.5
Placement of implants before soft tissue closure
is the least favorable scenario since the zygoma
implant could touble the soft tissue reconstruction
with a persistent oroantral communication around
the implant.5
In routine dental implants the biological seal
around the implant is identified as a determining
factor of the long-term success of the peri-implant
health.25 This case-report seems to indicate that in
zygomatic implants, even when the implant surface
has been soiled with calculus, the application
of a free vascularized flap allows for a clinically
sufficient seal provided the adequate cleaning of
the skin around the implant.
A question to be raised is whether the initial
planning could have favored the placement of
short implants.
The old assumption that it is contraindicated
to place short implants into atrophic posterior
maxillae has been recently challenged by
excellent results.26, 27 The necessity to apply a
free vascularized flap to close a defect after
recurrent failures to surgically resolve an oro-antral
communication around zygomatic implants has
been well perceived by this patient. The advantage
to be able to preserve a well-functioning prosthetic
solution and to preserve well integrated implants
certainly outweigh the surgical morbidity and work
incapacity of afree flap surgery.
This choice could be a solution in rare instances
where the gold standard of removing zygomatic
implants in an infected area, even if well integrated,
is not achievable for some reason.
Conclusion
Adverse complications do occur in zygomatic
implant surgery.
One of these is a recurrent oro-antral
communication leading to a large soft tissue and
bony defect around a well-integrated zygomatic
implant with a most satisfactory prosthetic solution
but with severe complaints of malodor, bad taste,
loss of fluids through the nose.
Local debridement, surface treatment of the
zygomatic implant and an anterolateral thigh free
flap were able to resolve these issues completely,
retaining the full advantage of the existing and
well-functioning prosthetic solution.
Permission
Written permission of the patient is obtained to
disclose all data and images in this manuscript.
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