StomatologyEduJournal1-2015 | Page 71

REHABILITATION OF SEVERELY RESORBED MAXILLAE WITH ZYGOMATIC IMPLANTS: A LITERATURE REVIEW Table 1 Treatment recommendations based on the presence of bone in the different zones of the maxilla Presence of bone Surgical approach Zones I, II and III Traditional, axial, implants Zones I and II Four traditional implants,tilted Zones I only Zygomatic implants plus two or four traditional implants Insufficient bone Four zygomatic implants Table 2 Zygomatic Success Code Criteria Condition I Success grade I Condition II Success grade II Condition III Success garde III Condition IV Failure Clear clinical mobility = evidence of disintegration of the apical part of the implant Rotation and/or pain Criterion A: zygomatic implant stability No mobility No pain Light clinical mobility No pain Clear clinical mobility = no evidence of disintegration of the apical part of the implant or rotation No pain Criterion B: Associated sinus pathology Lanza & Kennedy test Lund-Mackay score = 0 Lanza & Kennedy test Lund-Mackay score =0 Lanza & Kennedy test Lund-Mackay score >0 Lanza & Kennedy test + Lund-Mackay score > 0 Light recession Implant head is visible = yuxta-gingival No exposed threads Recession Up to seven exposed threads Recession. More than seven exposed threads 6mm15mm D<-5mm Criterion C: periimplant soft tissue condition No recession Criterion D: prosthetic offset 0 mm ≤D≤6mm -3mm≤D≤0mm the posterior zygomatic implants can restore the second premolar/first molar (Fig. 4). The main indications for this type of implant are: 1) Patients with extensive defects of the maxilla caused by tumour-resections (17, 26); 2) History of periodontitis (27); 3) Traumatic injuries , cleft lip and palate and congenital defects (20, 27-29); 4) Failure of previous maxillary rehabilitations (30). Contraindications to the use of zygomatic implants include (19): 1) Acute sinus infections; 2) Maxillary or zygoma pathology; 3) Uncontrolled or malignant systemic disease. Relative contraindications are: 1) Chronic infectious sinusitis 2) The use of bisphosphonates 3) Smoking more than 20 cigarettes a day STOMA.EDUJ (2015) 2 (1) For these reasons, accurate pre-surgical evaluations are required before the placement of the zygomatic implants. Data collection The articles reported in this literature review were searched on pubmed/medline database, considering only the English-written scientific journals; case reports and review studies were excluded. The keywords selected were “Zygoma Implants”, “Rehabilitation”, “Survival” and “Results”. After this research only 17 works presented the characteristics described above. 71