ORAL REHABILITATION
Table 3 Sinus complications in studies in which zygomatic implants were placed using the two-stage protocol
Two-stage protocol
Patients (n)
Follow-up period
(months)
Survival rate of
zygomatic implants %
Sinusitis %
Malevez
et al.(2004)
55
6-48
100
5 (9)
Hirsch
et al.(2004)
76
12
98
3 (4)
Becktor
et al.(2005)
16
9-69
90.3
6 (26.6)
Farzad
et al.(2006)
11
18-56
100
1 (9.1)
Davo
et al.(2009) (53)
24
60
97.4
5 (20.8)
Stièvenart
et al.(2010) (54)
10 (of 20)
40
96.3
1 (1.3)
Aparicio
et al.(2012)
22
120
97.7
2 (9.1)
Table 4 Sinus complications in studies in which zygomatic implants were placed using the immediate function protocol
Immediate
function protocol
Total number of
patients
Follow-up period
(months)
Survival rate of zygomatic
implants %
Sinusitis %
Aparicio
et al. (2004)
20
6-48
100
0
Mozzati
et al. (2008)
7
24
100
0
Outcomes
The severely atrophied maxilla constitues a
therapeutic problem for a restorative dentist,
especially
when
previously
performed
rehabilitations result in failure and patients’
dissatisfaction. The zygomatic implants were
introduced to solve prosthetic reconstruction
problems in fully edentulous patients.
The zygomatic implant is a titanium endosteal
implant ranging from 30 mm to 52.5 mm in
length. The apical two thirds of the implant is
4 mm in diameter and the alveolar one third is
5 mm in diameter. The surgical technique for
inserting zygomatic implants has been the subject
of modification during the last years, with today
essentially two major vari ations existing: the
internal and the external approach. In the first
option, the sinus membrane is carefully dissected
and the implant is inserted internal to the maxillary
sinus as reported by Brånemark and colleagues
(31). The extrasinusal technique is characterized
by inserting the implant external to the maxillary
sinus before anchoring in the zygomatic bone. In
this case the implant is covered only by soft tissue
along its lateral maxillary surface. The decision for
an “external” rather than an “internal” placement
72
of the zygomatic implant must be the result of
accurate anatomic assessments. For this reason
Aparicio et al. (32) proposed a classification for
zygomatic implant patient based on the zygoma
anatomy guided approach: the ZAGA approach.
It is a modification of the original zygomatic
implant technique and it focuses on interindividual
anatomic differences. Thus, the path of the implant
body can vary from being totally intrasinus to being
totally extrasinus, depending on the relationship
between the different anatomic components.
Keller et al. (10) and Branemark et al. (31)
suggested that zygomatic implants may be used
as an alternative to bone grafts in case of severe
maxillary resorption, because the insertion of
these implants does not require additional surgery.
This major surgical technique requires a proper
training and many studies were conducted in an
institutional environment, such universities or
specialty clinics. The presurgical protocols provide
for the selection and preparation of patients
in order to allow promising results. Once the
clinical examination is complete, radiographic
examinations are performed to ensure appropriate
treatment planning of the zygomatic implants.
The presurgical exams recommended are
following:
STOMA.EDUJ (2015) 2 (1)