05 June 2024

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Zygomatic Implant-Supported Prosthetic Rehabilitation of a Patient with Post-COVID-19 Mucormycosis and Maxillectomy

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Abstract

Mucormycosis has been prevalent in the past few years with the COVID-19 pandemic largely affecting the maxilla due to its proximity to the respiratory corridor. Resection of the maxillary dentition along with the maxillary bone itself has a huge psychosocial impact on the patient. When seeking prosthetic rehabilitation, poor esthetics, difficulty in mastication, and social embarrassment are the patients’ concerns. Hence, it becomes great responsibility for the clinician to restore the patient’s natural teeth while causing him/her minimum discomfort. This article describes such a case of post-COVID-19 mucormycosis that has been provisionally restored by the means of all-on-four zygomatic implants.

Introduction

Edentulism is a common concern for patients treated for mucormycosis followed by COVID-19. Most of these patients undergo varying degrees of maxillary resection that cause edentulism of varying severity. The maxillary teeth and the underlying residual alveolar ridge are lost, leading to severely hampered esthetics and mastication that eventually affects the patient’s health, i.e., both psychological and physical.

Mucormycosis is an opportunistic fungal infection that occurs in the presence of an existing systemic disease. The microorganisms spread from the respiratory mucosa to the maxillary antrum, nasal and paranasal sinuses, and the oral cavity. This infection eventually leads to thrombosis of blood vessels and necrosis of tissues leaving aggressive surgical debridement as the treatment of choice. Maxillary tissue left is usually with a defect or only soft tissue. Contingent upon the augmentation of the necrosed tissue, the patient would need to go through maxillectomies of various amounts. The classification for the maxillary defects proposed by Aramany [1] and Brown et al. [2] is the most broadly perceived for the reason.

Rehabilitation of defects of the maxilla poses a challenge to the prosthodontist due to the poor foundation available. In such cases, placement of endosseous implants provides a stable foundation for the future prosthesis rendering sufficient retention and patient acceptability [3]. The ideal sites for the placement of implants for patients with maxillary defects are the premaxillary segment and the maxillary tuberosity [3]. However, in the absence of bone in these sites, the pterygoid and zygomatic bones can be utilized [3]. This provides a graft-less approach for the placement of implants [4]. Bedrossian et al. and Davo et al. suggested that the number of implants placed can be either two zygomatic with two axial implants [5] or two to three zygomatic implants in each bone for maxillary rehabilitation [6].

The temporization of these implants can be done using the denture conversion technique as proposed by Misch [7]. Zygomatic implants are advised to be loaded immediately [8–10] although intermediate loading is acceptable. The definitive prosthesis is then fabricated after 3 months [11]. This case report presents a method of rehabilitation of a patient with total maxillectomy without a defect using zygomatic implants and temporization with implant-supported prosthesis using temporary metal cylinders.

Author: Rewa Kawade, Seema Sathe, Anjali Bhoyar, Bhushan Mundada, Neeraj Chachediya, Aditee Apte

Source: https://www.hindawi.com/journals/crid/2024/8193822/