15 August 2022

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Zygomatic implants and Full-Arch rehabilitations in severely atrophic jaws

Lara Figini

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Several techniques have been proposed to resolve the maxillary atrophy, as elevation of the maxillary sinus floor, surgical maxillary reconstruction with iliac crest, cortical plate expansion, osteotome sinus lifting, bone grafts, titanium meshes, or Le Fort I maxillary down fracture. Some of these treatment options need multiple surgical interventions, varying success rates and increased surgical fees. Brånemark, in 1989, initially developed the ZIs for the rehabilitation of atrophied maxillae in patients with tumors who had undergone total or partial maxillectomy. Currently, ZIs are indicated for dental rehabilitation of atrophic upper jaws. An implant with the following characteristics was initially designed: 45° head, 4.5-mm diameter at its widest part, and a length of 30 to 50 mm.
The implant follows an insertion path of the palatal aspect in the alveolar process, following the zygomatic alveolar crest until its anchorage in the malar body

Materials and Methods
In a systematic review, published on International Journal of Implant Dentistry, February 2021, the authors illustrated the results of treatment with zygomatic implants (ZI) in rehabilitations of the atrophic upper jaw.
Two reviewers carried out a bibliographic search using PubMed, as well as a manual search, according to a pre-established search strategy, taking into account the language and the study period, selecting any type of clinical trial and study that involved the insertion of zygomatic implants for the rehabilitation of atrophic jaws. The search was limited to the English language. Reviews of the literature and case reports were not considered.

Results
Forty-two articles published between March 2003 and April 2019 were included in this analysis. 1247 patients were evaluated in which 2919 ZI zygomatic implants were placed. Fifty-two ZIs were lost during the follow-up period. The survival rate of these zygomatic implants was found to be 98.22%, with a minimum follow-up of 1 month and a maximum of 228 months. Different types of surgery and different techniques have been adopted to place the ZI; however, the intrasinusal technique was found to be the most used (23 studies). Post-surgical sinusitis was the most common complication reported in the studies (39 cases).

Conclusions
From the results of this review, which need to be confirmed by other similar reviews, it can be concluded that ZI zygomatic implants are commonly used for the rehabilitation of patients with severely atrophic upper jaw, and show high survival rates. The surgical technique depends on the individual experience of the practitioner and the specific anatomy.

Clinical implications
Faced with severely atrophic and edentulous jaws, the specialist can rely on zygomatic implants for rehabilitation as they represent a predictable and reliable method. However, further studies on bone resorption, aesthetic outcomes and physiological characteristics are needed.

For additional information: Full arch rehabilitation in patients with atrophic upper jaws with zygomatic implants: a systematic review