36th Int’l Dental ConfEx CAD/CAM Digital & Oral Facial Aesthetics

Abstract

Traditionally, a severely resorbed maxilla would need multiple surgeries, including grafting to create sufficient bone for traditional dental implant placement. 

With increased costs, treatment time and patient morbidity due to extensive bone grafting procedures often required in full arch implant reconstruction of the atrophic maxilla increased patient resistance to implant treatment has been noted.

In severely resorbed cases, zygomatic implants have been an evidence-based surgical and prosthetic solution since 1999 and have significantly eliminated the need for bone grafting. 

Using zygomatic implants either on their own or in combination with pterygoid and/or conventional implants in an All-on-X fashion is a well-documented and evidence-based treatment option reducing treatment time, morbidity and cost. Furthermore, with good primary stability, these implants can be loaded immediately with SameDay teeth for immediate function. 

The original surgical technique for zygomatic implant placement used a palatal trans-sinus approach which often resulted in surgical( chronic sinusitis) & prosthodontic ( poor phonetics & oral hygiene) complications. The purpose of this presentation is to present significant improvements to the original technique in order to avoid surgical and prosthodontic complications thereby optimising zygomatic implant placement. 

These optimising changes are based on : 

• Patient-specific zygoma anatomy guided approach (ZAGA), to avoid sinus and prosthodontic complications
• Osseodensification to preserve bone for a conservative implant osteotomy 
• Osseodensification to maintain  sinus membrane integrity & prevent chronic sinusitis 
• Prosthodontically has driven implant osteotomy 
• Appropriate zygomatic implant design to avoid soft tissue recession 
• Appropriate soft tissue management to prevent soft tissue recession

Learning Objectives

• Identify patients who are candidates for zygomatic & pterygoid implants
• Classify midfacial atrophy according to the patient-specific Zygoma Anatomy Guided Approach (ZAGA)
• Identify the objectives of a conservative zygomatic implant osteotomy
• Recognise methods how to optimise implant treatment in the atrophic challenging maxilla 
• Avoid and manage implant complications

References

1. Aparicio C, Ouazzani W, Hatano N. The use of zygomatic implants for prosthetic rehabilitation of the severely resorved maxilla. Periodontology 2000 2008: 47; 162-171 
2. Aparicio C. Zygomatic implants: New surgery approach. J Clin Periodontol 2006:33, Supplement,(Second part):128. 
3. Aparicio et al. Extrasinus Zygomatic implants. Three Year Experience Clin Implant Dent Relat Res (E- pub Mar. 2008 ) 
4. Migliorança,et Al. Exteriorização de fixações zigomáticas em relação ao seio maxilar: uma nova abordagem cirúrgica. Implant News, 2006.
5. Davo R. Sinus reactions to Zygomatic Implants in: Zygomatic implants.. Carlos Aparicio (ed.) Quintessence pub. 2012 Stocchero M, Toia M, Cecchinato D, Becktor JP, Coelho PG, Jimbo R. Biomechanical, Biologic, and Clinical Outcomes of Undersized Implant Surgical Preparation: A Systematic Review. Int J Oral Maxillofac Implants. 2016 Nov/Dec.