Evaluation of surgical techniques in survival rate and complications of zygomatic implants for the rehabilitation of the atrophic edentulous maxilla: a systematic review

Abstract

Purpose To assess the outcome [zygomatic implant (ZI) survival] and complications of the original surgical technique (OST) and an Anatomy-Guided approach (AGA) in the placement of ZI in patients with severely atrophic maxillae. Methods Two independent reviewers conducted an electronic literature search from January 2000 to August 2022. The inclusion criteria were articles reporting at least five patients with severely atrophic edentulous maxilla undergoing placement OST and/or AGA, with a minimum of 6 months of follow-up. Number of patients, defect characteristics, number of ZI, implant details, surgical technique, survival rate, loading protocol, prosthetic rehabilitation, complications, and follow-up period were compared. Results Twenty-four studies comprised 2194 ZI in 918 patients with 41 failures. The ZI survival rate was 90.3–100% in OST and 90.4–100% in AGA. Probability of complications with ZI with OST was as follows: sinusitis, 9.53%; soft tissue infection, 7.50%; paresthesia, 10.78%; oroantral fistulas, 4.58%; and direct surgical complication, 6.91%. With AGA, the presenting complications were as follows: sinusitis, 4.39%; soft tissue infection, 4.35%; paresthesia, 0.55%; oroantral fistulas, 1.71%; and direct surgical complication, 1.60%. The prevalence of immediate loading protocol was 22.3% in OST and 89.6% in the AGA. Due to the heterogeneity of studies, statistical comparison was only possible after the descriptive analysis. Conclusions Based on the current systematic review, placing ZI in severely atrophic edentulous maxillae rehabilitation with the OST and AGA is associated with a high implant survival rate and surgical complications within a minimum of 6 months follow-up. Complications, including sinusitis and soft tissue infection around the implant, are the most common. The utilization of immediate loading protocol is more observed in AGA than in OST. Graphical Abstract

Bone reconstruction of extensive maxillomandibular defects in adults

“…As a result, 52 zygomatic implants were reported with a success rate of 96% and a follow‐up period of more than 5 years 200 . Since then, various modifications in materials and techniques have been described, also leading to a safe and reliable treatment option for patients with an atrophic upper jaw 201–203 . Overall, current reviews indicate cumulative survival rates for zygomatic implants of more than 95% with follow‐up periods of more than 5 years 203–206 .…”

“…Since then, various modifications in materials and techniques have been described, also leading to a safe and reliable treatment option for patients with an atrophic upper jaw 201–203 . Overall, current reviews indicate cumulative survival rates for zygomatic implants of more than 95% with follow‐up periods of more than 5 years 203–206 . Patients rehabilitated with zygomatic implant‐supported prosthetic superstructures report significant improvements in oral quality of life and overall satisfaction (Figure 12).…”

“…[201][202][203] Overall, current reviews indicate cumulative survival rates for zygomatic implants of more than 95% with follow-up periods of more than 5 years. [203][204][205][206] Patients rehabilitated with zygomatic implant-supported prosthetic superstructures report significant improvements in oral quality of life and overall satisfaction (Figure 12). 207 Compared with traditional implant treatment of the atrophic maxilla, the most notable advantage of augmentation-free zygomatic implant placement is immediate loading to restore the patient's oral function and esthetics after surgery.…”

Treatment of Severely Atrophic Maxilla by Using Zygomatic, Pterygoid, and Transnasal Implants

“…Dental implant placement is difficult in the severely resorbed maxilla for a variety of reasons. Bone volume decreases due to advanced periodontal diseases, excessive pneumatization of the sinus and there is usually not enough bone to place conventional implants 1 …”

“…Advanced surgical procedures have disadvantages such as long treatment duration, major surgery, the risk of morbidity in the donor area, and high treatment costs. In recent years, implants that are anchored from anatomic structures adjacent to the maxilla have been used to prevent these disadvantages 1 …”