Peri‐zygomatic infection associated with zygomatic implants: A retrospective longitudinal cohort study

Abstract

Objectives The main objective of this retrospective, longitudinal, cohort study was to describe the occurrence of peri‐zygomatic infection (PZI) as a complication associated with zygomatic implant (ZI) placement in a period of 22 years. Materials and methods A retrospective search was carried out in the department of oral and maxillofacial surgery of Saint John's hospital in Genk, Belgium. Patients that had a severely atrophic fully or partially edentulous maxilla, and at least one ZI placed, were included. Results A total of 302 eligible patients, underwent ZI surgery between 1998 and 2020. From a total of 940 ZI, 45 were associated with the development of PZI. PZI was located in the upper portion of the cheek in relation to the external corner of the eye, one or two centimeters under the lower lid. The total number of affected patients was 25 (8.3%), who had a mean age of 58.1 years. In this subset, PZI occurred in 15 cases on the right side, in eight cases on the left side, and in two cases bilaterally. Ultimately, 16 ZI were lost in the PZI site. The mean time since the implant placement to the diagnosis of PZI was 1.9 years (SD ±2.4) and to the ZI removal of 3.8 years (SD ±3.7). After implant removal, the PZI symptomatology dissipated in all patients. Conclusion Peri‐zygomatic infection should be informed to the patients as a possible complication after ZI placement. Once identified, it should be acknowledged as a risk factor for ZI failure.

Retrospective cohort assessment of survival and complications of zygomatic implants in atrophic maxillae

“…Figure 3 illustrates an overview of the number of implants placed and total complication events each year and Table 1 provides an overview of the ZI survival rate and its association with each complication. Amongst the infectious biological complications, sinusitis was the most commonly reported ( n = 138) occurring at a mean follow‐up time‐point of 4.5 years (range 0.04–19.37), followed by cheek soft tissue infection ( n = 72, 3.2 years, range 0.05–17.9), zygomatic region infection ( n = 39, 3.2 years, range 0.03–10.4), peri‐zygomatic infection ( n = 25, 1.9 years, range 0.01–10.4) (Vrielinck et al, 2022), oroantral communication ( n = 24, 5.3 years, range 0.1–19.4), gingival hyperplasia ( n = 24, 4.1 years, range 0.6–10.1), permanent intraoral dehiscence ( n = 16, 2.7 years, range 0.1–11.6), peri‐implantitis of the standard implant ( n = 11, 6 years, range 1.38–14.4), permanent oroantral communication ( n = 8, 2.2 years, range 0.4–3.9), orbital region infection ( n = 5, 3.4 years, range 1.7–5.6), and fracture of the zygomatic bone ( n = 2, 1.1 years, range 0.2–1.9).…”

“…A previous study found a positive association between zygomatic region infection and high torque force for achieving primary stability which could result in implant loss. Therefore, it is of vital importance that an equilibrium is achieved between sufficient primary stability and torque (Vrielinck et al, 2022). All these aforementioned factors are biological in nature with an infectious component which might get resolved following antibiotics administration.…”

“…Therefore, it is of vital importance that an equilibrium is achieved between sufficient primary stability and torque (Vrielinck et al, 2022).…”

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“…Purulent processes of the zygomatic and perizygomatic area are not common. Among etiologies are: otitis media, 1,2 complication of zygomatic implants placement, 3,4 osteomyelitis, 5 medicationrelated osteonecrosis of the jaw (MRONJ), "Krokodil" drug-related osteonecrosis, 6 and odontogenic infection 7,8 . The last one in the peri-zygomatic area can manifest in a form of sinus tract 7 , abscess 8 , and even phlegmon 8 .…”

Trans-sinus dental implants, for immediate placement when insufficient alveolar height is present: an alternative to zygomatic implants – surgical case series

“…There is less surgical morbidity and is similar to a standard lateral sinus approach 8 . Potential complications compared to zygomatic implants are reduced as is surgical trauma to the patient during surgery and during the postoperative period 9 , 10 . The implant platform can be positioned at the mesial portion of the first molar or at the second premolar depending on the A-P spread required for proper posterior support.…”