Abstract:Background: Zygomatic implants have been introduced to rehabilitate edentulous patients with severely atrophic maxillae. Their use has been reported by several studies, describing high overall survival rates at medium–long follow-up. The aim of this study was to retrospectively analyze if a few patient-related and implant-related features are correlated with implant success or the onset of complications. Materials and methods: Data of patients treated with zygomatic implants between May 2005 and November 2012 … Show more
Purpose
The purpose of this study was to perform a systematic review with meta-analysis on the long-term survival rates of zygomatic implants (ZI). ZI success, prostheses survival and success, sinus pathology and patient reported outcomes were also investigated.
Methods
Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed. Embase and OvidMedline databases were searched alongside the grey literature. The systematic review was recorded in PROSPERO (CRD42022358024). Studies reporting titanium/titanium alloy ZI survival data, ZI-supported prosthesis data, ZIs directly compared to any other implant therapy including grafted sites, a minimum follow-up time of 3 years and a minimum number of 10 patients were included. All study designs were considered if they met the inclusion criteria. Studies not involving ZIs, ZIs not made from titanium/titanium alloy, a follow-up time of < 3 years or < 10 patients, animal studies and in vitro studies were excluded. Long-term follow-up has not been defined in the literature. A minimum of 3 years follow-up was considered acceptable to capture survival after initial healing, alongside in-function prosthesis data via delayed or immediate load protocols. ZI success, was predominantly defined as ZI survival without biological or neurological complications. Meta-analyses were performed for ZI survival, ZI failure incidence, ZI success, loading protocol, prosthesis survival, and prevalence of sinusitis using random effects models. Descriptive analysis was used for ZI success, prosthesis success and patient reported outcome measures.
Results
Five hundred and seventy-four titles were identified, of which 18 met the inclusion criteria. Eligible studies included 1349 ZIs in 623 patients. Mean follow-up period was 75.4 months (range 36–141.6). The mean survival of ZIs was 96.2% [95% CI: 93.8; 97.7] at 6 years. Mean survival for delayed loading was 95% [95% CI: 91.7; 97.1] and 98.1% [95% CI: 96.2; 99.0] for immediate loading (p = 0.03). Annual incidence rate of ZI failure was 0.7% [95% CI 0.4; 1.0]. Mean ZI success was 95.7% [95% CI 87.8; 98.6]. Mean prosthesis survival was 94% [95% CI 88.6; 96.9]. Sinusitis prevalence was 14.2% [95% CI 8.8; 22.0] at 5 years. Patients’ reported increased satisfaction with ZIs.
Conclusions
ZIs have long-term survival comparable to conventional implants. Immediate loading showed a statistically significant increase in survival over delayed loading. Prosthesis survival was similar to that of prostheses supported by conventional implants, with similar complications. Sinusitis was the most frequently encountered biological complication. Patients reported improved outcome measures with ZI use.
Graphical Abstract
Purpose
The purpose of this study was to perform a systematic review with meta-analysis on the long-term survival rates of zygomatic implants (ZI). ZI success, prostheses survival and success, sinus pathology and patient reported outcomes were also investigated.
Methods
Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed. Embase and OvidMedline databases were searched alongside the grey literature. The systematic review was recorded in PROSPERO (CRD42022358024). Studies reporting titanium/titanium alloy ZI survival data, ZI-supported prosthesis data, ZIs directly compared to any other implant therapy including grafted sites, a minimum follow-up time of 3 years and a minimum number of 10 patients were included. All study designs were considered if they met the inclusion criteria. Studies not involving ZIs, ZIs not made from titanium/titanium alloy, a follow-up time of < 3 years or < 10 patients, animal studies and in vitro studies were excluded. Long-term follow-up has not been defined in the literature. A minimum of 3 years follow-up was considered acceptable to capture survival after initial healing, alongside in-function prosthesis data via delayed or immediate load protocols. ZI success, was predominantly defined as ZI survival without biological or neurological complications. Meta-analyses were performed for ZI survival, ZI failure incidence, ZI success, loading protocol, prosthesis survival, and prevalence of sinusitis using random effects models. Descriptive analysis was used for ZI success, prosthesis success and patient reported outcome measures.
Results
Five hundred and seventy-four titles were identified, of which 18 met the inclusion criteria. Eligible studies included 1349 ZIs in 623 patients. Mean follow-up period was 75.4 months (range 36–141.6). The mean survival of ZIs was 96.2% [95% CI: 93.8; 97.7] at 6 years. Mean survival for delayed loading was 95% [95% CI: 91.7; 97.1] and 98.1% [95% CI: 96.2; 99.0] for immediate loading (p = 0.03). Annual incidence rate of ZI failure was 0.7% [95% CI 0.4; 1.0]. Mean ZI success was 95.7% [95% CI 87.8; 98.6]. Mean prosthesis survival was 94% [95% CI 88.6; 96.9]. Sinusitis prevalence was 14.2% [95% CI 8.8; 22.0] at 5 years. Patients’ reported increased satisfaction with ZIs.
Conclusions
ZIs have long-term survival comparable to conventional implants. Immediate loading showed a statistically significant increase in survival over delayed loading. Prosthesis survival was similar to that of prostheses supported by conventional implants, with similar complications. Sinusitis was the most frequently encountered biological complication. Patients reported improved outcome measures with ZI use.
Graphical Abstract
“…Even if dental implants may significantly contribute to restore an adequate overall functionality, fixtures of standard dimensions cannot be used in most of the abovementioned cases, for lack of sufficient bone levels [ 2 ]. Several options have been developed over the years to correct deficient edentulous ridges, including short or reduced diameter dental implants [ 3 , 4 ]; tilted dental implants [ 5 ]; zygoma implants [ 6 ]; bone splitting/expansion of narrow ridges [ 7 ]; alveolar distraction osteogenesis [ 8 ]; guided bone regeneration [ 9 ]; and Le Fort I osteotomy with inter-positional bone grafts [ 2 , 10 ] (in cases of large sagittal discrepancy between the jaws and when implant inclination is too unfavorable). In this proposal, one of the most frequently employed procedures is represented by the reconstruction of alveolar defects with autogenous bone grafts, harvested from intraoral or extraoral sites: this modality of treatment was found to be a reliable means to correct both moderate and severe alveolar bone deficiencies of partially or totally edentulous patients [ 11 , 12 ].…”
Objectives
Up-to-date literature regarding long-term success of implant rehabilitations after microvascular reconstructions with free fibula flap (FFF) is still very scarce. This study aimed to evaluate clinical outcomes, especially related to oral hygiene conditions, of patients rehabilitated with this technique.
Materials and methods
A total of 25 patients who underwent maxillofacial reconstructive surgery with FFF were retrospectively evaluated for soft tissues conditions, oral hygiene habits, and implant survival and success, assessed with a mean follow-up of 6 (range 2–15) years after loading.
Results
Fourteen patients received full-arch fixed prostheses and 11 removable bar-supported overdentures. At the follow-up evaluation, 52% of prostheses did not allow proper accessibility for oral hygiene. Overall prosthetic survival was 100%, and implant survival and success were respectively 93.6% and 72%. Prevalence of peri-implantitis was 29% at implant level and that at patient level 96%.
Conclusions
Six-year clinical outcomes of this study reveal that poor oral hygiene practices and compliance by patients who underwent maxillofacial reconstruction with FFF are significantly associated with peri-implant disease.
Clinical relevance
Findings of the present study underline the need by clinicians for a careful assessment, in reference to a specific implant therapy, of patient’s prosthetic accessibility for oral hygiene procedures.
“…Zygomatic implants have demonstrated their effectiveness as a viable solution in addressing the challenges of managing atrophic edentulous maxilla [3][4][5][6] and maxillectomy defects [7]. Brånemark introduced these implants to cater to patients requiring prosthetic rehabilitation due to extensive maxillary defects resulting from tumor resections, trauma, and congenital issues [8].…”
Zygomatic implants are used for the rehabilitation of the upper jaw of patients with severe and moderate bone atrophy. Possible post-surgical complications include soft tissue dehiscence, sinusitis, and prosthodontic fractures, and maintaining an accurate control is crucial. Additionally, zygomatic implants have a unique peri-implant anatomy, making traditional periodontal parameters unsuitable. The present paper aims to provide guidelines for the maintenance and interception of complications in patients rehabilitated with these kinds of implants. The proposed protocol includes: 1. intra/extraoral and temporo-mandibular joint examination; 2. soft tissue and transmucosal path observation with magnifiers; 3. peri-implant health indices and digital stimulation of tissues; 4. examination of prosthodontic devices; and 5. photographic recording. These steps facilitate the comprehensive evaluation and monitoring of clinical conditions of zygomatic-supported rehabilitations, including dehiscence and occlusal wear during follow-up appointments.
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