Three-Dimensional Guided Zygomatic Implant Placement after Maxillectomy

Abstract

Zygomatic implants are used in patients with maxillary defects to improve the retention and stability of obturator prostheses, thereby securing good oral function. Prosthetic-driven placement of zygomatic implants is even difficult for experienced surgeons, and with a free-hand approach, deviation from the preplanned implant positions is inevitable, thereby impeding immediate implant-retained obturation. A novel, digitalized workflow of surgical planning was used in 10 patients. Maxillectomy was performed with 3D-printed cutting, and drill guides were used for subsequent placement of zygomatic implants with immediate placement of implant-retained obturator prosthesis. The outcome parameters were the accuracy of implant positioning and the prosthetic fit of the obturator prosthesis in this one-stage procedure. Zygomatic implants (n = 28) were placed with good accuracy (mean deviation 1.73 ± 0.57 mm and 2.97 ± 1.38° 3D angle deviation), and in all cases, the obturator prosthesis fitted as pre-operatively planned. The 3D accuracy of the abutment positions was 1.58 ± 1.66 mm. The accuracy of the abutment position in the occlusal plane was 2.21 ± 1.33 mm, with a height accuracy of 1.32 ± 1.57 mm. This feasibility study shows that the application of these novel designed 3D-printed surgical guides results in predictable zygomatic implant placement and provides the possibility of immediate prosthetic rehabilitation in head and neck oncology patients after maxillectomy.

The Accuracy of Zygomatic Implant Placement Assisted by Dynamic Computer-Aided Surgery: A Systematic Review and Meta-Analysis

“…After removing duplicates ( n = 56), 51 articles were screened using title-abstract-keyword reading, leaving 35 reports eligible (substantial agreement, κ = 0.95). After full-text reading and a subsequent search for relevant citations, 14 studies were included in this systematic review [ 8 , 10 , 11 , 12 , 13 , 14 , 15 , 19 , 32 , 33 , 34 , 35 , 36 , 37 ] (100% of agreement among the reviewers) ( Figure 1 ). One current retrospective study from Wu included [ 19 ], and other fives studies from the same team (Shanghai Jiaotong University) were excluded due to the same population were collected in Wu’s publication [ 19 ].…”

“…In 2016, a modified surgical guide with double sleeves, designed to stabilize the long drill and to overcome the deviation, was introduced [ 9 ]. Later, studies focused on utilizing this modified guide concept to assist in ZI placement with increased intra-operative safety and accuracy [ 10 , 11 , 12 , 13 , 14 , 15 ]. Gecchi et al demonstrated that the accuracy of ZI placement with a modified surgical guide was superior to the free-hand approach, particularly at the level of the zygomatic bone [ 10 ].…”

“…Gecchi et al demonstrated that the accuracy of ZI placement with a modified surgical guide was superior to the free-hand approach, particularly at the level of the zygomatic bone [ 10 ]. Vosselman et al successfully used a revised 3D-printed guide to assist in ZI placement in the patient with unilateral maxillary defect [ 13 ].…”

Application of 3D printing technology in tumor diagnosis and treatment

“…Second, an accurate cutting of the tumor is realized under the guidance of the 3D printed cutting guide plate [124]. Vosselman et al [125] performed a maxillectomy using the 3D printed surgical guide plate, achieving a precise placement of the zygomatic implant (figures 6(a)-(c)). The degree of accuracy of the placement is high (average deviation is 1.73 ± 0.57 mm and 3D angle deviation is 2.97 ± 1.38 • ).…”

Reply to Letter to the Editor regarding “Zygomatic implant perforated (ZIP) flap technique: A milestone in rehabilitation of low‐level maxillectomy”

“…We have never used or wished to use computerized guides to place zygomatic implants in these patients for a variety of reasons. We do however recognize the difficulty of placing these implants for new users who may well benefit from employing this technology if available and are aware of units who adopt this approach 3 . In addition, there is a two‐day hands‐on training course specifically focused on the techniques required.…”