Search Results (19)

Background/Objectives: Severe jawbone atrophy, particularly in elderly or medically compromised patients, presents a significant challenge for conventional implant placement. In cases where bone augmentation is not feasible, alternative techniques—such as short, narrow, tilted, and zygomatic implants—may be indicated for the rehabilitation of the atrophic jaw. Subperiosteal implants have re-emerged as a further viable alternative, especially with recent advancements in digital planning and custom fabrication. This study aims to evaluate the clinical outcomes and complications associated with subperiosteal implants through a literature review and a supporting case series, and to propose clinical preliminary guidelines for their use. Methods: Fourteen studies—including case reports, case series, retrospective studies, and systematic reviews—were analyzed to assess the effectiveness and risk profile of subperiosteal implants. Additionally, we present a case series of nine patients with advanced vertical and horizontal alveolar bone atrophy treated using custom-made, digitally-designed subperiosteal implants. Surgical techniques, prosthetic workflows, and complications were recorded and assessed. Results: Subperiosteal implants were found to be particularly suitable for patients with narrow alveolar crests and severe atrophy where traditional implants are contraindicated. Literature and case series data indicated favorable outcomes, with early complications such as soft tissue inflammation and prosthetic misfit being manageable. A low complication rate was recorded in our series, with digital workflows contributing to improved implant fit and reduced technical errors. Conclusions: Subperiosteal implants could offer an effective solution for complex atrophic cases, provided that patient selection, surgical precision, and prosthetic design are meticulously managed. Based on our findings, clinical recommendations are proposed to guide their application in contemporary practice. Full article

Background/Objectives: The satisfaction of patients following maxillary full-arch rehabilitation is crucial in assessing treatment effectiveness. This one-year study evaluated patients’ satisfaction, quality of life, and aesthetic perception after receiving the Maxilla-for-All^®/All-On-X treatments, which combine standard, pterygoid, trans-sinus, and zygomatic implants to support a fixed prosthesis and offer a graftless solution that reduces morbidity and treatment time. Methods: A prospective cohort study using convenience sampling of subjects treated for severe maxillary atrophies was conducted on patients receiving immediate implant-supported full-arch fixed prostheses. The Oral Health Impact Profile (OHIP-14) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ-23) were administered preoperatively and one year post-treatment. Patients were grouped based on the presence or absence of complications (surgical, technical, and mechanical) and Wilcoxon tests were used for comparison (significance level = 0.05). Results: A total of 56 patients (29 female, 27 male) participated, with no implant or prosthesis failures. Eleven patients reported unilateral sinus membrane perforation, and seven had technical or mechanical complications. Preoperatively, 69% of patients rated their oral condition as unfavorable according to the OHIP-14; this dropped significantly to 21.8% post-treatment (p-value < 0.0001). After one year, the average PIDAQ-23 score improved significantly from 44.7 ± 16.6 to 6.8 ± 5.3 (p-value < 0.0001). No significant differences were observed between patients with or without complications (p-values ranging from 0.5270 to 0.8920). Conclusions: Full-arch rehabilitation using Maxilla-for-All^®/All-On-X treatments significantly improved both aesthetic perception and chewing function in patients with severe maxillary atrophies. They reported a substantial reduction in oral health-related discomfort, as shown by a significant decrease in OHIP-14 scores one year post-treatment. Clinical or technical complications did not significantly impact patients’ quality-of-life outcomes or satisfaction, supporting the reliability of this treatment protocol. Full article

Background/Objectives: Severe maxillary atrophy presents challenges in maxillofacial rehabilitation. This study compares the clinical outcomes of zygomatic and subperiosteal implants, focusing on implant survival, soft tissue management, and postoperative complications over a five-year follow-up. Methods: A retrospective cohort study analyzed 150 patients divided into two groups based on the type of implant. Zygomatic implants were assessed for immediate functional loading, procedural efficiency, and complications such as sinus-related issues and orbital damage. Subperiosteal implants were evaluated for their customized design, keratinized mucosa integration, and adaptation to severe anatomical limitations. Statistical analyses, including Chi-square tests, were used to determine significant differences (p < 0.05). Results: This study demonstrated differences in complication rates (sinus-related complications: 12.4% for zygomatic implants; peri-implantitis: 5.6% for subperiosteal implants). Implant survival rates were comparable (zygomatic: 96.3%, subperiosteal: 97.1%, p = 0.278). Zygomatic implants demonstrated higher incidences of sinus-related complications (12.4%) and risks of orbital damage. Subperiosteal implants exhibited superior soft tissue stability with fewer cases of peri-implantitis (5.6%, p < 0.05). Procedural duration was shorter for zygomatic implants (177 min vs. 123 min); however, subperiosteal implants allowed for re-implantation after failure, providing flexibility that was unavailable with zygomatic implants. Conclusions: Zygomatic implants excel in immediate functional loading and reduced procedural time but require advanced surgical expertise to mitigate anatomical risks. Subperiosteal implants offer a safer, customizable solution, particularly in anatomically complex cases. These findings emphasize the importance of individualized treatment planning and technological advancements in implant design to optimize clinical outcomes for patients with severe maxillary atrophy. Full article

Background: The malar bone provides an anchorage point for zygomatic implants, avoiding invasive reconstructive surgeries in the fixed rehabilitation of fully edentulous and severely atrophic maxillae. The limited bone volume, however, requires precise implant placement to prevent complications related to nearby anatomical structures. This observational cross-sectional study aims to measure the malar and zygomatic arch bones and their distances from critical anatomical landmarks to guide surgeons in safe zygomatic implant placement. Methods: Dissections were performed bilaterally on 29 heads from human donated bodies in a cross-sectional observational study. Key landmarks evaluated include the infraorbital foramen (IF), pyriform nasal aperture (PNA), infraorbital margin (IM), zygomaticofacial foramen (ZFF), anterior end (A), and the most protruding point of the zygomatic arch (B). Measurements included IF-PNA, IF-IM, IF-ZFF, ZFF-IM, A-B, and orbital floor depth (OFD). Results: Significant findings showed IF-PNA was greater in males (18.66 ± 2.63 mm, p = 0.001), and IF-ZFF varied between sides (26.72 ± 8.7 mm, p = 0.002). ZFF-IM was larger in males (7.43 ± 2.09 mm, p < 0.001). Heights and thicknesses were also assessed, with significant side differences observed. Conclusions: These findings underscore the importance of understanding precise anatomical distances for successful implant placement. The study provides essential data to enhance surgical planning and training, ensuring safer procedures and minimizing the risk of complications. Full article

Background/Objectives: There is a need for alternative approaches to full-arch rehabilitation of atrophic maxillae. The aim of this short case series was to describe the technique and assess the short term-outcomes of atrophic maxillae rehabilitation using transnasal implants in conjunction with zygomatic implants. Methods: Three female patients (average age: 62 years) presenting comorbidities and atrophic maxillae preventing the insertion of standard maxillary anchored implants received a full-arch fixed prosthesis supported by transnasal implants together with zygomatic implants, using the ad modum all-on-4 concept. Patients were followed during the functional osseointegration period. Primary outcome measures were prosthetic and implant survival based on function. Secondary outcome measures were complication parameters (biological and mechanical), plaque and bleeding levels, and probing pocket depths > 4 mm. Results: No implant failures were registered, and all prostheses remained in function. The only complication was a fracture of a provisional crown that was resolved. Plaque and bleeding scores were mild during the follow-up period. Conclusions: The present manuscript describes the use of extra-long transnasal implants in combination with zygomatic implants in immediate function for full-arch fixed prosthetic rehabilitation of atrophic maxillae, with the objective of promoting more research into this relatively recent technique. More studies are needed to validate the technique. Full article

Hemifacial Microsomia (HFM) is the second most common congenital craniofacial malformation syndrome, and the complexity of HFM makes its treatment challenging. The present study aimed to introduce a new approach of utilization of virtual surgical planning (VSP) and 3D-printed surgical adjuncts for maxillofacial reconstruction. Five HFM patients were included in this study. All participants were provided with a full VSP, including the design of osteotomy lines, the design and fabrication of 3D-printed cutting guides, fixation plates, and titanium mesh for implantation. With the assistance of 3D-printed cutting guides and fixation plates, the orbital deformities were corrected, and a 3D-printed titanium mesh combined with iliac cancellous bone graft was applied to reconstruct the zygomatic arch. The surgical accuracy, effectiveness, and bone absorption rate were evaluated. All patients completed the entirely digital treatment process without experiencing severe complications. The surgical adjuncts were effective in aligning the movement of the bone segments with the surgical plan, resulting in mean 3D deviations (1.0681 ± 0.15 mm) and maximum 3D deviations (3.1127 ± 0.44 mm). The image fusion results showed that the patients’ postoperative position of the maxilla, zygoma, and orbital rim was consistent with the virtual surgical plan, with only a slight increase in the area of bone grafting. The postoperative measurements showed significant improvement in the asymmetry indices of Er (AI of Er: from 17.91 ± 3.732 to 5.427 ± 1.389 mm, p = 0.0001) and FZ (AI of FZ: from 7.581 ± 1.435 to 4.070 ± 1.028 mm, p = 0.0009) points. In addition, the observed bone resorption rate at the 6-month follow-up across the five patients was 45.24% ± 3.13%. In conclusion, the application of VSP and 3D-printed surgical adjuncts demonstrates significant value in enhancing the precision and effectiveness of surgical treatments for HFM. A 3D-printed titanium mesh combined with iliac cancellous bone graft can be considered an ideal alternative for the reconstruction of the zygomatic arch. Full article

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. Full article

Purpose: The present systematic review aimed to investigate the accuracy of zygomatic implant (ZI) placement using dynamic computer-aided surgery (d-CAIS), static computer-aided surgery (s-CAIS), and a free-hand approach in patients with severe atrophic edentulous maxilla and/or deficient maxilla. Methods: Electronic and manual literature searches until May 2023 were performed in the PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases. Clinical trials and cadaver studies were selected. The primary outcome was planned/placed deviation. Secondary outcomes were to evaluate the survival of ZI and surgical complications. Random-effects meta-analyses were conducted and meta-regression was utilized to compare fiducial registration amounts for d-CAIS and the different designs of s-CAIS. Results: A total of 14 studies with 511 ZIs were included (Nobel Biocare: 274, Southern Implant: 42, SIN Implant: 16, non-mentioned: 179). The pooled mean ZI deviations from the d-CAIS group were 1.81 mm (95% CI: 1.34–2.29) at the entry point and 2.95 mm (95% CI: 1.66–4.24) at the apex point, and angular deviations were 3.49 degrees (95% CI: 2.04–4.93). The pooled mean ZI deviations from the s-CAIS group were 1.19 mm (95% CI: 0.83–1.54) at the entry point and 1.80 mm (95% CI: 1.10–2.50) at the apex point, and angular deviations were 2.15 degrees (95% CI: 1.43–2.88). The pooled mean ZI deviations from the free-hand group were 2.04 mm (95% CI: 1.69–2.39) at the entry point and 3.23 mm (95% CI: 2.34–4.12) at the apex point, and angular deviations were 4.92 degrees (95% CI: 3.86–5.98). There was strong evidence of differences in the average entry, apex, and angular deviation between the navigation, surgical guide, and free-hand groups (p < 0.01). A significant inverse correlation was observed between the number of fiducial screws and the planned/placed deviation regarding entry, apex, and angular measurements. Conclusion: Using d-CAIS and modified s-CAIS for ZI surgery has shown clinically acceptable outcomes regarding average entry, apex, and angular deviations. The maximal deviation values were predominantly observed in the conventional s-CAIS. Surgeons should be mindful of potential deviations and complications regardless of the decision making in different guide approaches. Full article

The repair and reconstruction of defects in the craniomaxillofacial region can be particularly challenging due to the complex anatomy, individuality of each defect, and sensitivity of the involved systems. This study aims to enhance the facial appearance and contribute to the reconstruction of the zygomatic arch. This was achieved through virtual planning of the surgery and assessment of clinical matching, including orbital measurements and registration of numerical models. A three-dimensional design of a young female case was generated on a skull model using Mimics^® software, and the orbit was isolated using 3-Matic^® to assess the reconstructive effect. 3D-printed implants were then surgically placed on the injured region, and Netfabb^® software was used to make a virtual registration between the numerical models before and after the intervention. This allowed for the calculation of a deviation of 7 mm, equivalent to 86.23% of the shape restoration rate, to assess the success of the surgery. The computerized method enabled a precise design of the needed plates and analysis of the fixation places, resulting in a satisfactory cosmetic and functional outcome for the patient with minimal complications and good implant stability. Notably, a significant difference was observed in the orbital frontal area after 3 months of surgery (p < 0.001). Within the limitations of the study, these results suggest that virtual planning and customized titanium implants can serve as useful tools in the management of complex zygomatic-orbital injuries. Full article

The oral rehabilitation of MRONJ patients represents a challenging situation. Conventional dental implant insertion is not indicated because of the risk of creating a new necrotic area. This case study describes the oral rehabilitation of a 78-year-old female patient, who developed an osteonecrotic lesion in the fourth year of bisphosphonate treatment. The patient underwent a series of surgeries, including resection of the necrotic tissue on the right maxillary region and removal of conventional implants. The patient had a large maxillary defect, and no other treatment modalities such as conventional prosthetic appliances and traditional dental implant insertions were applicable. The patient had a very poor quality of life and as a rehabilitation option, two zygomatic implant insertions were planned and performed as an anchorage for maxillary fixed prosthesis. Radiographic and clinical examination after three years of follow-up indicated that healing was achieved, and healthy tissues formed around zygomatic implants. The patient did not suffer from any additional necrotic tissues or other complications in the oral cavity. According to the results of this case report, zygomatic implantation after resective surgery might be considered as a promising alternative for MRONJ patients with large defects when other treatment alternatives fail or are not applicable. Full article

Zygomatic implants imply the use of the zygoma as the implant anchorage and have been proposed as a valuable alternative to the invasive classical procedures in cases of severe maxillary atrophy. Despite the numerous manuscripts published in this field, a quantitative analysis of the research products to infer the trends and the status identification of this specific issue was missing, as well as an objective map of this area. Thus, the present scientometric study analyzed all the research papers published within the interval 1990–2021 that included the keyword “zygomatic implants”. Research papers containing the keywords “zygomatic implants” were collected using Web of Science and analyzed with Cytoscape 3.7.2 and Sci software. A total of 654 studies were published between 1990 and 2020, reaching up to 11639 citations in total, with a mean of 17.8 citations per research study. Data show that the number of publications per year is rapidly increasing, as well as the sum of citations per year. While the USA was identified as the most productive country in this field, followed by Italy, Spain, and Brazil, the National Natural Science Foundation of China stands up as the major funding agency, followed by the National Institutes of Health (NIH) in the USA and the United States Department of Health and Human Services. The analysis of the keywords showed that “zygomatic fractures” represents the most common word within this field, with “complications” as the most recent keyword and “screws” as the keyword used for the longest time. The map of science representing the authors and their collaborations highlighted the existence of multiple small-size research groups that contribute to scientific production, forming highly clustered structures that do not collaborate between them. The present scientometric analysis demonstrates the rising interest in using the zygomatic implants technique as an alternative to the classical ones. The obtained data suggest that the scientific community involved in the study of such a field is highly fragmented, emphasizing the lack of communication among the scientists and research groups. Full article

Zygomatic implants are a treatment solution for patients with severe maxillary atrophy. This treatment option allows delivering immediate fixed teeth within 24 h. Numerous peer-reviewed publications have reported different success rates, resulting in a disagreement on the topic. Therefore, the overall efficacy and predictability of this rehabilitation is still a matter of discussion. With this study, we aimed to identify the published literature on the use of zygomatic implants for the reconstruction of the severely atrophic maxilla and report the cumulative success rate (CSR) as a function of follow-up time. A systematic review of the literature on zygomatic implant for the treatment of severe maxillary atrophy was performed and 196 publications were included in the study. The cumulative success rate of zygomatic implants for the treatment of severe maxillary atrophy was 98.5% at less than 1 year, 97.5% between 1 and 3 years, 96.8% between 3 and 5 years and 96.1% after more than 5 years. The most commonly reported complications were soft tissue dehiscence, rhinosinusitis and prosthetic failures. The treatment of severe lack of bone in the upper maxilla with zygomatic implants is a safe procedure, reaching a cumulative success rate of 96.1% after more than 5 years. Full article

Aims: The aim of this review is to consider maxillary sinusitis as a complication of zygomatic implants placements. Maxillary sinusitis a common complication but in the literature there are no reviews that focus only on this condition and its possible treatment. This review was carried out with to highlight the main findings of the literature on this topic and to improve knowledge in this field. Methods: The search strategy resulted in 155 papers. After selection of the inclusion criteria only 11 papers were examined. From the papers these, 12.3% patients presented maxillary sinusitis but only four studies evaluated sinusitis (both clinical and radiological evaluation). The most common treatment used by the authors were antibiotics alone or combined with functional endoscopic sinus surgery (FESS). Results: The literature shows an absence of precise and shared guidelines diagnosis and post-operative follow-up, and of the treatment of maxillary sinusitis following zygomatic implantology. It has not been determined if the surgical placement of ZIs is better than the other techniques for treatment of the onset of maxillary sinusitis in the post-operative period. Conclusion: To date there are no shared protocols for maxillary sinusitis treatment. In our experience, and according to the literature in the presence of risk factors such as age, comorbidities, smoking, nasal septal deviation or other anatomical variants, we suggested that FESS is performed at the same time as placement of zygomatic implants. Full article

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 at three private clinics were collected and retrospectively analyzed. For each implant, the following data were collected: implant length, insertion path, ridge atrophy and sinus characteristics (width, pneumatization, thickness of mucosae, patency of sinus ostium). General patient characteristics and health status data were also recorded. The outcomes evaluated were implant failure, infective complications, early neurologic complications and overall complications. Results: A total of 33 patients (14 men, 17 women, mean age 59.1) that received 67 zygomatic implants were included in the study. The mean duration of the follow-up was of 141.6 months (min 109; max 198). In this period, a total of 16 (23.88%) implants in 8 (24.24%) patients were removed and 17 (51.51%) patients with 36 (53.73%) implants reported complications. Immediate loading resulted in a significantly lower risk of complications compared with the two-stage prosthetic rehabilitation (OR: 0.04, p = 0.002). A thickness of the sinus mucosa > 3 mm emerged to be correlated with a greater occurrence of infective complications (OR: 3.39, p = 0.019). Severe and extreme pneumatization of the sinus was significantly correlated with the incidence of overall complications (p = 0.037) and implant failure (p = 0.044). A large sinus width was predisposed to a higher risk of neurologic complications, infective complications and implant failure (p = 0.036, p = 0.032, p = 0.04, respectively). Conclusions: zygomatic implants are an alternative procedure for atrophic ridge rehabilitation when a conventional implant placement is not possible. Several clinical and anatomical factors can have a significant role in complication occurrence. Full article

The use of new devices for the rehabilitation of the severely atrophic maxillae needs validation. We aimed to report the short-term outcome of severely atrophic jaws rehabilitated with zygomatic implants with no implant head angulation placed extramaxillary in conjunction with standard implants. Forty-four patients were consecutively included with 77 zygomatic implants (31 abutments of 45 degrees and 46 abutments of 60 degrees) and 115 standard implants. Outcome measures were prosthetic survival, implant/abutment success, complications, modified plaque index (mPLI), modified bleeding index (mBI), mucosal seal efficacy evaluation (MSEE) >4 mm, and Zygomatic implants classification level (ZICL). Two patients (4.5%) were lost to follow-up. No prosthesis was lost; one patient lost one zygomatic implant; two angulated abutments of 60 degrees needed to be replaced in one patient due to an aesthetic complaint; rendering a cumulative success rate at 2-years of 95.3% and 95.9% using patient and implant/abutment as unit of analysis, respectively. Mechanical and biological complications occurred in 13 and six patients, respectively; all resolved. The median mPLI and mBI was 1; MSEE > 4 mm occurred in 17% and 21% of patients at 1- and 2-years, respectively; ZICL1 was registered in 80% of patients. The current protocol enabled good short-term outcomes. Full article