Search Results (67)

Background and Objectives: Zygomatic implants have progressively become a widely adopted graft-free treatment option for the rehabilitation of severe maxillary atrophy. However, the expansion of their clinical indications has generated debate regarding patient selection, treatment hierarchy, and potential overtreatment. This review aimed to critically analyze current evidence regarding the use of zygomatic implants in the rehabilitation of the atrophic maxilla. Methods: A comprehensive narrative review of the literature was conducted through searches of PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. Relevant clinical studies, systematic and narrative reviews, and consensus statements published in English up to 27 March 2026 were critically analyzed to provide a comprehensive narrative synthesis focusing on treatment indications, surgical protocols, complications, patient-reported outcomes, and evidence gaps. Results: The reviewed literature consistently reported high implant survival rates and highlighted the role of zygomatic implants in reducing the need for extensive grafting procedures in selected patients with severe maxillary atrophy. The most frequently reported complications included sinus-related disorders, soft-tissue complications, prosthetic problems, and challenges associated with the management of implant failure. Different surgical approaches, including intra-sinus, sinus-slot, and extra-sinus techniques, were described. However, substantial heterogeneity emerged regarding treatment algorithms, complication reporting, success criteria, and patient-reported outcome assessment. Conclusions: Zygomatic implants represent an established treatment option associated with high reported implant survival in selected patients with severe maxillary atrophy, particularly when conventional implant placement would require extensive reconstructive procedures. However, in borderline clinical situations characterized by partial residual bone availability, treatment planning should also consider less invasive alternatives, including short implants, tilted implants, regenerative procedures, or customized subperiosteal implants, according to individual anatomical, prosthetic, and patient-related factors. Greater standardization of indications, complication reporting, and patient-reported outcome assessment is needed to better define the role of zygomatic implants within evidence-based treatment planning for the atrophic maxilla. Full article

Background: The rehabilitation of patients who have undergone extensive maxillectomy for neoplastic lesions is a significant clinical challenge. The resulting anatomical and functional defects severely impact quality of life, and traditional removable prostheses often lack stability. Zygomatic implants offer a viable solution by providing stable anchorage in the zygomatic bone, bypassing the need for bone reconstruction. Methods: This case report details the rehabilitation of a 62-year-old female patient with a history of recurrent oral squamous cell carcinoma. A fully digital workflow, including CBCT and CAD/CAM technology, was used for meticulous surgical and prosthetic planning. The surgical procedure involved a guided maxillectomy, a free forearm flap reconstruction, and the simultaneous placement of two zygomatic implants and one conventional implant. The procedure was done with EZGOMA guided surgery, which, starting from the EZPLAN software design of zygomatic and traditional implants, allowed us to determine the implant’s position in the three-dimensional axes and also the position of the internal hexagon. This allowed us to design the implant beneath the diagnostic wax-up in the three axes, and also to calculate the degrees of inclination of the multi-unit abutment. Results: All implants achieved primary stability with a torque exceeding 45 Ncm. The patient received an immediate provisional prosthesis, which allowed for the rapid restoration of phonetic and esthetic function. The post-operative course was uneventful, with no complications. Follow-up imaging confirmed the successful integration of the implants and the absence of any prosthetic or surgical issues at 24-month successful follow-up. Conclusions: This case suggests that implant-supported rehabilitation with zygomatic implants can be a highly effective treatment for patients with severe maxillary defects following cancer surgery. By using an integrated surgical and prosthetic strategy, along with advanced digital technology, we can achieve fast, safe, and predictable results. This approach successfully restores both function and esthetics, even in challenging anatomical situations. The auxilium of guided plates is a helpful aid for both implant placement and managing bone resection during cancer surgery. Full article

Background: Custom-made subperiosteal implants have re-emerged as a valuable option for the rehabilitation of patients with severe maxillofacial atrophy and post-oncological defects. Despite advances in digital workflows and implant design, their unique anatomical, biological, and prosthetic characteristics pose specific challenges for long-term maintenance, and no dedicated standardized guidelines are currently available. Methods: This narrative review critically appraises the available literature on implant maintenance and related fields. A comprehensive search was conducted across PubMed, Scopus, and Web of Science, including studies on peri-implant maintenance, supportive periodontal therapy, full-arch and zygomatic implant rehabilitations, and subperiosteal implants. Due to the lack of direct evidence, a qualitative narrative synthesis was adopted to develop preliminary clinical considerations for maintenance of custom-made subperiosteal implants. These considerations should be interpreted as an expert-informed perspective rather than validated clinical guidelines. Results: Conventional maintenance protocols developed for endosseous implants are not directly transferable to subperiosteal implants due to differences in the implant–tissue interface, biomechanics, diagnostic parameters, and hygiene accessibility. Key challenges include the absence of a conventional peri-implant sulcus, possible implant exposure, complex prosthetic geometries, and potential susceptibility to biofilm accumulation in areas with limited access. Evidence from related fields highlights the importance of structured maintenance, individualized risk-based follow-up, effective biofilm control, and patient-specific home-care strategies. Conclusions: Preliminary evidence-informed clinical considerations for the maintenance of subperiosteal implants are proposed, with emphasis on plaque control, individualized follow-up, descriptive clinical monitoring, and hygiene-oriented prosthetic and surgical planning. These considerations are not intended as validated guidelines, but as a practical starting point for clinical reasoning in an area where dedicated evidence remains limited. Full article

Background: Severe trismus and post-oncologic maxillary defects often prevent conventional zygomatic implant placement. This study evaluates a novel implant specifically designed for reverse insertion (from the zygoma toward the oral cavity) and assesses its feasibility and accuracy in a cadaveric model. Materials and Methods: A Brown Class II maxillectomy was simulated in a fresh-frozen cadaver. Four custom reverse zygomatic implants were virtually planned and placed using CAD/CAM surgical guides. Superior and inferior orbital approaches were compared. Postoperative CT was superimposed onto the preoperative plan to measure linear and angular deviations, and a 3D-printed verification bar assessed prosthetic alignment. Results: All implants were successfully inserted with primary stability and without compromising critical structures. The superior orbital approach yielded lower deviations and better guide stability, which was reflected in the results: deviation at the zygomatic bone was 1.25 mm in the superior approach vs. 2.32 in the inferior approach, intraorally 4.7 mm vs. 7.3 mm, and angular deviation 1.85° vs. 5.63°. Despite minor distal deflection, intraoral emergence remained within clinically acceptable limits, allowing partial seating of the verification bar. Conclusions: Reverse-insertion zygomatic implants are technically feasible, anatomically safe, and compatible with fixed prosthetic rehabilitation in cases where conventional placement is impossible. Penetrating the orbit, injuring the skin or the infraorbital nerve could be possible but guided surgery seems to prevent them. A forthcoming clinical series of eight additional cases will further validate this protocol. Full article

Zygomatic implant perforated (ZIP) flap reconstruction offers immediate surgical rehabilitation following maxillectomy, integrating oncologic zygomatic implants with a fascio-cutaneous free flap. A critical technical challenge is safely perforating the free flap skin paddle to accommodate implants’ abutments without damaging its vasculature. Near-infrared (NIR) vein visualization technology provides real-time mapping of subcutaneous vessels and has been widely investigated in settings such as pediatric intravenous (IV) cannulation. By projecting vein pathways onto the skin, NIR visualization facilitates precise vascular identification, potentially reducing complications. We describe a case of ZIP flap reconstruction in a 25-year-old patient utilizing NIR vein visualization to preemptively locate flap vasculature and minimize the risk of vessel puncture. Our discussion places these findings within the context of the existing literature on NIR devices, underscoring their benefits of non-invasive operation, rapid imaging, and minimal need for advanced operator skills, and highlighting their utility in microvascular reconstructive surgery. Full article

Background: Zygomatic implants (ZIs) were initially pioneered by Brånemark to rehabilitate patients suffering from destructive diseases through original surgical technique (OST). Subsequently, other techniques were proposed, such as the zygomatic anatomy-guided approach (ZAGA). This umbrella review was conceived to quantify and critically characterize the spectrum of complications associated with different techniques of ZI placement. Methods: Systematic reviews, encompassing both those with and without meta-analysis, focusing on the complications associate with ZIs and published only in the English language were systematically sought. A systematic literature search was performed through MEDLINE/Pubmed, Scopus, BioMed Central, and the Cochrane Library, and the PROSPERO register. Results: A total of 11 articles were included. The latter documented the spectrum of complications associated with ZIs, ranging from minor morbidities such as sinusitis, hematoma, and soft tissue complications up to severe adverse events such as orbital penetration and diplopia. Conclusions: The use of described ZI OST and ZAGA in cases of severe maxillary resorption is associated with a high implant survival rate and a low incidence of surgical complications. However, complications, the most common of which were sinusitis and peri-implant soft tissue infection, may be underestimated due to the heterogeneity of the studies included. Full article

Zygomatic implants have emerged as a promising surgical technique to rehabilitate severe atrophic maxilla and maxillectomy. However, this implant design lacks an appropriate standard test protocol. This study aimed to simulate and evaluate zygomatic implants under compressive and lateral loads using finite element analysis, following the current ISO parameters for dental implants, employing different cylindrical holders. These holders simulate the bone configuration of clinical scenarios of the zygoma anatomic-guided approach (ZAGA) and maxillectomy rehabilitation with zygomatic implants. Six three-dimensional models were generated and subjected to a 150 N compressive load at a 40° angle. In the next step, a simultaneous 50 N lateral load was applied. Von Mises stress data and contour plots were collected and analyzed. Von Mises peak stresses increased by more than 100% when a lateral load was applied. Data demonstrated the influence of the setup support and lateral load on the implant components’ peak stress values. Full article

Background: All-on-six implants are a reliable and efficient full-arch restoration option in patients with atrophic maxilla. Aim: The present study aimed to evaluate and compare the distribution of stress surrounding implants and adjacent osseous structures by utilizing all-on-six tilted and zygomatic methodologies in the maxillary region by using finite element (FEA) analysis. Materials and Methods: Two finite element models were constructed with CT images of 50-year-old female. Model 1 was constructed with zygomatic implants, while model 2 was constructed with tilted implants. A vertical force of 150 N on the anterior component and 300 N on the posterior component were applied and maximum stress and deformation was assessed. Results: In the present study, the von Mises stress on the bone and implant overall was higher in the tilted implant model than the zygomatic implant model. Conclusions: The findings of the present study suggests that zygomatic implants help distribute occlusal loads more favourably, especially under horizontal and combined loading conditions in an all-on-six configuration. Full article

Background and Objectives: Stereolithography (SLA) enables the creation of physical replicas of digital models, offering surgeons a realistic representation of patient anatomy. This technology improves diagnostics and surgical planning, facilitates communication within the medical team, and enhances the doctor–patient relationship by promoting compliance. This study aims to place the intervention addressed in a broader context and highlight the utility of SLA models in complex surgical scenarios. Case Presentation: The study presents two cases of patients with severe maxillary atrophy: a 67-year-old healthy male (with well-controlled hypertension) and a 72-year-old female patient (with hypercholesterolemia). Intervention and Outcome: Zygomatic implant procedures with immediate loading were performed to resolve the bone atrophy in both cases. These procedures heavily leveraged preoperative planning using stereolithographic models. Both interventions resulted in a positive outcome, which was confirmed at the 6-month follow-up. Conclusions: The integration of stereolithographic models into the preoperative planning process improved the prognosis of these complex cases, confirming their value in managing severe maxillary atrophy. Full article

Background: Computer-assisted implant surgery (CAIS) aims to improve placement accuracy versus freehand drilling. We compared the three-dimensional accuracy of robot-guided CAIS (r-CAIS), dynamic navigation (d-CAIS), static-template guidance (s-CAIS), and freehand (FH) in clinical and in vitro settings. Methods: We searched PubMed/MEDLINE, Scopus, and Web of Science (1 January 2019–2025). Eligible populations were adults receiving conventional or zygomatic implants in vivo, plus validated in vitro human-jaw models using plan-versus-placement workflows; studies had to report study-level means with dispersion for ≥1 primary outcome with ≥5 implants per arm. Interventions were r-CAIS, d-CAIS, or s-CAIS; with a baseline as the freehand technique. Risk of bias used RoB 2 (RCTs), ROBINS-I (non-randomized clinical), and QUIN (in vitro). Because of heterogeneity in definitions and workflows, we performed a descriptive synthesis by modality (no meta-analysis). Registration: OSF. Results: Forty-three studies (7 RCTs, 10 non-randomized clinical, 26 in vitro) reported more than 4000 implants. Across studies, typical study-level means for global linear deviation clustered around < 1 mm (r-CAIS), ~1 mm (d-CAIS), ~1.3 mm (s-CAIS), and ~1.8 mm (FH). In clinical contexts, d-CAIS often showed slightly lower angular deviation than s-CAIS. Conclusions: CAIS improves accuracy versus freehand. d-CAIS and s-CAIS show similar linear accuracy, with d-CAIS frequently yielding slightly lower angular deviation; r-CAIS exhibits tight error clusters in our dataset, but limited comparative clinical evidence precludes superiority claims. Limitations: non-uniform registration/measurement, variable operator experience, and absence of meta-analysis. Full article

Background/Objetives: Zygomatic implants are an effective solution for the prosthetic rehabilitation of atrophic maxillae, but their placement can alter maxillary sinus anatomy and influence surgical outcomes. This study presents a computational algorithm for automated segmentation and volumetric assessment of the maxillary sinus from cone-beam computed tomography (CBCT) images, offering a reproducible and clinically oriented tool. Methods: Six sinus samples from four patients undergoing pterygoid or zygomatic implant surgery were analyzed. The algorithm was designed to integrate image binarization, surface detection, and iterative reconstruction to delineate sinus boundaries and compute volumes with minimal operator dependence. Results: Postoperative analyses consistently revealed reductions in sinus volume, with relative changes ranging from 1.1% to 24.5%, validated by expert review. Conclusions: These results demonstrate the feasibility of algorithm-driven volumetric assessment as a non-invasive approach to support surgical planning and monitor anatomical changes. Although limited by the small sample size, this pilot study establishes a foundation for further research and highlights the clinical potential of computational methods to enhance precision and safety in zygomatic implantology. Full article

Background: Midfacial trauma involving the zygomatic-maxillary-orbital (ZMO) complex poses significant reconstructive challenges due to anatomical complexity and the necessity for high-precision alignment. Traditional manual reduction techniques often result in inconsistent outcomes, necessitating revisions. Methods: This feasibility study presents two clinical cases treated using a novel, fully digital workflow incorporating computer-aided design and manufacturing (CAD/CAM) of patient-specific osteosynthesis plates and surgical drill guides. Following virtual fracture reduction and implant design, drill guides and implants were fabricated using selective laser melting. Surgical procedures included intraoral and transconjunctival approaches with intraoperative 3D imaging (mobile C-arm CT) to verify implant positioning. Postoperative results were compared to the virtual plan through image fusion. Results: Both cases demonstrated precise fit and anatomical restoration. The “one-position-fits-only” orbital implant design enabled highly accurate orbital wall reconstruction. Key procedural refinements between cases included enhanced interdisciplinary collaboration and improved guide designs, resulting in decreased planning-to-surgery intervals (<7 days) and seamless intraoperative application. Image fusion confirmed near-identical congruence between planned and achieved outcomes. Conclusions: The presented method demonstrates that fully digital, CAD/CAM-based midface reconstruction is feasible in the primary trauma setting. The technique offers reproducible precision, reduced intraoperative time, and improved functional and aesthetic outcomes. It may represent a paradigm shift in trauma care, particularly for complex ZMO fractures. Broader clinical adoption appears viable as production speed and workflow integration continue to improve. Full article

Background/Objectives: When solving the problems of installing zygomatic implants after partial or full maxillectomy with subsequent attachment of a removable overdenture (ROD), computer simulation based on the finite element method (FEM) is an effective tool for treatment planning. In this study, stress-strain states of the ‘zygomatic bones–implants–splinting bar–ROD’ dental structure were evaluated under various loading conditions. Methods: A 3D FEM computer simulation was carried out to estimate stress-strain states of the elements of the dental structure and to study the effect of redistribution of the loads transferred from the ROD to the zygomatic bones through four implants. Results: That successive insertion and removal of the ROD caused identical stresses in the elements of the dental structure. Given the accepted level of critical stress of about 13 MPa, their values may be exceeded in the zygomatic bones during both processes. In the ROD, the equivalent stresses did not exceed the critical levels upon alternate loading of 50 N on the posterior teeth (both molars and premolars) under all biting and mastication. Taking into account the linear dependence of the applied load and the stresses in the ROD, it can be stated that its integrity is maintained until 118 N (or the generally accepted typical value of 100 N). Under the 90° biting angle, the equivalent stresses are below the critical level in all the studied cases; thus, the acceptable value increases to 213 N, but it is only 63 N at a biting angle of 45°. Conclusions: It has been established that the equivalent stresses in the zygomatic bones can exceed the critical stress level of 13 MPa. In addition, some practical recommendations and prospects of the study have been formulated. Full article

Background. The use of zygomatic implants (ZIs) provides a highly predictable treatment option for rehabilitation in patients with severe atrophic maxillae. However, these long implants can potentially cause a number of more serious complications than those seen with conventional dental implants. The aim of this study is to report a case of peri-zygomatic cutaneous fistula following placement of monolateral double zygomatic implants and to analyse the available literature on this complication. Methods. The 55-year-old patient was treated with placement of 3 ZIs, two on the left side. Left periorbital swelling with pain appeared 10 days after surgery with progressive worsening of symptoms. After antibiotic treatment, she developed a left cutaneous fistula with purulent discharge. CT showed two ZIs on the left side with the apical portions in close contact with a 1 cm-wide portion of resorbed zygomatic external cortex and a layer of granulation tissue. Results: Due to the limited amount of bone involved by the fixation tip, the left ZIs were removed and the skin fistula repaired. The patient healed without complications but required prosthesis replacement. Conclusions. After conducting a literature review, peri-zygomatic fistulas seem to be more common in patients with two ZIs placed on the same zygoma. In this case, the amount of available zygomatic bone is relatively limited; the bone drill holes can often be too close together and cause overheating, leading to inter-implant bone resorption and infection, with further orbito-zygomatic fistula development. The authors identified the lack of distance between ZI fixtures as one of the main causes of extraoral ZI infection. Full article