Zygomatic needn’t mean traumatic

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  Posted by: Dental Design      2nd February 2019

Some patients are unsuitable for conventional implant treatment in the edentulous maxilla due to insufficient bone to provide sound anchorage. This can be due to factors such as advanced bone resorption, atrophy of the alveolar ridge, or extensive maxillary sinuses. While for many patients, bone grafts are employed in order to provide the necessary foundation into which implants can then be placed, this is not suited to everyone.

Although the number of patients suffering from a fully edentulous maxilla today may be lower than in the past, when the condition does manifest even experienced clinicians can face serious challenges in successfully rehabilitating the patient. Autogenous bone grafts are often seen as the current gold standard, but they are not without their drawbacks, including donor site morbidity, unpredictable resorption and the potential lack of available volume. Meanwhile, extraorally sourced bone grafts have been associated with increased risks of morbidity and complications.[1]

While bone graft procedures do generally afford a high rate of success, there now exists an alternative for patients who are contraindicated for, or wish to avoid, bone grafting – zygomatic implants.

What is a zygomatic implant?

Instead of attempting to rebuild the necessary bone structure, zygomatic implants bypass this need entirely. Zygomatic implants have been in use for around two decades now, with an impressive track record. A systematic review of over two dozen studies reported a 100% success rate, with an implant survival rate of 98% after three years.[2]Many implant failures are caused by weaknesses in this area, with a 5 year analysis reporting that 35% of all implant failures occurred in porous trabecular bone due to its thin cortex, likewise immature bone grafts have been found to increase failure rates.[3]Rather than using the comparatively delicate tissue found in the roof of the mouth, zygomatic implants utilise longer screws to access the zygom,a which provides a firm foundation (though typically four cortical portions are required due to the specific microarchitecture of the region rather than one or two as with conventional implants).[4]Because the procedure is graftless, only a single surgical procedure under local anaesthetic is required, which may be particularly desirable for certain patients.

Contraindications for sinus bone grafts

The main contraindications for sinus bone grafts are:

  • Alcoholism
  • Heavy smoking
  • Acute or chronic maxillary sinusitis
  • Recent radiotherapy in the maxilla
  • An uncontrolled systemic disease such as diabetes mellitus
  • Psychosis
  • Oroantral fistula
  • A tumour in the maxillary sinus.[5]

The presence of an antral pseudocyst was previously considered an absolute contraindication for a sinus lift procedure, with additional surgery recommended to remove the cyst prior to attempting a sinus lift. That said, more recent reports suggest that sinus lifts can still be preformed in the presence of pseudocysts, though larger lesions increase the risk of complications. A pseudocyst reduces the size of the maxillary antrum, which can lead to blockages and can provoke the development of sinusitis. It is also possible that a pseudocyst may leak into the grafted area, which can result in infection and cause the graft to fail.[6]

Previous failed bone grafts may also make subsequent attempts more difficult or indicate an underlying problem.

Which patients benefit most from zygomatic implants?

The main beneficiaries of zygomatic implants are patients with:

  • Severe resorption of the maxilla
  • Total edentulism, especially if coupled with reduced bone height
  • Pneumatisation of the maxillary sinus.[7]

For edentate patients with extremely severe resorption of the anterior maxilla, it is possible to combine this technique with a bone graft. The dimensions of the graft in this case can be smaller than would be required with the more common approach.7

Due to the reduced treatment time and preoperative risk of zygomatic implant placement compared to traditional bone grafting methods, it may be an option for older patients and those with significant general health problems.7

Referring patients for the best outcomes

 Zygomatic implants have several advantages over conventional graft-based procedures and for some patients, they are the optimal or only realistic treatment modality. If you feel that your patient may benefit from this treatment but are unsure or unable to offer it yourself, referring them to a practice you can trust is highly desirable. BPI Dental has the expertise to work with you on challenging cases where the patient may otherwise be left without a stable or long-term solution. Dr Boota Ubhi brings a wealth of training and experience to his consultations on zygomatic implants and enjoys an outstanding success rate.

Quality dental referrals help ensure the very best outcomes for patients and reflect well on your own practice – with BPI Dental your patients will receive excellent care, no matter how challenging the case.

 

For more information on the referral service available from Birmingham Periodontal & Implant (BPI) Dental, visit www.bpidental.co.uk, call 0121 427 3210 or email info@bpidental.co.uk

 
 
REFERENCES
[1]Jensen A., Jensen S., Worsaae M. Complications related to bone augmentation procedures of localized defects in the alveolar ridge. A retrospective clinical study. Oral and Maxillofacial Surgery.2016; 20(2): 115-122. DOI: 10.1007/s10006-016-0551-8. Available at https://www.ncbi.nlm.nih.gov/pubmed/26932593Accessed October 18, 2018.
[2]Goiato M., Pellizzer E., Moreno A., Gennari-Filho H., dos Santos D., Santiago J., dos Santos E. Implants in the zygomatic bone for maxillary prosthetic rehabilitation: a systematic review. International Journal of Oral Maxillofacial Surgery.2014; 43(6): 748-757. DOI: 10.1016/j.ijom.2014.01.004. Available at https://www.ncbi.nlm.nih.gov/pubmed/24530034Accessed October 18, 2018.
[3]Kate M., Palaskar S., Kapoor P. Implant failure: a dentist’s nightmare. Journal of Dental Implants.2016; 6(2): 51-56. Available at http://www.jdionline.org/text.asp?2016/6/2/51/202154Accessed October 18, 2018.
[4]Sharma A., Rahul G. Zygomatic implants/fixture: a systematic. Journal of Oral Implantology. 2013; 39(2): 215-224. Available at https://www.ncbi.nlm.nih.gov/pubmed/22248122Accessed October 18, 2018.
[5]Kumar A., Anand U. Maxillary sinus augmentation. Journal of the International Clinical Dental Research Organisation. 2015; 7(3): S81-93. Available at http://www.jicdro.org/text.asp?2015/7/3/81/172935Accessed October 18, 2018.
[6]Delilbasi C., Gurler G., Burgaz I. Sinus lifting in the presence of pseudocyst: case series. Oral Health and Dental Management. 2014; 13(4): 959-962. Available at https://www.researchgate.net/publication/273085964Accessed October 18, 2018.
[7]Sharma A., Rahul G. Zygomatic implants/fixture: a systematic. Journal of Oral Implantology. 2013; 39(2): 215-224. Available at https://www.ncbi.nlm.nih.gov/pubmed/22248122Accessed October 18, 2018.

 

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