Advertisement

Zygomatic Implants After 20 Years: Systematic Overview and Global Perspective

Chapter
  • 299 Downloads

Abstract

In the 1980s, P-I Brånemark conceived the creation of zygomatic implants for totally edentulous patients presenting with advanced bone resorption of the posterior maxilla as well as moderate-to-severe atrophy in the premaxilla. Trusting his experience in hemimaxillectomy cases where he could find a strong anchorage in the zygoma, he imagined a long implant entering at the position of the second premolar from the palatal side of the maxillary crest, through the sinus to ultimately attain anchorage in the zygoma. Since then, zygoma implants have been developed in several lengths, made of pure titanium, and a two-stage protocol has been utilized: First, a surgery with the placement of the implants and, 6 months later, the loading of the implants with a fixed prosthesis.

The zygoma concept was launched internationally in 1997 through a multicenter study in which 16 centers participated. The author of this chapter participated in this study at the Université Libre de Bruxelles where the first cases of zygomatic implants used for atrophied maxillae without discontinuity outside Sweden were performed. The two-stage protocol yielded very high survival rates of around 98%.

In 2004, surgeons confronted with significant atrophy of the anterior part of the maxilla as well as the posterior part began placing four zygomatic implants instead of two.

Over the past 20 years, the zygoma implant surface and the surgical protocol have been revised. A one-stage procedure with immediate loading was developed and yielded high survival rates.

The zygoma concept including surgery as well as prosthetic rehabilitation became the first choice for restoring the quality of life of the patients with significantly atrophic maxillae.

This chapter reviews more than 20 years of experience at ULB where the first zygomatic implants were placed in December 1997. The author shares the different modalities developed over the years. These modalities will be further explained in other chapters.

Keywords

Zygomatic implant Zygoma implant Atrophied jaws Zygoma Delayed loading Immediate loading Zygomatic fixtures 

References

  1. 1.
    Cawood JI, Howell RA. A classification of the edentulous jaws. Int J Oral Maxillofac Surg. 1988;17:232–6.CrossRefGoogle Scholar
  2. 2.
    Lekholm U, Zarb GA. Patient selection and preparation. In: Brånemark PI, Zarb GA, Albrektsson T, editors. Tissue-integrated prosthesis. Chicago, IL: Quintessence Publishing; 1985. p. 201–2.Google Scholar
  3. 3.
    Breine U, Branemark PI. Reconstruction of the alveolar jawbone. An experimental and clinical study of immediate and preformed autologous bone grafts in combination with osseointegrated implants. Scand J Plast Reconstr Surg. 1980;14:23–48.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Calandriello R, Tomatis M. Simplified treatment of the atrophic posterior maxilla via immediate/early function and tilted implants: a prospective 1-year clinical study. Clin Implant Dent Relat Res. 2005;7(Suppl 1):S1–12.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Balshi TJ, Wolfinger GJ, Slauch RW, Balshi SF. Brånemark system implant lengths in the pterygomaxillary region: a retrospective comparison. Implant Dent. 2013;22(6):610–2.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Renouard F, Nisand D. Short implants in the severely resorbed maxilla: a 2-year retrospective clinical study. Clin Implant Dent Relat Res. 2005;7(Suppl 1):S104–10.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Boyne PJ, James RA. Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg. 1980;38:613–6.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Nyström E, Nilson H, Gunne J, Lundgren S. Reconstruction of the atrophic maxilla with interpositional bone grafting/Le fort I osteotomy and endosteal implants: a 11-16 year follow-up. Int J Oral Maxillofac Surg. 2009 Jan;38(1):1–6.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Winkler S, Morris HF, Ochi S. Implant survival to 36 months as related to length and diameter. Ann Periodontol. 2000;5:22–31.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Parel SM, Brånemark PI, Ohrnell LO, Svensson B. Remote implant anchorage for the rehabilitation of maxillary defects. J Prosthet Dent. 2001;86:377–81.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Landes CA, Paffrath C, Koehler C, Thai VD, Stubinger S, Sader R, Lauer HC, Piwowarczyk A. Zygoma implants for midfacial prosthetic rehabilitation using telescopes: 9-year follow-up. Int J Prosthodont. 2009;22:20–32.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Brånemark PI, Gröndahl K, Öhrnell LO, et al. Zygoma fixture in the management of advanced atrophy of the maxilla: technique and long-term results. Scand J Plast Reconstr Surg Hand Surg. 2004;38:70–85.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Hirsch JM, Ohrnell LO, Henry PJ, Andreasson L, Brånemark PI, Chiapasco M, Gynther G, Finne K, Higuchi KW, Isaksson S, Kahnberg KE, Malevez C, Neukam FW, Sevetz E, Urgell JP, Widmark G, Bolind P. A clinical evaluation of the Zygoma fixture: one year of follow-up at 16 clinics. J Oral Maxillofac Surg. 2004;62(9 Suppl 2):22.CrossRefGoogle Scholar
  14. 14.
    Kahnberg KE, Henry PJ, Hirsch JM, Ohrnell LO, Andreasson L, Brånemark PI, Chiapasco M, Gynther G, Finne K, Higuchi KW, Isaksson S, Malevez C, Neukam FW, Sevetz E Jr, Urgell JP, Widmark G, Bolind P. Clinical evaluation of the zygoma implant: 3- year follow-up at 16 clinics. J Oral Maxillofac Surg. 2007;65:2033–8.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Aparicio C, Manresa C, Francisco K, et al. Zygomatic implants placed using the zygomatic anatomy-guided approach versus the classical technique: a proposed system to report rhinosinusitis diagnosis. Clin Implant Dent Relat Res. 2014;16:627–42.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Chow J, Hui E, Lee PK, Li W. Zygomatic implants—protocol for immediate occlusal loading: a preliminary report. J Oral Maxillofac Surg. 2006;64:804–11.CrossRefGoogle Scholar
  17. 17.
    Davó R, Pons O. 5-year outcome of cross-arch prostheses supported by four immediately loaded zygomatic implants: a prospective case series. Eur J Oral Implantol. 2015;8:169–74.Google Scholar
  18. 18.
    Stiévenart M, Malevez C. Rehabilitation of totally atrophied maxilla by means of four zygomatic implants and fixed prosthesis: a 6-40-month follow-up. Int J Oral Maxillofac Surg. 2010;39(4):358–63.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Nkenke E, Vairaktaris E, Kramer M, Schlegel A, Holst A, Hirschfelder U, Wiltfang J, Neukam F, Stamminger M. Anatomic site evaluation of the zygomatic bone for dental implant placement. Oral Maxillofac Surg. 2008;12:5–12.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Van Steenberghe D, Malevez C, Van Cleynenbreugel J, et al. Accuracy of drilling guides for transfer from three-dimensional CT-based planning to placement of zygoma implants in human cadavers. Clin Oral Implants Res. 2003;14:131–6.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Rossi M, Duarte LR, Mendonça R, Fernandes A. Anatomical bases for the insertion of zygomatic implants. Clin Implant Dent Relat Res. 2008;10(4):271–5.Google Scholar
  22. 22.
    Aparicio C, Manresa C, Francisco K, Claros P, Alández J, González-Martín O, Albrektsson T. Zygomatic implants: indications, techniques and outcomes, and the zygomatic success code. Periodontol. 2014;66(1):41–58.CrossRefGoogle Scholar
  23. 23.
    Prado FB, Noritomi PY, Freire AR, Rossi AC, Neto FH, Caria PHF. Stress distribution in human zygomatic pillar using three dimensional finite element analysis. Int J Morphol. 2013;31:1386–1.CrossRefGoogle Scholar
  24. 24.
    Prado FB, Freire AR, Rossi AC, Ledogar JA Smith AL, Dechow PC, Strait DS, Voigt T, Ross CF. Review of in vivo bone Strai studies and finite element models of the Zygomatic complex in humans and non human primates: implications for clinical research and practice. Anat Rec. 2016;299(12):1753–78.CrossRefGoogle Scholar
  25. 25.
    Brunski JB. Biomechanical aspects of tilted regular and zygoma implants. In: Aparicio C, editor. Zygomatic implants: the anatomy-guided approach: Quintessence Publishing Co Ltd.London; UK. 2012. p. 25–45.Google Scholar
  26. 26.
    Freedman M, Ring M, Stassen LF. Effect of alveolar bone support on zygomatic implants: a finite element analysis study. Int J Oral Maxillofac Surg. 2013;42:671–6.CrossRefGoogle Scholar
  27. 27.
    Freedman M, Ring M, Stassen LF. Effect of alveolar bone support on zygomatic implants in an extra-sinus position--a finite element analysis study. Int J Oral Maxillofac Surg. 2015;44:785–90.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Wen H, Weihua G, Liang R, Xiang L, Long G, Wang T, Deng M, Tian W. Finite element analysis of three zygomatic implant techniques for the severely atrophic edentulous maxilla. J Prosthet Dent. 2014;111(3):203–15.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Verstreken K, Van Cleynenbreugel J, Martens K, Marchal G, van Steenberghe D, Suetens P. An image-guided planning system for endosseous oral implants. IEEE Trans Med Imaging. 1998;17:842–52.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Petruson B. Sinuscopy in patients with titanium implants in the nose and sinuses. Scand J Plast Reconstr Surg. 2004;38:86–93.CrossRefGoogle Scholar
  31. 31.
    Davó R, Malevez C, López-Orellana C, Pastor-Beviá F, Rojas J. Sinus reactions to immediately loaded zygoma implants: a clinical and radiological study. Eur J Oral Implantol. 2008;1(1):53–60.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Malevez C, Abarca M, Durdu F, Daelemans P. Clinical outcome of 103 consecutive zygomatic implants: a 6-48 months follow-up study. Clin Oral Implants Res. 2004;15:18–22.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Bedrossian E, Stumpel L 3rd, Beckely ML, Indresano T. The zygomatic implant: preliminary data on treatment of severely resorbed maxillae. A clinical report. Int J Oral Maxillofac Implants. 2002;17(6):861–5.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Ferrara ED, Stella JP. Restoration of the edentulous maxilla: the case for the zygomatic implants. J Oral Maxillofac Surg. 2004;62:1418–22.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Aparicio C, Ouazzani W, Aparicio A, Fortes V, Muela R, Pascual A, Codesal M, Barluenga N, Manresa C, Franch M. Extrasinus zygomatic implants: three year experience from a new surgical approach for patients with pronounced buccal concavities in the edentulous maxilla. Clin Implant Dent Relat Res. 2010;12(1):55–61.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Malo P, Nobre Mde A, Lopes I. A new approach to rehabilitate the severely atrophic maxilla using extramaxillary anchored implants in immediate function: a pilot study. J Prosthet Dent. 2008;100:354–66.CrossRefGoogle Scholar
  37. 37.
    Chow J, Wat P, Hui E, Lee P, Li W. A new method to eliminate the risk of maxillary sinusitis with zygomatic implants. Int J Oral Maxillofac Implants. 2010;25(6):1233–40.Google Scholar
  38. 38.
    Stevenson AR, Austin BW. Zygomatic fixtures--the Sydney experience. Ann R Australas Coll Dent Surg. 2000;15:337–9.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Higuchi KW. The zygomaticus fixture: an alternative approach for implant anchorage in the posterior maxilla. Ann R Australas Coll Dent Surg. 2000;15:28–33.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Sharma A, Rahul GR. Zygomatic implants/fixture: a systematic review. J Oral Implantol. 2013;39(2):215–24.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Goiato MC, Pellizzer EP, Moreno A, Gennari-Filho H, dos Santos DM, Santiago JF Jr, dos santos EG. Implants in the zygomatic bone for maxillary prosthetic rehabilitation: a systematic review. Int J Oral Maxillofac Surg. 2014;43(6):748–57.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Aparicio C, Manresa C, Francisco K, Ouazzani W, Claros P, Potau JM, Aparicio A. The long-term use of zygomatic implants: a 10-year clinical and radiographic report. Clin Implant Dent Relat Res. 2014;16(3):447–59.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Candel-Marti E, Carillo-Garcia C, Penarrocha-Diago M. Rehabilitation of atrophic posterior maxilla with zygomatic implants: review. J Oral Implantol. 2012;38(5):653–7.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Esposito M, Worthington HV. Interventions for replacing missing teeth: dental implants in zygomatic bone for the rehabilitation of the severely deficient edentulous maxilla. Cochrane Database Syst Rev. 2013;9:CD004151. Eur J Oral Implantol. 2014 Summer;7 Suppl 2:S91–109.Google Scholar
  45. 45.
    Wang F, Monje A, Lin GH, et al. Reliability of four zygomatic implant-supported prostheses for the rehabilitation of the atrophic maxilla: a systematic review. Int J Oral Maxillofac Implants. 2015;30:293–8.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Tuminelli FJ, Walter LR, Neugarten J, Bedrossian E. Immediate loading of zygomatic implants: a systematic review of implant survival, prosthesis survival and potential complications. Eur J Oral Implantol. 2017;10(Suppl1):79–87.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Aboul-Hosn Centenero S, Lazaro A, Giralt-Hernando M, Hernandez-Alfaro F. Zygoma quad compared with 2 zygomatic implants: a systematic review and meta-analysis. Implant Dent. 2018;27(2):246–53.Google Scholar
  48. 48.
    Chrcanovic BR, Abreu MH. Survival and complications of zygomatic implants: a systematic review. Oral Maxillofac Surg. 2013;17:81–93.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Chrcanovic B, Albrektsson T, Wennerberg A. Survival and complications of zygomatic implants: an updated systematic review. J Oral Maxillofac Surg. 2016;75(10):81–93.Google Scholar
  50. 50.
    Molinero-Mourelle P, Baca-Gonzalez L, Gao B, Saez Alcaide LM, Helm A, Lopez-Quiles J. Surgical complications in zygomatic implants: a systematic review. Med Oral Patol Oral Cir Bucal. 2016;21(6):e751–7.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Esposito M, Davo R, Marti-Pages C, Ferrer-Fuertes A, Barausse C, Pistilli R, Ippolito DR, Felice P. Immediately loaded zygomatic implants versus conventional dental implants in augmented atrophic maxillae : 4 months post-loading results from a multicentre randomised controlled trials. Eur J Oral Implantol. 2018;11(1):11–28.Google Scholar
  52. 52.
    Davo R, Felice P, Pistilli R, Barausse C, Marti-Pages C, Ferrer-fuertes, Ippolito DR, Esposito M. Immediately loaded zygomatic implants vs conventional dental implants in augmented atrophic maxillae: 1 year post-loading results from a multicentre randomised controlled trial. Eur J Oral Implantol. 2018;11(2):145–61.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Malevez C. The zygoma concept for the totally edentulous patient. Proceedings of the P-I Brånemark memorial symposium. Stockholm: Edit Daniel van Steenberghe; 2015. p. 99–107.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Faculty of MedicineUniversité Libre de BruxellesBrusselsBelgium

Personalised recommendations