: Carlos Aparicio
: Zygomatic Implants The Anatomy Guided Approach
: Quintessence Publishing Co Inc USA
: 9781647241773
: 1
: CHF 158.10
:
: Zahnheilkunde
: English
: 352
: DRM
: PC/MAC/eReader/Tablet
: ePUB
Zygomatic implants have been in use for more than two decades, and clinical follow-up studies have shown good outcomes. However this treatment approach is only now seeing a strong resurgence of interest because it can provide patients with a fixed dentition in a short amount of time without any grafts, general anesthesia, or morbidity from a donor site, even in challenging clinical situations. Thus, a technique of relative complexity becomes minimally invasive in its application. This book reviews the state of the art of zygomatic implants and outlines several new surgical techniques and adjunctive procedures. The authors cover the fundamentals of using zygomatic implants, including the rationale behind the approach, anatomical and biomechanical considerations, imaging of the zygoma, possible sinus reactions, contraindications, prosthodontic considerations, and management of complications. This book will arm clinicians with clear guidelines for using zygomatic implants in the rehabilitation of edentulous patients.

Dr. Carlos Aparicio MD, DDS, MSc, MSc, DLT, PhD Spain Dr Carlos Aparicio received his Bachelor of Medicine and Surgery degree from the University of Navarra in 1978, completed his postgraduate studies in dentistry at the Univeristy of Barcelona, and became a dental laboratory technician in 1983 at the Ramon y Cajal School in Barcelona. He received his Diploma in Implant Dentistry in 1984 from the University of Gothenburg (with Professor Per-Ingvar Brånemark as tutor) and was awarded a Master of Materials Science from the University of Barcelona in 1990 before receiving his Diploma in Periodontics from the University of Gothenburg in 1995. He was awarded a master's in biomedical research from the University of Barcelona in 2010, and became a Ph.D. in medicine (summa cum laude with international mention) in 2013. Dr Aparicio has written numerous articles for international journals. In 2012, he edited the book Zygomatic Implants: The Anatomy-Guided Approach (ZAGA). He is a Fellow of the Royal Society of Medicine in England and became an Academic at The Royal European Academy of Doctors in 2016. He is former president of the Osseointegration Foundation of the American Academy of Osseontigration. He received the Fonseca Award from the Spanish Society of Periodontics three times and was awarded the Simo Virgili Prize by the Catalonian Society of Ondonto-Stomatology twice. Today, Dr Aparicio is an International Teaching Scholar at Indiana University School of Dentistry and is honorary president of the Spanish Society of Minimally Invasive Dentistry, which he founded. His latest endeavor is founding the Zygoma ZAGA Centers Network in 2018 with the goal of spreading the ZAGA philosophy globally. Currently, he is sharing his knowledge as a senior consultant in zygomatic implants at Hepler Bone Clinic in Barcelona, Spain.

Rehabilitating patients with severe maxillary atrophy has remained a consistent challenge for clinicians. In select cases, a complete or partial dental rehabilitation anchored with zygomatic implants can be an excellent option. In practice, though, the historical long-term unpredictability of such procedures means that some clinicians still opt for conventional methods, even though they can be more complex, time-consuming, and costly for the patient. As is true of techniques for placing standard implants in different situations, zygomatic implant placement practices have evolved over the years, from the original Brånemark technique to the slot, extrasinus, and extramaxillary approaches, and now the zygoma anatomy-guided approach (ZAGA). As zygomatic implant placement systems have evolved, so have the implants, tools, technology, and thinking behind them.

Thirty years ago, zygomatic implants were uncharted territory for the vast majority of clinicians. Today, zygomatic implant therapy represents a milestone of progress in the genesis of oral implantology. As it has become more commonplace, a substantial body of evidence has grown to support it. The technique has been well documented over the long term, with success rates that compare favorably with conventional treatment using dental implants and bone grafting. Changes in zygomatic implant design have occurred over the past 20 years, and with these changes, surgical protocols have also evolved. This chapter examines the evolution of oral rehabilitation with zygomatic implant–supported prostheses, from its origins to the present.

Technique Evolution


Brånemark’s original technique: The beginning of the ZAGA story


In the early 1990s, several reports were published on the possibility of anchoring implants into the zygomatic bone for both nasofacial1 and dental prostheses.2 In 2004, Brånemark et al published a long-term follow-up study on onlay bone grafting and the simultaneous placement of zygomatic implants,3 and zygomatic implants were accepted into the scientific implantology community. In this study, 52 zygomatic implants and 106 conventional implants were placed across 28 patients. Bone grafting was performed in 17 patients. All patients were followed closely for 5 to 10 years. The procedure for placing the zygomatic implants consisted of performing a window antrostomy in the upper lateral quadrant of the anterior maxillary wall. The sinus mucosa was then reflected, and “no special effort was made to keep it intact.”3

According to Brånemark, “the direction of the zygoma fixture was selected to provide optimal stability against prosthetic requirements,” meaning the implant path had a more-or-less palatal point of entry, depending on the curvature of the maxillary wall.3 This implant path was said to achieve an intrasinus trajectory (Fig 1-1). Due to the palatal positioning of the zygomatic implants, the palatal flap had to be thinned and the fat tissue eliminated to prevent any soft tissue inflammation around the final abutments. However, despite the palatal positioning of the implant head, no patient discomfort or speech difficulties were reported in the initial study.

FIG 1-1 This clinical photograph shows some of the features of the original surgical technique, such as palatal entry and the opening of an anterior window to visualize the implant path.

The results


In the long term, there were three reported zygomatic implant failures, reflecting a survival rate of 94.2%. Overall, the prosthetic restoration success rate at 5 years was 96%. At least 96 conventional implants between 10 and 20 mm in length were placed. The success rate for the original conventional implants was about 71%. In 2 of the 28 patients, one of the two zygomatic implants installed was disconnected from the prosthesis due to suppuration at the palatal entry point of the implant combined with sinus infection. Recurrent sinusitis affected four patients within the follow-up time (Fig 1-2). The treatment of these four cases was identical: an antrostomy of the inferior meatus with satisfactory results. An additional four patients were found to have radiographically diagnosed sinusitis with clinically symptom-free maxillary sinuses. In those cases, no treatment was considered necessary. According to the definition of Lanza and Kennedy,4 the percentage of cases that developed clinical sinusitis was 21%. If we also apply the radiologic criteria of Lund and Mackay,5 the percentage of rhinosinusitis would rise to 35.7%.

FIG 1-2(a) Tomographic section of the maxillary sinus taken 1 year after placement of the zygomatic implant through the thin palatal wall. Note the transparency of the maxillary sinus.(b) After a period of 3 years, the patient was diagnosed with rhinosinusitis with radiologic occupation of the sinus with no apparent cause.

In 2010, Bedrossian reported a retrospective follow-up of 36 patients treated with the immediate loading protocol over a period of 5 to 7 years. The survival rate was 97.2