Probiotic supplements and postoperative complications after tooth extractions and third molar surgery: a systematic review.

INTRODUCTION: Probiotics have gained considerable attention as intervention for various conditions in dentistry. The purpose of this review is to evaluate the current literature on the efficacy of probiotic supplements for alleviating symptoms after tooth extractions and third molar surgery. EVIDENCE ACQUISITION: We searched the PubMed and Google Scholar databases up to October 15, 2021 using pertinent keywords to retrieve relevant literature. Based on abstracts, the authors reviewed the full text papers, extracted key outcome data, and assessed the risk of bias. EVIDENCE SYNTHESIS: Four articles based on three RCT's were included of which three allowed compilation. There were no beneficial effects on the occurrence of postoperative infections or alveolitis, but we disclosed a significant trend towards less self-reported pain one week after the tooth extractions (RD -0.22; 95% CI -0.33; -0.11; P<0.05). Findings concerning swelling, discomfort and use of painkillers were inconsistent. CONCLUSIONS: Probiotic supplements may offer clinical benefits within oral surgery, such as alleviating pain after tooth extractions. However, the certainty of these findings was very low due to risk of bias, heterogeneity, and inconsistencies across the studies. Further and larger investigations are required to strengthen the level of evidence.

An open, randomised, multi-centre study, comparing straight and tapered apex implants design, in partially and totally edentulous maxillae.

The design of the commercially available implant OsseoSpeed® (control) was changed to a tapered apex with a smaller apical diameter; OsseoSpeed® TX (test). OBJECTIVE: The present study evaluated the clinical outcome of marginal bone level as primary outcome, and cumulative implant survival rate, primary stability and condition of the peri-implant mucosa as secondary outcomes, one year after loading. MATERIAL AND METHODS: 92 subjects (150 implants, ten centres), with partially or totally edentate maxillae were randomized to receive either test or control implants. One to six implants were placed in each subject using a one-stage surgical procedure. Subjects received a permanent prosthesis 10-12 weeks after implant placement and were followed for one year. RESULTS: 47 subjects in the test group received 82 implants and 45 subjects in the control group received 68 implants. Marginal bone level alterations from loading to 1-year follow-up was -0.02 × 0.41 mm (mean × SD) and -0.03 × 0.38 mm (mean × SD) for the test and the control group, respectively, indicating no difference between the groups. Non-inferiority was declared as confidence interval for the difference between control and test implants was no worse than 0.5 mm. The CSR was 98.8% in the test group and 100% in the control group, with no statistically significant difference between the groups. CONCLUSIONS: Change of the apical design of a commercially available implant showed no significant effect on marginal bone level and CSR compared to the control implant. Missing data and many investigators may have influenced on the result. Trial registration number: NCT01324778.

Treatment of temporomandibular joint luxation: a systematic literature review.

OBJECTIVES: To evaluate the effectiveness of surgical and nonsurgical treatment of temporomandibular joint (TMJ) luxation. MATERIALS AND METHODS: This systematic literature review searched PubMed, the Cochrane Library, and Web of Science databases to identify randomized controlled trials on TMJ luxation treatment published between the inception of each database and 26 March 2018. RESULTS: Two authors assessed 113 unique abstracts according to the inclusion criteria and read nine articles in full text. Eight articles comprising 338 patients met the inclusion criteria, but none of these evaluated surgical techniques. Three studies including 185 patients concerned acute treatment with manual reduction of luxation while five studies including 153 patients evaluated minimally invasive methods with injection of autologous blood or dextrose prolotherapy for recurrent TMJ luxation. These studies reported that mouth opening after treatment was reduced and that independent of type of injection, recurrences of TMJ luxation were rare in most patients. CONCLUSIONS: In the absence of randomized studies on surgical techniques, autologous blood injection in the superior joint space and pericapsular tissues with intermaxillary fixation seems to be the treatment for recurrent TMJ luxation that at present has the best scientific support. Well-designed studies on surgical techniques with sufficient numbers of patients, long-term follow-ups, and patient experience assessment are needed for selection of the optimal surgical treatment methods. CLINICAL RELEVANCE: Autologous blood injection combined with intermaxillary fixation can be recommended for patients with recurrence of TMJ luxation.

Vertical bone augmentation with titanium granule blocks in rabbit calvaria.

To determine whether it is possible to vertically augment bone utilizing a block graft from compressed titanium granules mainly used previously for contained bone defects and to determine whether there exists a difference in osteoconductive properties between the white and the grey granules. In 11 rabbits, 4 titanium blocks were inserted on each rabbit's skull bone according to a randomized scheme. These blocks were made from standardized compressed titanium granules. Type A: PTG grey, small granules (Pourus Titanium Granules, Tigran, Malmö, Sweden); Type B: PTG grey, large granules; Type C: PTG white, small granules; Type D: PTG white large granules. After 12 weeks, the animals were sacrificed and specimens were collected for histology and µCT scanning. From both the µCT and histology, it can be said that bone formation was successfully achieved for all groups, and the granules maintained their volume. The histomorphometric BA (bone area) evaluation in the entire grafted area presented that there were no statistical differences between all groups tested. The lowest 1/4 BA in contact with the rabbit skull presented that groups A and C presented the highest mean BA, and group A presented significantly higher BA than that of group D (p = 0,049). No significant differences were noted between groups A, B and C. Within the limitation of this study, no differences were noted between small white or grey PTG blocks. The large granules presented less bone ingrowth area compared to the small granules and this trend was regardless of the different PTG types. The entire grafted area was not filled with new bone suggesting that bone migration occurred mostly from the existing cortical bone side suggesting contact osteogenesis.

The impact of surface roughness and permeability in hydroxyapatite bone regeneration membranes.

BACKGROUND: One of the crucial aspects in guided bone regeneration is the space maintenance. This is normally created by a membrane, which should primarily be accepted by the surrounding tissues without causing any adverse reactions. The impact of surface topography, biological acceptance as well as permeability of these membranes has been carefully discussed in the literature. PURPOSE: The purpose of this study was to evaluate histologically the bone forming properties inside of hollow hydroxyapatite space-maintaining devices with different inner surfaces and different permeabilities in an animal calvaria model in vivo. MATERIALS AND METHODS: A total of 36 hollow domes with three different designs made of hydroxyapatite were surgically attached to the skulls of rabbits. Group 1 had a moderately rough inner surface. Group 2 had a smooth inner surface. Group 3 had the same properties as Group 1 but had macroscopic holes on the top. The domes were left to heal for 12 weeks and were then processed for undecalcified ground sectioning. Histological evaluations were performed using a light microscope and scanning electron microscopy. The bone-implant contact (BIC) percentage along the device was calculated. RESULTS: The median percentage of BIC was higher for Group 1 compared with Group 2 (P = 0.004). Group 1 produced a larger median BIC compared with Group 3 (P < 0.0001). CONCLUSIONS: Within the limits of this preclinical study, these findings suggest that a moderately rough inner surface of a ceramic membrane along with a non-permeable device produces more bone than a smooth inner surface.

Guided bone augmentation using ceramic space-maintaining devices: the impact of chemistry.

The purpose of the study was to evaluate histologically, whether vertical bone augmentation can be achieved using a hollow ceramic space maintaining device in a rabbit calvaria model. Furthermore, the chemistry of microporous hydroxyapatite and zirconia were tested to determine which of these two ceramics are most suitable for guided bone generation. 24 hollow domes in two different ceramic materials were placed subperiosteal on rabbit skull bone. The rabbits were sacrificed after 12 weeks and the histology results were analyzed regarding bone-to-material contact and volume of newly formed bone. The results suggest that the effect of the microporous structure of hydroxyapatite seems to facilitate for the bone cells to adhere to the material and that zirconia enhance a slightly larger volume of newly formed bone. In conclusion, the results of the current study demonstrated that ceramic space maintaining devices permits new bone formation and osteoconduction within the dome.

Guided bone augmentation using a ceramic space-maintaining device.

OBJECTIVE: The purpose of this study was to evaluate 3-dimensionally whether vertical bone augmentation can be achieved using a hollow hydroxyapatite space-maintaining device in a rabbit calvarial model. Furthermore, different inner surface topographies, different permeabilities, and different porosities of the ceramic were tested to determine the optimal conditions for bone regeneration. STUDY DESIGN: A total of 48 hollow domes made of hydroxyapatite in 4 different designs were placed subperiosteally on rabbit skull bone. The rabbits were humanely killed after 12 weeks, and the results were analyzed 3-dimensionally using micro-computed tomography. RESULTS: The results suggest a larger production of bone volume when using an occlusive, dense hydroxyapatite space-maintaining device with a rough inner surface. CONCLUSIONS: Hydroxyapatite space-maintaining devices permit new bone formation and osteoconduction within the dome.

Surgical treatment of recurring ameloblastoma, are there options?

Our aim was to evaluate the treatment given to patients with intraosseus ameloblastomas with special emphasis on recurrence and the outcomes of primary and secondary resection. Forty-eight patients who were treated for intraosseous ameloblastoma at 8 centres across Sweden met the inclusion criteria. They showed typical distribution of age, sex, site of lesion, and characteristic presenting features. Eleven of the 48 were initially treated with radical resection and none recurred. Twenty-two of the remaining 37 who were initially treated by conservative resection presented with recurrences. Sixteen of the 22 then had conservative secondary resections, which resulted in further recurrence in 6 patients. Initial radical resection is therefore superior to conservative management as far as recurrences are concerned. We argue, however, that a conservative surgical approach is adequate for many intraosseous ameloblastomas with limited extension, because relapse can be followed by radical resection if clinically indicated in selected cases.

Periosteal expansion before local bone reconstruction using a new technique for measuring soft tissue profile stability: a clinical study.

PURPOSE: To evaluate the outcome of intraoral soft tissue expansion by measuring the profile change using objective 3D metering equipment and to evaluate localized bone grafting after soft tissue expansion with regard to gain of bone and complications. MATERIALS AND METHODS: Using a prospective study design, we asked patients with an osseous and soft tissue defect on the buccal aspect of the alveolar process to participate in this study. In 10 patients (experimental group) a self-inflatable soft tissue expander was placed under the periosteum. After 2 weeks, the expander was removed and a particulated onlay bone graft was placed in the expanded area, protected by a titanium mesh covered with a collagen membrane. Ten patients (reference group) were treated with a mandibular ramus bone block graft. The soft tissue profile was registered before each surgical procedure. The vertical and lateral dimensions of the bone grafts were noted at the grafting procedure and at the implant installation. P < .05 was considered significant. RESULTS: The mean soft tissue profile change was 2.9 ± 1.1 mm after soft tissue expansion and 2.3 ± 2.1 mm at implant placement in the experimental group compared with 1.5 ± 1.4 mm at implant placement in the reference group (P = .065). Two patients had minor perforations of the soft tissue expander. In the experimental group, the mean lateral bone augmentation after soft tissue expansion was 4.5 ± 1.3 mm, and after healing, it decreased to 3.9 ± 1.4 mm (P = .063). The mean vertical augmentation was 4.1 ± 1.7 mm and had decreased at implant placement to 3.0 ± 1.4 mm (P = .041). In the reference group, the mean lateral augmentation was 3.8 ± 0.8 mm, and after healing, it reduced to 2.7 ± 0.8 mm (P = .024). The mean vertical augmentation was 2.9 ± 0.9 mm, and after healing of the bone graft at implant placement, it was reduced to 1.6 ± 0.8 mm (P = .01). When smokers were excluded, there was significantly less resorption of the bone grafts in both lateral (P = .049) and vertical (P = .012) dimensions in the experimental group compared with the reference group. CONCLUSION: Hydrogel expansion of the periosteum is an applicable method to achieve a surplus of soft tissue to cover bone grafts. More refinements to the technique may be required to minimize complications, especially in smoking patients.

Periapical tissue response after use of intermediate restorative material, gutta-percha, reinforced zinc oxide cement, and mineral trioxide aggregate as retrograde root-end filling materials: a histologic study in dogs.

PURPOSE: To investigate the periapical tissue response of 4 different retrograde root-filling materials, ie, intermediate restorative material, thermoplasticized gutta-percha, reinforced zinc oxide cement (Super-EBA), and mineral trioxide aggregate (MTA), in conjunction with an ultrasonic root-end preparation technique in an animal model. MATERIALS AND METHODS: Vital roots of the third and fourth right mandibular premolars in 6 healthy mongrel dogs were apicectomized and sealed with 1 of the materials using a standardized surgical procedure. After 120 days, the animals were sacrificed and the specimens were analyzed radiologically, histologically, and scanning electron microscopically. The Fisher exact test was performed on the 2 outcome values. RESULTS: Twenty-three sections were analyzed histologically. Evaluation showed better re-establishment of the periapical tissues and generally lower inflammatory infiltration in the sections from teeth treated with the intermediate restorative material and the MTA. New root cement on the resected dentin surfaces was seen on all sections regardless of the used material. New hard tissue formation, directly on the surface of the material, was seen only in the MTA sections. There was no statistical difference in outcome among the tested materials. CONCLUSIONS: The results from this dog model favor the intermediate restorative material and MTA as retrograde fillings when evaluating the bone defect regeneration. MTA has the most favorable periapical tissue response when comparing the biocompatibility of the materials tested.

Guided bone generation in a rabbit mandible model after periosteal expansion with an osmotic tissue expander.

OBJECTIVES: To evaluate the space-maintaining capacity of titanium mesh covered by a collagen membrane after soft tissue expansion on the lateral border of the mandible in rabbits, and to assess bone quantity and quality using autogenous particulate bone or bone-substitute (Bio-Oss(®) ), and if soft tissue ingrowth can be avoided by covering the mesh with a collagen membrane. MATERIAL AND METHODS: In 11 rabbits, a self-inflatable soft tissue expander was placed under the lateral mandibular periosteum via an extra-oral approach. After 2 weeks, the expanders were removed and a particulated onlay bone graft and deproteinized bovine bone mineral (DBBM) (Bio-Oss(®) ) were placed in the expanded area and covered by a titanium mesh. The bone and DBBM were separated in two compartments under the mesh with a collagen membrane in between. The mesh was then covered with a collagen membrane. After 3 months, the animals were sacrificed and specimens were collected for histology. RESULTS: The osmotic soft tissue expander created a subperiosteal pocket and a ridge of new bone formed at the edges of the expanded periosteum in all sites. After the healing period of 3 months, no soft tissue dehiscence was recorded. The mean bone fill was 58.1±18% in the bone grafted area and 56.9±13.7% in the DBBM area. There was no significant difference between the autologous bone graft and the DDBM under the titanium mesh with regard to the total bone area or the mineralized bone area. Scanning electron microscopy showed that new bone was growing in direct contact with the DBBM particles and the titanium mesh. There is a soft tissue ingrowth even after soft tissue expansion and protection of the titanium mesh with a collagen membrane. CONCLUSION: This study confirms that an osmotic soft tissue expander creates a surplus of periosteum and soft tissue, and that new bone can subsequently be generated under a titanium mesh with the use of an autologous bone graft or DBBM.

Development and evaluation of a liquid chromatography tandem mass spectrometry method for simultaneous determination of salivary melatonin, cortisol and testosterone.

Circadian disruption can have several possible health consequences, but is not well studied. In order to measure circadian disruption, in relation to shift or night work, we developed a simple and sensitive method for the simultaneous determination of melatonin, cortisol and testosterone in human saliva. We used liquid-liquid extraction (LLE) followed by liquid chromatography coupled to electrospray tandem mass spectrometry (LC-ESI-MS/MS) recorded in positive ion mode. Saliva samples were collected by spitting directly into tubes and 250 µL were used for analysis. The limits of detection were 4.1 pmol/L, 0.27 nmol/L and 10.8 pmol/L for melatonin, cortisol, and testosterone, respectively. The developed method was sensitive enough to measure circadian rhythms of all 3 hormones in a pilot study among four healthy volunteers. It can therefor be used to study the impact of night work and working in artificial light on the workers circadian rhythms. To our knowledge this is the first LC-ESI-MS/MS method for simultaneous determination of salivary melatonin, cortisol and testosterone.

Intra-oral soft tissue expansion and volume stability of onlay bone grafts.

Insufficient regeneration of missing bone and soft-tissue may present aesthetic or functional problems in patients indicated for dental implant surgery. Several techniques such as bone grafts, bone substitutes and guided tissue regeneration (GTR) have been described to rebuild a compromised alveolar ridge. Adequate soft-tissue coverage of grafted bone and titanium-mesh is important to avoid exposure which may result in loss of the bone graft. The general aim of this thesis was to evaluate use of an osmotic tissue expander for expanding intra-oral soft tissue--creating a surplus of soft tissue-- in preparation for onlay bone grafting. An experimental rabbit model was used in studies (I), (II) and (III). In (I) an osmotic soft-tissue expander was placed bilaterally on the lateral wall of the mandible via an extra-oral approach. After two weeks of expansion the rabbits were killed and specimens were collected for histology. No inflammatory reaction and no resorbtion of the cortical bone occured. The periosteum was expanded and new bone formation was seen in the edges of the expander. In (II) and (III) the expander was placed under the periosteum in the same way as in (I): bilaterally in 13 rabbits in (II) and unilaterally in 11 rabbits in (III). After two weeks of expansion the expander was identified and removed. In (II) particulated bone was placed at the recipient site protected by a titanium mesh in one site and a bio-resorbable mesh on the other site. In (III), DBBM particles and bone particles collected from the lateral border of the mandible separated by a collagen membrane was placed at the recipient site. The graft was protected by a pre-bent titanium mesh covered by a collagen membrane. After a healing period of 3 months specimens were collected for histological and SEM examination. New bone was growing in direct contact with the titanium mesh and bio resorbable mesh. The newly formed bone had the same calcium content as the mature bone in the base of the mandible. In the clinical study (IV) 20 patients were consecutively recruited and randomised into two groups. The experimental group (ten patients) had an osmotic soft tissue expander implanted. After two weeks of expansion the expander was removed and a particulated bone graft protected by a titanium mesh and a collagen membrane was fixed to the recipient site. Titanium implants were installed after a healing period of 6 months. The patients in the reference group had a bone block grafted from the anterior ramus fixated to the recipient site with one or two titanium mini screws. Implants were installed after a healing period of 6 months. A three dimensional optical measuring device was used to measure alterations in the soft tissue profile before each surgical procedure. The three-dimensional changes were then analysed on a PC. The results from the clinical study in patients confirmed the results from the experimental rabbit studies. The osmotic tissue expander expanded the soft tissue. Expander perforations of the soft tissue occurred in two patients. The optical measurements demonstrated a positive volume gain after soft tissue expansion and bone grafting. The expanded tissue could be used to cover a bone graft. There still was a risk of mesh exposure, even after soft tissue expansion, which occurred in two patients. In both groups, implants could be installed in the grafted bone in positions that would allow the crowns to fit aesthetically into the dental arch.

Super-EBA and IRM as root-end fillings in periapical surgery with ultrasonic preparation: a prospective randomized clinical study of 206 consecutive teeth.

OBJECTIVE: This study evaluated the treatment outcome after periapical surgery with the use of 2 different retrograde root-filling materials and the influence of 3 pre- and perioperative variables on the periapical healing. STUDY DESIGN: Two hundred six teeth in 164 patients were randomly allocated to receive either IRM or Super-EBA as a retrograde root-end seal. The teeth were reviewed 12 months after surgery. The influence of lesion size, lesion type, and orthograde root filling quality on healing was analyzed. RESULTS: One hundred ninety-four teeth in 153 patients were reviewed. Radiologic evaluation and clinical examination revealed 91% success rate for the IRM group and 82% for the Super-EBA group. There was no statistical significance in the healing outcome between the 2 groups (Fisher exact test). The analyzed pre- and perioperative variables had no significant influence on the treatment outcome (Z test). CONCLUSIONS: Both retrograde materials tested in this study can serve as a root-end seal in periapical infected teeth, according to the results of the healing outcome after 12 months' follow-up.

Onlay bone grafting of the mandible after periosteal expansion with an osmotic tissue expander: an experimental study in rabbits.

OBJECTIVES: To evaluate the space-maintaining capacity of a titanium mesh or a bioresorbable mesh after periosteal expansion and to assess bone formation under a titanium mesh or a bioresorbable mesh on the lateral border of the mandible by qualitative and quantitative histological analysis. MATERIAL AND METHODS: In 13 rabbits, a self-inflatable soft tissue expander was placed intraorally, bilaterally under the mandibular periosteum via an extra oral approach. After 2 weeks, the expanders were removed and a particulated onlay bone graft was placed and covered by a titanium mesh or a bioresorbable mesh. After 3 months, the animals were sacrificed and specimens were collected for histology. RESULTS: The osmotic soft tissue expander created a subperiosteal pocket and a ridge of new bone had formed at the edges of the expanded periosteum in all sites. After the healing period of 3 months, soft tissue dehiscence was recorded in two of the sites with bioresorbable meshes. The mean bone fill was 65% under the titanium mesh and 85% under the bioresorbable mesh (P<0.05). There was no significant difference between the titanium mesh and the bioresorbable mesh regarding the height of the meshes, mesh area and mineralized bone area. Scanning electron microscopy shows that new bone is growing in direct contact with the resorbable mesh and the titanium mesh. CONCLUSION: This study confirms that an osmotic soft tissue expander creates a surplus of periosteum and soft tissue and that new bone can be generated under a titanium mesh or bioresorbable mesh.

Periapical surgery using ultrasonic preparation and thermoplasticized gutta-percha with AH Plus sealer or IRM as retrograde root-end fillings in 160 consecutive teeth: a prospective randomized clinical study.

OBJECTIVE: The aim of this study was to evaluate the healing outcome after periapical surgery with an ultrasonic cleaning technique in conjunction with the use of either of 2 different retrograde root-filling materials in teeth with apical periodontitis. STUDY DESIGN: One hundred sixty teeth in 139 consecutive patients were randomly allocated into 2 groups receiving either IRM or thermoplasticized gutta-percha (GP) with AH Plus sealer as a retrograde root-end seal. The patients were reviewed 12 months after surgery. The results were analyzed with Fisher exact test. RESULTS: One hundred forty-seven teeth in 131 patients were reviewed. Radiologic evaluation and clinical examination showed an 85% success rate for the IRM group and 90% for GP group. There was no statistical significance between the 2 groups. CONCLUSION: Both tested materials, IRM and GP, are suitable as retrograde root-end filling materials in conjunction with ultrasonic root-end preparation according to the results of the healing outcome after 12 months follow-up.

Periosteal expansion of rabbit mandible with an osmotic self-inflatable expander.

We aimed to evaluate a new technique for intraoral expansion of soft tissue with a self-inflatable expander in rabbits. We placed a self-inflatable soft tissue expander bilaterally in eight rabbits under the periosteum of the mandible through an extraoral approach. The expander was left to self-inflate for two weeks, after which the animals were killed and specimens collected for histological examination. The self-inflatable soft tissue expanders expanded the periosteum. There were no dehiscences or infections. Histological observations showed no signs of any inflammatory reaction and there was no evidence of bony resorption. New bone had formed at the edges of the expanded periosteum. In the control area no new bone had formed. The osmotic soft tissue expander model for intraoral soft tissue and periosteal expansion suggests a promising way of creating a surplus of soft tissue that can be used to cover bone grafts.

Prospective study of periapically infected teeth treated with periapical surgery including ultrasonic preparation and retrograde intermediate restorative material root-end fillings.

PURPOSE: The aim of this prospective study was to evaluate the current method of periapical surgery at the Maxillofacial Unit, Halmstad Hospital, which included ultrasonic root-end preparation and the use of intermediate restorative material as a root-end filling material. PATIENTS AND METHODS: Fifty-five consecutive patients with a total of 56 treated teeth, within the close vicinity of the hospital, were included in the study during a period of 10 months in 2002. Teeth with advanced periodontal bone loss or presence of root fractures were excluded from the study. RESULTS: All teeth but 1 were followed up after 1 year (12-19 months). Radiological evaluation (complete or incomplete healing) and clinical examination showed an 80% success rate. Twenty percent of the patients were stated as failures (uncertain healing and unsatisfactory healing). The success rate was highest among incisors (100%) and lowest among molars and premolars (78% and 69%, respectively). CONCLUSION: Compared with other studies, these findings seemed to be a bit inferior regarding success rate. However, our study population was not selected for the study purpose but rather represented the true clinical variety taken care of in our practice.

Evaluation of 31 zygomatic implants and 74 regular dental implants used in 16 patients for prosthetic reconstruction of the atrophic maxilla with cross-arch fixed bridges.

BACKGROUND: The use of a specially designed implant to be anchored in the zygomatic body has been proposed as an alternative to bone grafting in the prosthetic rehabilitation of the severely resorbed maxilla. However, few studies have evaluated the long-term stability and soft tissue conditions of zygomatic implants. PURPOSE: The aim of this retrospective study was to evaluate the clinical performance of zygomatic implants when used for prosthetic reconstruction of atrophic maxillae. MATERIALS AND METHODS: Sixteen patients consecutively treated with 31 zygomatic implants and 74 additional dental implants from 1998 to 2002 were retrospectively evaluated and prospectively followed using a standardized clinical and radiographic study design. Data were collected from the time of implant treatment until the last follow-up RESULTS: The follow-up period ranged from 9 to 69 months from the day of implant treatment, with a mean of 46.4 months (3 years, 10 months). Three (9.7%) of the 31 zygomatic implants were surgically removed because of recurrent sinusitis. Three (4.1%) of the 71 additional dental implants failed to integrate. Poor oral hygiene and gingivitis were seen at most zygomatic implant sites (10/16). Local infections were observed in 9 of 16 patients. Sinusitis occurred in 6 patients. All patients (16/16) eventually received fixed bridges, which were stable throughout the observation period. CONCLUSIONS: The results showed an acceptable outcome with regard to implant and prosthetic survival rates. However, postoperative complications not related to implant and prosthesis stability were frequent. Further investigations of the long-term performance of zygomatic implants and with a focus on soft tissue and maxillary sinus health are needed.