The use of zygomatic implants in severe maxillary atrophy: a systematic and meta-analysis review of randomised clinical trials / El uso de implantes zigomáticos para atrofia maxilar severa: una revisión sistemática y meta-análisis de ensayos clínicos aleatorizados

SUMMARY: Conventional implant treatment cannot always be used to rehabilitate edentulous patients with advanced maxillary atrophic. Zygomatic dental implants have been used over the past 20 years as an alternative treatment solution to bone grafting. The purpose of this meta-analysis is to evaluate the implant and prosthetic survival rate in non-oncologic patients with a severely atrophic maxilla. This review also aims to better understand the rate of peri-operative complications in this cohort of patients. A multi-database (PubMed, MEDLINE, EMBASE, and CINAHAL) focused systematic search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Any randomised control trials studies involving human participants treated with zygomatic osseous implants were included. After eliminating duplicates, a total of 4 studies met the inclusion criteria for this meta-analysis review. With all the studies included there was a total of 174 patients treated with zygomatic osseous implants. The overall implant success rate was 98.03 %. The prosthetic success rate was 96.4 %. The most frequent peri-operative complication was sinusitis. Based on the limited data available in literature, zygomatic dental implants represent a valid alternative to bone augmenting procedure. However, they are not without risks and longer follow-ups are required to confirm the validity of the treatment in long term.

Los tratamientos convencionales con implantes no siempre pueden ser usados para rehabilitar pacientes edentulos con atrofia maxilar avanzada. Los implantes dentales zigomáticos son usados por los pasados 20 años como alternativa de tratamiento a las reconstrucciones óseas. El objetivo de este meta-análisis es evaluar la sobrevida de implantes y prótesis en pacientes no oncológicos con maxila severamente atrófica. Esta revisión también pretende entender al promedio de complicaciones peri operatorias en esta cohorte de pacientes. Una búsqueda sistemática en bases de datos múltiples (PubMed, MEDLINE, EMBASE y CINAHAL) fue desarrollada de acuerdo a recomendaciones de Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Cualquier estudio clínico aleatorizado de participantes humanos donde se utilizaron los implantes zigomáticos fueron incluidos. Después de eliminar duplicados, un total de 4 estudios cumplieron los criterios de inclusión para esta meta análisis. Con todos los estudios incluidos se obtuvieron 174 pacientes tratados con implantes zigomáticos. El promedio de éxito fue de 98,03 %. El promedio de éxito de la rehabilitación fue de 96,4 %. La complicación mas frecuente fue la sinusitis. Basados en los datos limitados en la literatura, los implantes zigomáticos representan una alternativa valida a los procedimientos de aumento óseo. Sin embargo, estos no están libres de riesgos y seguimientos de mayores periodos son necesarios para confirmar la validez de los tratamientos en el largo plazo.

Zygomatic implants in intra-sinus versus extra-maxillary approaches for prosthetic rehabilitation in severely atrophic maxillae: finite element analysis / Implantes cigomáticos en abordajes intra sinusal versus extra maxilar para rehabilitación protésica en maxilares severamente atróficos: análisis de elementos finitos

Objetive: To compare the stresses and deformations generated on the surrounding bone of the zygomatic implants when using an intra sinusal and extra-maxillary approach, through the finite element method. Material and Methods: Computer aided designs (CADs) were constructed using SolidWorks Software of a skull with bone resorption to be rehabilitated through a fixed hybrid prosthesis using two zygomatic and two conventional straight implants. For the boundary conditions (load conditions), symmetry in the sagittal plane was assumed and that all the materials were isotropic, homogeneous and linearly elastic. Two zygomatic implantation techniques were simulated: intra sinusal (Is) and extra maxillary (Em). Vertical and lateral loads of 150 N and 50 N were applied to the finite element models to obtain Von Mises equivalent stress and strain (displacement). Results: The average measurement of the Von Mises stress (MPa) recorded were as follows: Approach of the implant body (Is: 0.24- Em: 0.28,) effort of implant body with vertical load: Is: 0.69 - Em: 0.96; effort of peri-implant surface under horizontal load: Is: 2.11 - Em: 0.94. Average displacement under vertical load of peri-implant surface Is: 0.35 - Em: 0.40, and of implant body Is: 1.34 - Em: 2.04. Average total deformation in approach Is: 2.23 mm - Em: 0.80mm, and average total deformation in the implant body under horizontal load was Is: 0.14 - Em: 0.21. Conclusion: The results of this study indicate that despite the differences that occurred in both stress and strain (displacement) between the intra-sinus and extra-maxillary approaches, the static strength of the bone, which is approximately 150 MPa in tension and 250 MPa in compression was not exceeded. Considering the limitations of finite element analysis, there seems to be no biomechanical reason to choose one approach over the other.

Objetivo: Comparar por el método de elementos finitos los esfuerzos y deformaciones generados sobre el hueso circundante de implantes cigomáticos tratados con un abordaje intra sinusal y extra maxilar. Material y Métodos: Se construyeron los diseños asistidos por computadora (CAD) utilizando el Software SolidWorks de un cráneo con una reabsorción ósea para ser rehabilitado, a través de una prótesis híbrida fija, mediante dos implantes cigomáticos y dos rectos convencionales. Para las condiciones de frontera (condiciones de carga) se asumió simetría en el plano sagital y que todos los materiales eran isotrópicos, homogéneos y linealmente elásticos. Se simularon dos técnicas de implantación cigomática: una intra sinusal (Is) y otra extra maxilar (Em). Se aplicaron cargas verticales y laterales de 150 N y 50 N a los modelos de elementos finitos para obtener el esfuerzo equivalente de Von mises y la deformación (desplazamiento). Resultados: La medición promedio del esfuerzo de Von Mises (MPa) registró: abordaje del cuerpo de implante (Is: 0.24-Em: 0.28) esfuerzo del cuerpo de implante con carga vertical: (Is:0.69 ­ Em: 0.96); esfuerzo de la superficie peri implantar ante carga horizontal (lateral):( Is:2.11 ­ Em:0.94). Desplazamiento promedio ante carga vertical de la superficie peri implantar (Is:0.35 ­ Em:0.40) y del cuerpo del implante (Is:1.34 ­ Em:2.04). Deformación total promedio en mm en abordaje (Is: 2.23 ­ Em:0.80) y deformación total promedio en el cuerpo del implante ante carga horizontal (Is:0.14 ­ Em:0.21). Conclusión: Los resultados de este estudio indican que a pesar de las diferencias que se presentaron tanto en el esfuerzo como en la deformación (desplazamiento) entre los abordajes intra sinusal y extra maxilar, la resistencia estática del hueso, que es de aproximadamente 150 MPa en tensión y 250 MPa en compresión no se superó. Considerando las limitaciones de los AEF, parece no haber razones biomecánicas para elegir uno u otro enfoque.

Estabilização zigomática e retalho de avanço facial lateral em canino filhote / Zygomatic stabilization and lateral facial advancement flap in a puppy dog

O trauma é frequentemente relatado na rotina clínica de pequenos animais, podendo gerar fraturas de componentes ósseos e lesões de tecidos moles adjacentes. No presente trabalho, objetivou-se relatar o caso de um canino, macho, sem raça definida, de sete meses de idade, vítima de trauma craniomaxilofacial decorrente de mordedura, diagnosticado com fratura e deslocamento de osso zigomático, além de importante laceração de pele. O tratamento estabelecido baseou-se no debridamento da ferida, estabilização cirúrgica de arco zigomático com fios de Nylon e na sutura dos ferimentos de pele causados. Em um segundo tempo cirúrgico, foi realizada enucleação e recobrimento do defeito na órbita com malha cirúrgica de polipropileno, além de remoção de tecido exuberante e confecção de retalho subdérmico de avanço facial lateral para recobrimento do defeito cutâneo. A complicação evidenciada na primeira intervenção cirúrgica foi a deiscência das suturas de pele, enquanto no segundo tempo cirúrgico, não houve sinais de complicações. No pós-operatório, o paciente apresentou evolução clínica satisfatória, recebendo alta médica 21 dias após o segundo procedimento cirúrgico realizado. Tendo em vista a adequada evolução clínica, bem como os reduzidos efeitos colaterais, sugere-se que a conduta clínica e técnicas cirúrgicas adotadas para tratamento do paciente em questão foram efetivas.

Trauma is frequently reported in the small animal clinics, and can lead to fractures of cranial bone components and injuries to the adjacent soft tissues. In the present study, the objective was to report the case of a seven-month-old male mongrel dog, that had a craniomaxillofacial trauma resulting from a bite, characterized by zygomatic bone fracture and displacement, in addition to a major skin laceration. The stablished treatment was based on wound debridement, surgical stabilization of the zygomatic arch with nylon threads and in the suturing of skin wounds. In a second surgical procedure, enucleation was performed and a surgical polypropylene mesh was applied to cover the orbital defect, exuberant tissue was removed and a subdermal advancement flap was used to cover the skin defect. The complication observed in the first surgical intervention was dehiscence of the skin sutures, while in the second surgical procedure, there were no signs of complications. Postoperatively, the patient had a satisfactory clinical recovery, being discharged 21 days after the second surgical procedure. Considering the adequate clinical evolution and the reduced complications, it issuggestedthat the clinical conduct and surgical techniques adopted for the treatment of the patient in question were effective.

Reabilitação de maxila atrófica com implantes zigomáticos: relato de caso / Rehabilitation of atrophic maxilla with zygomatic implants: case report

Introdução: maxilas severamente atrofiadas representam um desafio às reabilitações implantossuportadas. A reconstrução maxilar com enxertos ósseos para permitir a reabilitação com implantes osseointegrados é um tratamento com boa previsibilidade e alto índice de sucesso. No entanto, a morbidade causada pela necessidade de regiões doadoras e grande quantidade de osso dificulta a aceitação dos pacientes, podendo, inclusive, ser contraindicada dependendo da condição sistêmica. Objetivos: revisar a literatura, discutir as indicações, as complicações, a previsibilidade das reabilitações com implantes zigomáticos, assim como relatar um caso. Relato de caso: os implantes zigomáticos surgiram como uma alternativa para a reabilitação de pacientes maxilectomizados, decorrente da exérese de tumores, perdas ósseas decorrentes de infecções ou traumas, e casos de atrofia óssea severa, como abordado no caso em questão, em que a paciente apresentava edentulismo total em maxila e não gostaria mais de utilizar a prótese convencional, optando pela prótese sobre implante. Considerações finais: a reabilitação com implantes zigomáticos pode apresentar complicações, como o mau posicionamento dos implantes, comprometendo a reabilitação; todavia, apesar das restrições da técnica, a literatura mostra que os implantes zigomáticos, quando bem indicados, representam uma boa alternativa para a reabilitação de maxilas severamente atrofiadas.(AU)

Introduction: severely atrophied jaws pose a challenge to implant-supported rehabilitations. Maxillary reconstruction with bone graft to allow rehabilitation with implants is a treatment with good predictability and high success rate. However, a morbidity is the disease of the donor regions and the greater amount of bone hinders the acceptance of the patients; including, to be contraindicated depending on the systemic condition. Objectives: this article is a review of the literature, such as the indications, complications, predictability of rehabilitations with zygomatic implants, as well as a case report. Case report: the zygomatic implants appeared as an alternative for the rehabilitation of maxilectomized patients, due to the excision of tumors, bone losses due to infections or trauma and cases of severe bone atrophy, as approached in the case in question, in which the patient had total maxillary edentulism and would no longer like to use the conventional prosthesis, opting for the implant prosthesis. Final considerations: rehabilitation with zygomatic implants may present complications, such as poor placement of implants, compromising rehabilitation; however, despite the limitations of the technique, the literature shows that zygomatic implants, when well indicated, represent a good alternative for the rehabilitation of severely atrophied maxilla.(AU)

Surgical Management of a Firearm Injury in the Infraorbital Area / Manejo quirúrgico de una herida por arma de fuego en el área infraorbitaria

Abstract The surgical management of firearm injuries to the zygomaticomaxillary complex is a topic that needs to be addressed with much care. The complications that can arise during treatment, as well as the potential residual problems that can appear, lead to the need of recognizing these injuries as a maxillofacial treatment challenge. The infraorbital zone is the second most common area of injury in the face, accounting for up to 45% of midfacial fractures. The case presented is of a 54 year old man affected by the backward firing of a gun rifle that caused an oblique impaction towards the posterior lateral inferior side of the infraorbital complex. He was rapidly stabilized with an antibiotic and analgesic scheme, yet presented the following: a comminute fracture of the orbit floor with consequent communication towards the maxillary sinus, a non-displacing fracture of the frontomalar suture, a non-displacing fracture of the zygomatic arch and a lesion with loss of osseous tissue in the petrous region of the temporal bone. Rigid fixation followed stabilization, and the area was covered with a titanium mesh. Occasional tinnitus and photopsia were reported by the patient upon return, yet all other evaluated factors were in order. There have been different forms of management described in the literature, and it is recognized that each patient has different needs, therefore each case must be closely evaluated, so it is approached in the most appropriate manner.

Resumen El manejo quirúrgico de las lesiones por armas de fuego al complejo cigomaticomaxilar representa una situación compleja en la práctica maxilofacial que debe ser abordada con extrema cautela, debido a las complicaciones que pueden surgir durante el tratamiento y los potenciales problemas residuales. La zona infraorbitaria es la segunda área más común de lesiones en la cara, representando hasta 45% de las fracturas mediocraneales. El presente caso es de un masculino de 54 años de edad, que sufrió trauma ocasionado por la parte trasera de un rifle de caza que causó un impacto en sentido oblicuo hacia el lado lateral inferior del complejo infraorbitario. El paciente fue estabilizado con esquema antibiótico y analgésico, el diagnóstico fue: fractura cominuta del piso de la órbita, con consecuente comunicación al seno maxilar, fractura no desplazada de la sutura frontomalar, fractura no desplazada del arco cigomático, y lesión con pérdida de tejido óseo en la región petrosa del hueso temporal. El tratamiento quirúrgico consistió en reducción de las fracturas y fijación rígida de las estructuras. Al control post operatorio el paciente refirió acufenos y fotopsia ocasional, no presentando otras alteraciones. Se ha descrito en la literatura diferentes abordajes para el manejo de estos traumatismos, sin embargo cada caso debe ser individualizado y evaluado de forma minuciosa para que éste, sea el adecuado.

Zygomatic arch fracture in a dog treated with Veterinary Cuttable Plate - case report / Fratura de arco zigomático em um cão tratado com placa veterinária cortável - relato de caso

The purpose of this paper is to describe a case of a right zygomatic arch fracture in a 5-year-old male Labrador Retriever diagnosed with aid of 3D Computed Tomography reconstruction. Because of the depressed fracture and interference with the eyeball, surgical repair of the right zygomatic arch fracture was performed with open reduction and stabilization with an 11-hole, 2.7mm Veterinary Cuttable Plate. Radiographs taken 60 days after surgery revealed that fracture healing occurred without complications with improved function and cosmetic appearance. Ninety days after surgery the patient was clinically discharged.(AU)

O objetivo deste trabalho é descrever um caso de fratura do arco zigomático direito em um Labrador Retriever, macho, de cinco anos de idade, diagnosticado com reconstrução 3D de tomografia computadorizada. Devido à depressão da fratura e à interferência com o globo ocular, reparação cirúrgica da fratura do arco zigomático direito foi realizada com redução aberta e estabilização com uma placa veterinária cortável de 2,7mm e 11 orifícios. As radiografias realizadas 60 dias após a cirurgia revelaram que a consolidação óssea ocorreu sem complicações, com melhor funcionalidade e aparência estética. Noventa dias após a cirurgia, o paciente teve alta clínica.(AU)

Zygomatic implant: late complications in a period of 12 years of experience

ABSTRACT: Purpose Zygomatic implants (ZI) constitute a suitable alternative for treating severe maxillary atrophy. However, a large number of complications associated with ZI have been reported in the literature. This paper presents the late complications associated with ZI during 12 years of experience in the same institution. Materials and methods All cases of ZI from 2000 to 2013 were retrospectively evaluated and the major complications relating to this type of rehabilitation were selected to report. Results The major complications found were: loss of implant, loss of osseointegration, bucco-sinusal communication, fenestration of alveolar mucosa, sinus pathology, and emergency palate fixations. Conclusion The clinical experience of the dental surgeon is critical in the success of zygomatic fixation. Furthermore, there should be careful planning of rehabilitation to reduce the rate of complications.

Post-operative hemimaxillectomy rehabilitation using prostheses supported by zygoma implants and remaining natural teeth

OBJECTIVES: This study aimed to evaluate the stability of prostheses supported by zygoma implants and remaining teeth for subjects who had undergone hemi-maxillectomy. METHODS: Ten patients were included in the study. Oral rehabilitation was performed using a temporary prosthesis that was supported by remaining teeth for the first three months. Then, a zygoma implant was placed to provide support for a final prosthesis in addition to the remaining teeth. Each prosthesis was tailor-made according to biomechanical three-dimensional finite element analysis results. The patients were assessed using the prosthesis functioning scale of the Memorial Sloan-Kettering Cancer Center. In addition, retention and bite force were recorded for both the temporary prosthesis and the final prosthesis. RESULTS: The mean bite force of the prosthetic first molar was increased to 69.2 N. The mean retentive force increased to 13.5 N after zygoma implant insertion. The bite force on the prosthetic first molar was improved to 229.3 N. CONCLUSION: Bite force increased significantly with the support of a zygoma implant. The use of zygoma implants in the restoration of maxillary defects improved functional outcome and patient satisfaction.

Comparação entre acesso transconjuntival com cantotomia lateral e acesso subciliar para tratamento das fraturas zigomáticoorbitárias / Comparison between transconjunctival access with lateral canthotomy and subciliary access for the treatment of orbitozygomatic fractures

INTRODUÇÃO: Fraturas zigomático-orbitárias são as mais comuns do terço médio da face. As principais causas de fraturas são os acidentes de trânsito, principalmente por motocicletas, e a violência interpessoal. Os princípios básicos para o tratamento das fraturas faciais são a redução e a fixação do foco fraturário. É fundamental que o acesso cirúrgico seja o mais direto e amplo possível. Pode ser utilizada abordagem subciliar e transconjuntival com cantotomia lateral. O objetivo deste estudo é avaliar e comparar as complicações, vantagens e desvantagens da abordagem transconjuntival com cantotomia lateral e o acesso subciliar convencional. MÉTODOS: Foram selecionados 15 pacientes nos quais as fraturas foram abordadas por meio de incisão subciliar e 15 pacientes nos quais as fraturas foram abordadas por incisão transconjuntival com cantotomia lateral e avaliadas a incidência de complicações com os dois métodos. Os dados foram analisados estatisticamente com o software SPSS 20.0. RESULTADOS: Foram operados 30 pacientes, metade com acesso subciliar e metade com acesso transconjuntival. Os traumas ocorreram mais frequentemente aos finais de semana. As complicações mais frequentes foram cicatriz aparente (26%), esclera aparente (23,3%) e ectrópio (20%). Ectrópio foi mais comum no grupo acima de 60 anos. CONCLUSÃO: Ambas as técnicas foram eficazes para correção das fraturas do complexo zigomático-orbitário. A técnica transconjuntival proporciona cicatrizes mais estéticas e menos estigmatizantes, constituindo hoje a primeira escolha do autor. A incidência global de complicações foi semelhante entre as duas técnicas. Ectrópio foi menos frequente com acesso transconjuntival.

INTRODUCTION: Orbitozygomatic fractures most commonly occur in the midface. The main causes of fractures are traffic accidents, mainly by motorcycles, and interpersonal violence. The basic principles for the treatment of facial fractures are the reduction and fixation of the fracture site. It is fundamental that the surgical access be the most direct and broad as possible. Either the subciliary approach or transconjunctival access with lateral canthotomy can be used. The objective of this study was to evaluate and compare the complications, advantages, and disadvantages of the transconjunctival approach with lateral canthotomy and conventional subciliary access. METHODS: We selected 15 patients in whom fractures were addressed through a subciliary incision and 15 patients in whom the fractures were addressed by using a transconjunctival incision with lateral canthotomy, and evaluated the incidence of complications with the two methods. The data were statistically analyzed by using the SPSS 20.0 software. RESULTS: Thirty patients were operated with the subciliary access in 15 patients and the transconjunctival access in the other 15. Trauma occurred more frequently on weekends. The most frequent complications were apparent scar (26%), apparent sclera (23.3%), and ectropion (20%). Ectropion was more common in the > 60-year age group. CONCLUSION: Both techniques were effective for the correction of fractures of the orbitozygomatic complex. The transconjunctival technique provides more esthetic and less stigmatizing scars. Hence, it is currently the author's first choice of treatment. The global incidence of complications was similar between the two techniques. Ectropion was less frequent with the transconjunctival access.

Post-traumatic-Zygomaticocoronoid Ankylosis: A Rare Clinical Case Report.

Fusion of the zygomatic bone to the coronoid process of the mandible is a rare phenomenon reported in the literature and commonly called as zygomaticocoronoid ankylosis. It can be sequel of trauma or infection in the midfacial region, mimicking a wide range of problems including the common temporomandibular joint ankylosis and dysfunction. Maxillofacial trauma involving the displaced fracture of zygoma can obstruct the movement of coronoid and if not treated can cause ankylosis between both bones. It is very diffi cult to identify zygomaticocoronoid ankylosis on conventional radiographs and requires the through clinical and advanced radiological evaluation like cone-beam computed tomographic (CBCT) to diagnose it. CBCT can be a great help to identify the size and extension of ankylotic mass and decide the approach to remove it. Zygomaticocoronoid ankylosis can be approached intraorally by Keen’s incision, and extraorally through a hemicoronal approach we have approached intraorally. Here, we present surgical management of post-traumatic zygomaticocoronoid ankylosis in 42-year-old male patient who had trismus for 18 years.

Photoelastic Analysis of Two Maxillary Protocols Using Zygomatic Implants / Análisis Fotoelástico de Dos Protocolos Maxilares con Uso de Implantes Cigomáticos

The aim of this study was to analyse the in vitro the stress distribution in craniofacial structures around zygomatic implants. Synthetic polyurethane skulls replicas were used as templates for installation of standard and zygomatic implants performing two techniques using rehabilitation with using one zygomatic implant in the right and left side in combination with 2 and 4 standard implants in the anterior maxilla (group 1 and group 2). The skull replicas of photoelastic resin were subjected to photoelastic analysis after linear loading using an Instron 4411 servohydraulic mechanical testing, with a 2 mm displacement. The stress distribution showed the fringes with concentration in the body and the frontal process of zygomatic bone. In the case of model 1, higher concentrations of stress were found around the standard and zygomatic implants and surrounding bone. Under this condition, the rehabilitation with 2 zygomatics implants and 4 standard implants (group 2) provided the most favorable behavior.

El objetivo de este estudio fue analizar el estrés in vitro y la distribución de tensiones en la estructura craneofacial a partir de los implantes cigomaticos. Réplicas de cráneo de poliuretano fueron usados como modelos para la instalación de implantes cigomáticos estándar utilizando dos modelos de distribución de implantes. Estos modelos fueron usados como modelos utilizando 1 implante en cada lado con dos o cuatro implantes convencionales en la región anterior maxilar (grupo 1 y grupo 2); posteriormente, se realizó una carga compresiva unilateral en la máquina Instrom 4411 utilizando 2 mm de desplazamiento máximo. La distribución de estrés se concentró principalmente en la región de cuerpo de hueso cigomático y en la región frontal del proceso cigomático; el modelo 1, con dos implantes convencionales, mostró mayor distribución de estrés en la región cigomática al comparase con el grupo 2; bajo estas condiciones, se concluye que la distribución con cuatro implantes convencionales entrega mejores condiciones de distribución de tensiones.

Modified bisecting angle technique in eliminating zygomatic superimposition over apices of maxillary molars.

Background: Image superimposition is a part and parcel of two‑dimensional radiography. However, some overlappings are a result of radiographic technique itself. The technique induced superimposition of zygomatic buttress on apices of maxillary molars is common in bisecting angle technique (BAT), which affects the endodontic performance. Certain alterations were carried out in BAT to remove these undiagnostic shadows. The aim of this study was to compare two techniques of periapical radiography namely, BAT and modified BAT (MBAT) in preventing zygomatic superimposition over apices of maxillary molars. Materials and Methods: A total of 62 patients requiring endodontic treatment for at least one maxillary molar were recruited in this cross‑sectional study. One tooth from every patient was subjected for two periapical radiographs, one with each BAT and MBAT respectively giving a total of 124 radiographs. Each radiograph was recorded as acceptable or unacceptable, based on zygomatic superimposition and different technical aspects. Chi‑square test was used for data analysis. The kappa statistic was used to test intra‑observer reliability. Results: With MBAT, the acceptability was 82.3% (n = 51) compared with 43.5% (n = 27) when BAT was employed. The statistically significant difference was found between these two techniques (P = 0.000). The level of agreement between two oral radiologists in their interpretation was high (kappa index = 0.897). Conclusion: Modified BAT was more accurate for periapical radiography of maxillary molars in preventing zygomatic superimposition and related technical errors than BAT.

Tratamento da bolsa malar e festoons / Treatment of malar mounds and festoons

Introdução: A alteração da região do malar, em muitos casos, é de difícil solução. O envelhecimento traz grande variação de deformidade na região. Neste sentido o objetivo do trabalho foi apresentar que procedimentos cirúrgicos com simplicidade e pouca agressividade têm demonstrado um bom resultado e rápida recuperação. Método: Desenha-se uma figura em forma de canoa ou elíptica margeando a bolsa malar ou da dobra de pele. Em seguida realiza-se a incisão até o plano do subcutâneo. Retira-se a pele e logo após realiza-se a sutura. Resultado: Os pacientes operados pelo método direto evoluíram de maneira convincente e com cicatrizes muito pouco visíveis. Conclusão: é uma maneira direta e que traz resultado bastante favorável e rápida recuperação. A indicação esta relacionada ao bom senso do cirurgião, a idade do paciente e a flacidez existente.

Introduction: Changes to the malar region are, in many cases, difficult to resolve. The ageing process causes great variation and deformity of this region. Therefore, the aim of this study was to describe a simple and less aggressive surgical procedure that has demonstrated good results and quick recovery. Method: A canoe-shaped or elliptical-shaped line is drawn bordering the malar mound or the skin fold. The skin is incised down to the subcutaneous plane. The excess skin is removed and a suture is then performed immediately. Result: The patients undergoing this direct surgical method showed a favorable postoperative course, and the scars were not very visible. Conclusion: This direct procedure provides a favorable result and quick recovery. Indications depend on surgical judgment, age of the patient, and degree of skin flaccidity.

Uso de implantes zigomáticos na fixação de próteses bucomaxilofaciais / Use of zygomatic implants in the fixacion of maxillofacial prothesis

A prótese bucomaxilofacial tem como objetivo a reabilitação de indivíduos com deformidades craniofaciais, decorrentes de traumatismos, más formações congênitas ou tumores. Muitas pesquisas foram realizadas para melhorar a estabilidade e retenção das próteses em pacientes mutilados. Com o advento da osseointegração, a prótese bucomaxilofacial sofreu um grande avanço tornando possível a realização de trabalhos protéticos com estabilidade, qualidade estética e resultados previsíveis. Esse trabalho faz uma revisão de literatura a respeito do uso de implantes zigomáticos na fixação de próteses bucomaxilofaciais...

The maxillofacial prosthetic rehabilitation aims of individuals with craniofacial deformities resulting from trauma, congenital malformations or tumors. Many researches have been done to improve the stability and retention of dentures in patients. With the advent of osseointegration, the maxillofacial prosthesis suffered a major advance making possible the realization of prosthetic works with stability, aesthetic quality and predictable results. This paper reviews the literature regarding the use of zygomatic implants in the fixation of maxillofacial prostheses...

Análisis morfométrico de los reparos anatómicos involucrados en la técnica quirúrgica de colocación de implantes cigomáticos / Morphometric analysis of anatomic landmarks involved in surgical technique of zygomatic implants placement

El objetivo de esta investigación fue ofrecer datos morfométricos de las estructuras óseas involucradas en la técnica quirúrgica de colocación de implantes cigomáticos, proveyendo así, informaciones que faciliten la planificación y realización de dicho procedimiento. Considerando los valores promedios obtenidos en nuestro estudio, concluimos que el mayor espesor del hueso cigomático se encuentra en la zona media del hueso. Sugerimos que el anclaje superior del implante cigomático no debe extenderse hasta el margen posterosuperior del hueso cigomático, ya que el espesor del hueso a este nivel no ofrece condiciones de adecuada oseointegración de implantes.

The aim of this study is to provide morphometric data of bony structures involved in the surgical technique of zygomatic implants, thus providing information to facilitate the planning and implementation of this procedure. Considering the average values obtained in our study, we conclude that the greatest thickness of the zygomatic bone is in the middle of the bone. We suggest that the upper anchorage of zygomatic implants should not extend to the posterior margin of the zygomatic bone, since the bone thickness at this level does not offer suitable conditions for osseointegration of implants.

Implantes zigomáticos como alternativa para reabilitaçãode maxilas atróficas / Zygomatic implants as an alternative for rehabilitation of atrophic maxilla

Existem casos em que o processo reabsortivoda maxila atinge níveis tão severos que nãohá suporte ósseo adequado para instalação deimplantes. Assim, os implantes zigomáticos surgiramcomo alternativa complementar e queapresenta elevados índices de sucesso descritosna literatura. Seu princípio se baseia no fato deque o osso zigomático não sofre o processo dereabsorção a que estão sujeitos os ossos maxilaresapós a perda dos elementos dentais. Nesteartigo relatamos um caso clínico de uma pacienteque apresentava uma reabsorção severada maxila e foi tratada por meio de implanteszigomáticos e implantes convencionais, recebendouma prótese provisória sete horas apóso procedimento cirúrgico. Esta técnica, além depossibilitar a reabilitação dos pacientes edêntulos,permite a instalação de prótese em umprotocolo de carga imediata caso os implantesatinjam um bom travamento inicial.

There are cases where the resorptive processof the maxilla reaches levels so severe thatthere is adequate bone support for implantplacement. So the zygomatic implants haveemerged as an alternative complementary inwith high success rates in the literature. Itsprinciple is based on the fact that the zygomaticbone does not undergo the process ofresorption they are subject to the jaws followingthe loss of dental elements. In this reporta case of a patient who had a severe resorptionof the jaw and was treated by means of zygomaticimplants and conventional implants andreceived a temporary prosthesis seven hoursafter surgery. This technique also enable therehabilitation of edentulous patients, allowsthe installation of prosthesis in a protocol ofimmediate load implant case to achieve a goodinitial crash.

Reabilitação de maxila atrófica com prótese implantossuportada empregando quatro fixações zigomáticas: relato de caso clínico / Rehabilitation of atrophic maxilla with implant-supported prosthesis using four zygomatic fixation: case report

A reabilitação de pacientes com maxila severamente atrófica é um dos maiores desafios na Implantodontia atual. A grande dificuldade inerente da reabilitação e a necessidade de extensas reconstruções ósseas (enxertos onlay, levantamento de seio maxilar) podem elevar o grau de morbidade cirúrgica e o tempo de tratamento. As fixações zigomáticas têm sido apresentadas na literatura como uma opção viável para o tratamento de pacientes com esse quadro clínico. Neste artigo será apresentado o relato de um caso clínico com reabilitação da maxila por meio da instalação de quatro implantes zigomáticos e uma prótese fixa parafusada sobre os implantes, instalada dois dias após a cirurgia, submetendo os implantes à carga imediata.

The rehabilitation of patients with severely atrophic maxilla is one of the greatest challenges in implant dentistry today. The difficulty inherent in this rehabilitation and the need for extensive bone reconstruction (onlay grafts, sinus Iifting) can raise the level of surgical morbidity and treatment time. The zygomatic fixations have been presented in literature as a viable option for the treatment of patients with this clinical scenario. This paper reports a clinical case of rehabilitation of the maxilla through the installation of four zygomatic implants and a fixed prosthesis screwed over the implants, installed two days after surgery, with the implants subjected to immediate loading.

Aplicação de técnica cirúrgica minimamente invasiva na instalação de implantes zigomáticos / Minimally invasive surgical approach for zygomatic implant placement

A reabilitação de maxilas atrófica é um grande desafio para cirurgiões e protesistas. Muitas técnicas têm sido propostas, dentre elas, o uso de implantes zigomáticos tem se mostrado eficiente e de baixa morbidade. O objetivo do presente artigo foi relatar um caso de implantes zigomáticos instalados através de cirurgia minimamente invasiva, reduzindo descolamento mucogengival e preservando os tecidos moles peri-implantares.

Rehabilitation of atrophic maxillae is a challenge to surgeons and prosthodontics. Several techniques have been suggested, being zygomatic fixtures efficient and showing low morbidity. The aim of this paper is to report a case of one with zygoma fixtures inserted through a minimally invasive approach, reducing the need for mucogingival detachment and at the same time protecting the peri-implant soft tissue.

Fixed rehabilitation of patient with aggressive periodontitis using zygoma implants.

Treatment of patients with aggressive periodontitis has always been a challenge to the clinician. Both young and old are known to be affected by this progressive destructive condition of the supporting dental structures. Although dental implants have been offered as a viable treatment alternative for such patients, additional procedures (like bone grafting) and delayed protocols have limited their usage. This case report describes the treatment of a young patient with aggressive periodontitis using a graftless implant solution. Zygoma implants in conjunction with conventional implants were used with immediate loading.

Complicações em fixações zigomáticas: revisão da literatura e análise retrospectiva de 16 casos / Complications in zygomatic fixtures: literature review and retrospective analysis of 16 cases

A reabilitação de maxilas atróficas permanece como grande desafio ao cirurgião, mesmo nos dias atuais. Nos últimos anos, as fixações zigomáticas têm sido apresentadas na literatura como uma opção viável para o tratamento daqueles pacientes que apresentam severa atrofia do rebordo alveolar maxilar com extensa pneumatização dos seios maxilares e que não desejam se submeter a procedimentos reconstrutivos. Sendo assim, o objetivo do presente estudo é realizar uma breve revisão da literatura e avaliar retrospectivamente as complicações encontradas em 16 casos de implantes zigomáticos, em um período mínimo de 24 meses de acompanhamento. Os resultados mostram que o percentual de complicações foi de 50% e que o índice de sucesso no tratamento foi de 76%. A dor foi o tipo de complicação mais comum (30%), seguida pela não osseointegração (25%) e pela infecção (20%). Em conclusão, podemos afirmar que complicações podem ocorrer em qualquer fase do tratamento e podem ocasionar a perda dos implantes zigomáticos instalados, devendo o cirurgião estar apto a intervir no momento necessário.

The rehabilitation of atrophied maxillary arches stands is a great challenge to surgeons. In the last years, the zygomatic fixations have been presented in literature as a practicable option to the treatment of patients with severe atrophy, large pneumatization of maxillary sinuses, and avoiding reconstructive procedures. In this case, the aim of this study is to perform a brief literature review and retrospectively evaluate the complications found in 16 cases of zygomatic implants, with a minimum period of 25- month follow-up. The results show that the percentage of complications was 50%, and the treatment success rate was 76%. Pain was the most common complication (30%), followed by the lack of integration (25%), and infection (20%). In this way, we can affirm that complications may occur in any treatment phase with loss of the zygomatic implant installed, obligating surgeons to interfere in certain occasions