Oral Rehabilitation of Bilateral Cleft Lip and Palate Patient with Simultaneous LeFort I Osteotomy and Zygomatic Implants: A Case Report.

The aim of this study is to evaluate Le Fort I Osteotomy and zygomatic implantation without any graft placement for management of a cleft lip and palate patient. This case report describes oral rehabilitation of a 33-year-old patient with bilateral cleft lip-palate and oronasal fistula and atrophic pre-maxilla. As treatment, the patient received simultaneous Le Fort I osteotomy, palatoplasty and two zygomatic implant insertions. The prosthetic superstructure included zygomatic implant-supported removable hybrid prosthesis on bar locator and metal-ceramic fixed bridges in the posterior region. As conclusion, this protocol can be promising for management of patients with cleft lip-palate and malocclusion.

Immediate Oral Rehabilitation With Quad Zygomatic Implants: Ultrasonic Technique vs Conventional Drilling.

Inserting zygomatic implants is a challenging surgery and requires special care and great precision. Piezoelectric surgery offers several advantages: more precise bone cutting with improved intraoperative visibility and a low temperature increase. The aim of this case-control study was to evaluate whether ultrasonic instruments can be as effective as standard drilling instruments for zygomatic implant surgery in terms of clinical outcomes. Ninety-two patients with atrophic maxilla were included in the study. Implant sites were prepared with the ultrasonic technique (test group = 47 patients) or traditional drilling (control group = 45 patients). In total, 368 zygomatic implants were inserted (202 with the extrasinus technique, 77 with the sinus slot technique, and 89 with the Brånemark technique). Complete arch provisional prostheses were delivered 3 to 5 hours after the surgical operations. The mean follow-up after surgery was 24 months (range = 12-32 months). The primary outcome evaluations were based on implant survival rates and postoperative complications. Operative time and surgeon's stress were evaluated as secondary outcomes. Implant survival rate was 100% in the test and 98.89% in the control group. Postoperative complications were seen in 9 patients (4 in the test and 5 in the control group); the difference was not statistically significant. Operative time was longer in the test group; however, surgeons were more comfortable using ultrasonic instruments. Within the limitations of this preliminary study, the ultrasonic technique was a feasible alternative to traditional drilling for zygomatic implant surgery.

Zygomatic implant survival in 9 ectodermal dysplasia patients with 3.5- to 7-year follow-up.

OBJECTIVE: Ectodermal dysplasia syndrome is a complex group of genetic disorders identified by the abnormal development of the ectodermal structures. The aim of this retrospective clinical case series report was to evaluate the outcomes of the ectodermal dysplasia syndrome patients that underwent zygomatic implant surgery. MATERIALS AND METHODS: A total of 9 ectodermal dysplasia syndrome patients aged between 21 and 56 years (mean age 36.8) with severely atrophic maxilla were included in this study. All the patients were treated with a total of 19 zygomatic implants. The mean follow-up of the patients was 55 months (with a range of 44-84 months). The implant survival rate was evaluated as a primary outcome. The intra- and postoperative complications were evaluated as additional criteria for success. RESULTS: The overall implant survival rate was 100% without any complications. Final or provisional prosthesis was delivered on the same day of surgery, which resulted in an improvement of the quality of life of the patients. CONCLUSION: According to the results of this study, zygomatic surgery can be considered as a viable and safe alternative to conventional treatment modalities for oral rehabilitation of ectodermal dysplasia syndrome patients.

Prospective Clinical and Histologic Evaluation of Alveolar Socket Healing Following Ridge Preservation Using a Combination of Hydroxyapatite and Collagen Biomimetic Xenograft Versus Demineralized Bovine Bone.

PURPOSE: This prospective study is aimed at investigating clinically and histologically the effectiveness of a biomimetic magnesium-enriched-hydroxyapatite (MgHA)/collagen-based bone substitute for alveolar socket preservation. MATERIALS: Patients scheduled for posterior single tooth extraction were included. The alveolar socket was filled either with MgHA or deproteinized bovine bone matrix (DBBM). In DBBM group, a punch of mucosa was taken from the palate and used to cover the graft. Vertical and horizontal dimensional changes of the alveolar process were assessed clinically with a periodontal probe and with 3-dimensional (3D) analysis of a cast model. Postoperative quality of life was assessed through a questionnaire. After 6 months of healing, an alveolar tissue biopsy was taken for histologic and histomorphometric analysis of the newly formed tissue. After checking normality of the distributions, parametric or nonparametric tests were used for statistical comparisons. RESULTS: Twenty patients (12 males, 8 females, mean age 42.8 ±â€Š5.1 years, range 33-50 years) were treated. After 6 months, vertical and horizontal alveolar ridge resorption was similar in the 2 groups. The 3D analysis of the models showed a significantly higher resorption at the buccal side than at the palatal/lingual side. Histomorphometric analysis showed similar new bone formation for MgHA group (23.07 ±â€Š10.3%) and DBBM (22.77 ±â€Š6.95%), and a significantly higher residual material% for DBBM (15.77 ±â€Š1.95%) than MgHA (5.01 ±â€Š1.04%). Significantly less pain was reported in the first 3 days after surgery in patients of the MgHA group. CONCLUSION: The MgHA was as safe and effective as DBBM and may represent a feasible bone substitute for alveolar socket preservation.

Gene Delivery Therapeutics in the Treatment of Periodontitis and Peri-Implantitis: A State of the Art Review.

BACKGROUND: Periodontal disease is a chronic inflammatory condition that affects supporting tissues around teeth, resulting in periodontal tissue breakdown. If left untreated, periodontal disease could have serious consequences; this condition is in fact considered as the primary cause of tooth loss. Being highly prevalent among adults, periodontal disease treatment is receiving increased attention from researchers and clinicians. When this condition occurs around dental implants, the disease is termed peri-implantitis. Periodontal regeneration aims at restoring the destroyed attachment apparatus, in order to improve tooth stability and thus reduce disease progression and subsequent periodontal tissue breakdown. Although many biomaterials have been developed to promote periodontal regeneration, they still have their own set of disadvantages. As a result, regenerative medicine has been employed in the periodontal field, not only to overcome the drawbacks of the conventional biomaterials but also to ensure more predictable regenerative outcomes with minimal complications. Regenerative medicine is considered a part of the research field called tissue engineering/regenerative medicine (TE/RM), a translational field combining cell therapy, biomaterial, biomedical engineering and genetics all with the aim to replace and restore tissues or organs to their normal function using in vitro models for in vivo regeneration. In a tissue, cells are responding to different micro-environmental cues and signaling molecules, these biological factors influence cell differentiation, migration and cell responses. A central part of TE/RM therapy is introducing drugs, genetic materials or proteins to induce specific cellular responses in the cells at the site of tissue repair in order to enhance and improve tissue regeneration. In this review, we present the state of art of gene therapy in the applications of periodontal tissue and peri-implant regeneration. PURPOSE: We aim herein to review the currently available methods for gene therapy, which include the utilization of viral/non-viral vectors and how they might serve as therapeutic potentials in regenerative medicine for periodontal and peri-implant tissues.

Autologous Platelet Concentrates in Treatment of Furcation Defects-A Systematic Review and Meta-Analysis.

BACKGROUND: The aim of this review was to evaluate the adjunctive effect of autologous platelet concentrates (APCs) for the treatment of furcation defects, in terms of scientific quality of the clinical trials and regeneration parameters assessment. METHODS: A systematic search was carried out in the electronic databases MEDLINE, SCOPUS, CENTRAL (Cochrane Central Register of Controlled Trials), and EMBASE, together with hand searching of relevant journals. Two independent reviewers screened the articles yielded in the initial search and retrieved the full-text version of potentially eligible studies. Relevant data and outcomes were extracted from the included studies. Risk of bias assessment was also carried out. The outcome variables, relative to baseline and post-operative defect characteristics (probing pocket depth (PPD), horizontal and vertical clinical attachment loss (HCAL, VCAL), horizontal and vertical furcation depth (HFD, VFD) were considered for meta-analysis. RESULTS: Ten randomized trials were included in this review. Only one study was judged at high risk of bias, while seven had a low risk, testifying to the good level of the evidence of this review. The meta-analysis showed a favorable effect regarding all outcome variables, for APCs used in adjunct to open flap debridement (p < 0.001). Regarding APCs in adjunct to bone grafting, a significant advantage was found only for HCAL (p < 0.001, mean difference 0.74, 95% CI 0.54, 0.94). The sub-group analysis showed that both platelet-rich fibrin and platelet-rich plasma in adjunct with open flap debridement, yielded significantly favorable results. No meta-analysis was performed for APCs in combination with guided tissue regeneration (GTR) as only one study was found. CONCLUSION: For the treatment of furcation defects APCs may be beneficial as an adjunct to open flap debridement alone and bone grafting, while limited evidence of an effect of APCs when used in combination with GTR was found.

Combined effect of parathyroid hormone and strontium ranelate on bone healing in ovariectomized rats.

OBJECTIVE: Parathyroid hormone (PTH) enhances bone healing. Strontium ranelate (SR) is an antiresorptive agent that increases bone formation. Reports about combined effects of PTH and SR on local bone regeneration in osteoporotic subjects are limited. We aimed at investigating the efficacy of PTH and SR for promoting new bone formation in critical-sized defects of ovariectomized rats. MATERIALS AND METHODS: Parathyroid hormone- and/or SR-containing poloxamer implant tablets with/without chitosan microparticles were delivered locally to calvarial defects of 90 Wistar rats. Biopsies were analyzed histologically and histomorphometrically at 4 and 8 weeks of healing. RESULTS: Histomorphometry revealed that PTH alone promoted new bone formation at 4 weeks but the efficiency declined in 8 weeks. There was no positive effect of SR alone on bone formation at 4 or 8 weeks. Calvarial defects treated with PTH+SR combinations showed statistically significant greater new bone formation than either treatment alone at both time intervals. Tissue responses were modest and supported the good biocompatibility of the biomaterials used. CONCLUSION: Parathyroid hormone and SR combinations can be effective for calvarial bone regeneration of ovariectomized rats. PTH plus SR may have potential use as bone graft material in orthopedic and dental surgery to enhance bone healing and osseointegration.

Ozone infiltration as an adjunctive treatment to piezoelectric surgery in the management of medication-related osteonecrosis of the jaws: case series of 29 patients.

PURPOSE: Medication-related osteonecrosis of the jaws has been reported to be associated with bisphosphonate and RANKL inhibitor medications. This prospective clinical study aimed to assess the outcomes of pre-operative ozone infiltration therapy in patients with established MRONJ. METHODS: The treatment protocol for ozone applications were designed as 20 applications ozone infiltration therapy followed by surgical interventions of necrotic tissue debridement using piezoelectric surgery instruments. The evaluation of the results based on the clinical and radiologic specifications considering the necrotic lesion reduction and healing. The study included 31 lesions in 29 patients. The mean follow-up was 23.6 months. RESULTS: 25 lesions out of 31 healed totally without any remissions. The outcomes were not affected by any variables such as gender, age, type of pharmacological treatment, lesion location, and MRONJ staging. The statistically significant results were found among the clinical condition of the patients (p = 0.01) and administration route of medications (p = 0.004). Healing was significantly less in patients that received intra-vascular administrations. Clinical conditions of the patients were divided as osteoporosis, oncologic, and arthritis. Significantly better results were obtained in osteoporosis patients. 38% of the population experienced spontaneous sequestration with signs of improvements and the surgical interventions were canceled. According to the results, total healing of MRONJ lesions was seen in 79% patients (81% lesions). CONCLUSION: Ozone therapy and debridement with Piezoelectric surgery can be considered as a safe and beneficial adjunctive treatment alternative for osteonecrosis lesions in cases of established MRONJ.

Zygomatic Implant Insertion in MRONJ: A Case Report with a Follow-Up of 3 Years.

The oral rehabilitation of MRONJ patients represents a challenging situation. Conventional dental implant insertion is not indicated because of the risk of creating a new necrotic area. This case study describes the oral rehabilitation of a 78-year-old female patient, who developed an osteonecrotic lesion in the fourth year of bisphosphonate treatment. The patient underwent a series of surgeries, including resection of the necrotic tissue on the right maxillary region and removal of conventional implants. The patient had a large maxillary defect, and no other treatment modalities such as conventional prosthetic appliances and traditional dental implant insertions were applicable. The patient had a very poor quality of life and as a rehabilitation option, two zygomatic implant insertions were planned and performed as an anchorage for maxillary fixed prosthesis. Radiographic and clinical examination after three years of follow-up indicated that healing was achieved, and healthy tissues formed around zygomatic implants. The patient did not suffer from any additional necrotic tissues or other complications in the oral cavity. According to the results of this case report, zygomatic implantation after resective surgery might be considered as a promising alternative for MRONJ patients with large defects when other treatment alternatives fail or are not applicable.

Outcomes of a Pharmacological Protocol with Pentoxifylline and Tocopherol for the Management of Medication-Related Osteonecrosis of the Jaws (MRONJ): A Randomized Study on 202 Osteoporosis Patients.

Medication-related osteonecrosis of the jaws (MRONJ) is a challenging situation in clinics. Previous studies have shown that pentoxifylline combined with tocopherol proved to be beneficial in patients with osteoradionecrosis, due to their antioxidant and antifibrotic properties. The aim of this randomized study was to evaluate the effect of pentoxifylline and tocopherol in patients that had developed MRONJ after tooth extractions. The study population consisted of 202 Stage I MRONJ female patients with an average age of 66.4 ± 8.3 years, who were divided into two groups. The test group (n = 108) received a pharmacological protocol with pentoxifylline and tocopherol (2 months pre-operatively and 6 months post-operatively). The control group (n = 94) had sequestrectomy operations without any pharmacological preparation. The main outcomes were clinical healing of the mucosa after 1 month, and clinical and radiographic healing of the bone lesion at 6 months. In the test group all patients had mucosal healing and there was only one relapse within 6 months. In the control group, in 17% of the patients the mucosa did not heal, 71% of the patients relapsed within two months, and 7% developed infectious complications (such as abscess or phlegmon). After 6 months, the control group patients with persisting issues were prescribed pentoxifylline and tocopherol, as in the test group. At a subsequent follow-up, all those patients healed completely. Patients were monitored for a period of 7.8 ± 0.3 years, during which no relapse or additional problems were reported. As a conclusion, pentoxifylline and tocopherol protocol seems to be beneficial in the management of MRONJ patients.

Guided Zygomatic Implantology for Oral Cancer Rehabilitation: A Case Report.

Oral rehabilitation after maxillary oncological resection is challenging. This case report presents the rehabilitation of a 65-year-old Caucasian male adenoid cystic carcinoma patient using a myo-cutaneous thigh flap, zygomatic implant placement, and an immediate fixed provisional prosthesis made with computer-aided technologies. The patient presented complaints of asymptomatic enlarged swelling of 5-mm on the right hard hemi-palate. There was an oro-antral communication deriving from a previous local excision. Preoperative radiographs showed the involvement of the right maxilla, maxillary sinus, and nose with a suspect involvement of the maxillary division of the trigeminal nerve. Treatment was planned through a fully digital workflow. A partial maxillectomy was performed endoscopically, and maxilla was reconstructed using an anterolateral thigh free flap. Two zygomatic implants were inserted simultaneously. A provisional fix full-arch prosthesis was manufactured preoperatively through a fully digital workflow and was placed in the operating room. Following post-operative radiotherapy, the patient received a final hybrid prosthesis. During the follow-up period of two years, the patient reported good function, aesthetics, and significant enhancement in quality of life. According to the results of this case, the protocol represented can be a promising alternative for oral cancer patients with large defects, and can lead to an improved quality of life.

Simultaneous Le Fort I osteotomy and zygomatic implant placement.

The aim of this retrospective study was to evaluate the outcomes of simultaneous LeFort I osteotomy and zygomatic/dental implant placement for oral rehabilitation of patients with extremely atrophic/dysmorphic edentulous maxilla. Simultaneous LeFort I osteotomy and zygomatic/dental implant placement was performed with patient-specific anatomical models and surgical guides produced through three-dimensional virtual planning methods. All patients received their final prosthesis, with immediate loading, on the day after surgery. The primary outcome variables were the implant survival rate, and the incidence of intra/postoperative complications. In total, 15 zygomatic implants and 33 conventional dental implants were inserted in eight patients. The mean follow-up of the patients was 38.5 months. The implant survival rate was 93.3% for zygomatic implants and 100% for dental implants. No intra/postoperative complications were observed. Simultaneous LeFort I osteotomy associated with zygomatic/dental implant surgery can be considered as a valuable treatment option for rehabilitation of patients with extremely atrophic edentulous maxilla and esthetic issues of the face.

Oral rehabilitation with unilateral zygomatic implants: A case series of 32 patients.

AIMS: Zygomatic implants are successful alternatives to conventional dental implants for oral rehabilitation of patients with severely atrophic maxillae; however, the use of unilateral zygomatic implants needs to be studied further to validate their efficacy. The present investigation aimed to evaluate unilateral zygomatic implant placement in the oral rehabilitation of partially edentulous patients with extremely atrophic maxillary bone and/or previous implant failures. MATERIALS AND METHODS: This retrospective clinical study included patients with partially edentulous maxillae who underwent unilateral zygomatic implant insertion. The primary outcome was implant survival. Intraoperative, postoperative and prosthetic complications were also assessed based on patients' clinical records. RESULTS: A total of 32 patients (34 zygomatic implants) with a mean age of 60.45 ± 8.74 years (range 47 to 78 years) were included in the study. The mean follow-up period was 34.3 ± 25.5 months, and the overall implant survival rate was 100%. No intraoperative or postoperative complications developed in any of the patients, and no prosthesis failures or complications were recorded. CONCLUSIONS: The results indicate that unilateral zygomatic implant insertion for oral rehabilitation of patients with partially edentulous posterior maxillae with severely atrophic bone and/or previous implant failures can be considered a successful alternative to use of conventional dental implants associated with advanced bone grafting procedures.

Post-Operative Patients' Satisfaction and Quality of Life Assessment in Adult Patients with Obstructive Sleep Apnea Syndrome (OSAS).

BACKGROUND: The treatment for severe OSAS includes maxillomandibular advancement surgical option in selected cases. The aim of this study was to evaluate the post-operative impact of bimaxillary surgery on satisfaction and consequently the quality of life of these patients. METHODS: This study included 18 patients with severe OSAS who received maxillomandibular advancement surgery. Patients were divided into Group A (operated by CAD/CAM) and Group B (conventional surgery). The impact of bimaxillary surgery on satisfaction and quality of life of these patients was evaluated by utilizing post-operative life quality and Rustemeyer's patient-satisfaction-based survey. RESULTS: A total of 18 adult OSAS patients (Group A: 11 patients, Group B: 7 patients) with a mean age of 44.39 years (SD ± 9.43) were included. Mean follow-up period was 32.64 months (SD ± 21.91). No intra-operative complications were seen in any patients. Post-operative complication was seen in one patient and the mandible did not integrate. According to the results, overall post-operative satisfaction score was 79.72% (SD ± 9.96). There was no significant difference among those in Group A and Group B. CONCLUSIONS: Maxillomandibular advancement surgery seems to be beneficial in terms of patients' satisfaction in severe adult OSAS patients and can be considered as a valuable option in selected cases.

Artificial Intelligence: A New Diagnostic Software in Dentistry: A Preliminary Performance Diagnostic Study.

BACKGROUND: Artificial intelligence (AI) has taken hold in public health because more and more people are looking to make a diagnosis using technology that allows them to work faster and more accurately, reducing costs and the number of medical errors. METHODS: In the present study, 120 panoramic X-rays (OPGs) were randomly selected from the Department of Oral and Maxillofacial Sciences of Sapienza University of Rome, Italy. The OPGs were acquired and analyzed using Apox, which takes a panoramic X-rayand automatically returns the dental formula, the presence of dental implants, prosthetic crowns, fillings and root remnants. A descriptive analysis was performed presenting the categorical variables as absolute and relative frequencies. RESULTS: In total, the number of true positive (TP) values was 2.195 (19.06%); true negative (TN), 8.908 (77.34%); false positive (FP), 132 (1.15%); and false negative (FN), 283 (2.46%). The overall sensitivity was 0.89, while the overall specificity was 0.98. CONCLUSIONS: The present study shows the latest achievements in dentistry, analyzing the application and credibility of a new diagnostic method to improve the work of dentists and the patients' care.

Multi-Layer Technique (MLT) with Porcine Collagenated Cortical Bone Lamina for Bone Regeneration Procedures and Immediate Post-Extraction Implantation in the Esthetic Area: A Retrospective Case Series with a Mean Follow-Up of 5 Years.

BACKGROUND: Augmentation of the edentulous atrophic anterior region is a challenging situation. The purpose of this article was to evaluate the effectiveness of a collagenated cortical bone lamina of porcine origin for horizontal ridge augmentation in patients with inadequate alveolar ridge width undergoing immediate post-extraction implantation in the anterior sites, and to report on implant survival rates/complications. MATERIALS AND METHODS: The cases were extracted electronically from a large database according to these specific inclusion criteria: patients with inadequate alveolar ridge width in the anterior maxilla or mandible, who underwent immediate post-extraction implant placement and simultaneous alveolar bone reconstruction using xenogeneic cortical bone lamina. An additional layer of palatal connective tissue graft was inserted between lamina and the vestibular mucosa, for improving soft tissue healing. A collagenated bone substitute was additionally placed in the gap between the lamina and implant surface in all patients. The main outcomes were implant survival and complications. RESULTS: Forty-nine patients with 65 implants were included. Patients' mean age at the time of implant surgery was 60.0 ± 13.6 years. The mean follow-up was 60.5 ± 26.6 months after implant placement. The implant survival was 100%. Four postoperative complications occurred in four patients. No specific factor was found to be associated with complication occurrence. CONCLUSION: The use of collagenated cortical bone lamina can be considered as a successful option for alveolar reconstruction in immediate post-extraction implant insertion procedures in anterior regions with inadequate alveolar ridge width.

Simplified Digital Protocol for Fully Edentulous Immediate Implant Placement and Loading: A Report of 10 Consecutive Cases.

The aim of this article is to propose a simplified digital protocol for the treatment of the fully edentulous patient, using an immediate implant and immediate loading protocol to deliver a polymethyl methacrylate metal-reinforced hybrid prosthesis. Ten consecutive patients were treated with this approach. At the end of 1 year, there was an implant survival rate of 97.8% and a prosthetic success rate of 100%. Based on the responses to the quality of life questionnaire, patients had a high acceptance rate for this treatment protocol. Within the limits of this case series, the proposed simplified digital protocol could be utilized for reconstruction in the fully edentulous patient and for delivering an implant-supported prosthesis immediately after implant placement.

A Novel Guided Zygomatic and Pterygoid Implant Surgery System: A Human Cadaver Study on Accuracy.

The aim of this human cadaver study was to assess the accuracy of zygomatic/pterygoid implant placement using custom-made bone-supported laser sintered titanium templates. For this purpose, pre-surgical planning was done on computed tomography scans of each cadaver. Surgical guides were printed using direct metal laser sintering technology. Four zygomatic and two pterygoid implants were inserted in each case using the guided protocol and related tools. Post-operative computed tomography (CT) scans were obtained to evaluate deviations between the planned and inserted implants. Accuracy was measured by overlaying the real position in the post-operative CT on the virtual presurgical placement of the implant in a CT image. Descriptive and bivariate analyses of the data were performed. As a result, a total of 40 zygomatic and 20 pterygoid implants were inserted in 10 cadavers. The mean deviations between the planned and the placed zygomatic and pterygoid implants were respectively (mean ± SD): 1.69° ± 1.12° and 4.15° ± 3.53° for angular deviation. Linear distance deviations: 0.93 mm ± 1.23 mm and 1.35 mm ± 1.45 mm at platform depth, 1.35 mm ± 0.78 mm and 1.81 mm ± 1.47 mm at apical plane, 1.07 mm ± 1.47 mm and 1.22 mm ± 1.44 mm for apical depth. In conclusion, the surgical guide system showed accuracy for all the variables studied and allowed acceptable and accurate implant placement regardless of the case complexity.

Clinical outcome of 302 zygomatic implants in 110 patients with a follow-up between 6 months and 7 years.

BACKGROUND: Zygomatic implant surgery is considered as a safe and successful alternative to the conventional implant surgery with bone grafts for patients with severe atrophic maxilla. PURPOSE: The aim of this retrospective clinical case series was to report clinical outcome of zygomatic implants with a follow-up between 6 months and 7 years. MATERIALS AND METHODS: A total of 110 patients with 302 zygomatic implants were included in this study. The intra and postoperative complications and survival rate of zygomatic implants were evaluated. RESULTS: The study included 110 consecutively treated patients with an age range of 21 to 76 years (mean 57.35 years, SD 10.42). The overall zygomatic implant survival rate was 98.34%. There were five implant failures in four patients. One intraoperative and 17 postoperative complications developed in 18 patients. There were no dropouts and the median follow-up of the patients was 41.75 months (with a range of 6-89 months). CONCLUSIONS: According to the results, in cases of severely atrophic posterior maxilla, zygomatic implant surgery can be considered as an effective and safe alternative to conventional implants and bone grafting procedures.