Initial speech problems in patients treated with multiple zygomatic implants.

PURPOSE: The aim of this study was to investigate the speech ability of patients treated with multiple zygomatic implants. This technique can be used in patients with severe atrophy of the maxilla when there is insufficient residual bone in the anterior region for placement of conventional implants. MATERIALS AND METHODS: Between 2004 and 2008, audio recordings were performed in patients treated with fixed dental prostheses (FDP) supported by multiple zygomatic implants. Patients with extensive resorption of the basal bone of the maxilla (Cawood and Howell Class VI) were included in the study. No bone grafts were used. Audio recordings were conducted before treatment (pretreatment), within 1 week after the FDP was inserted (1 week posttreatment), and then again after 4 months (4 months posttreatment). Perceptual evaluations of the recordings were performed by a panel of speech and language pathologists (n = 3), and the patients' subjective views of speech quality were investigated on the three different occasions. RESULTS: Seven consecutive patients were treated with a total of 28 zygomatic implants and five conventional implants. All patients received a FDP. According to the evaluations by professionals, five of the seven patients, all of whom wore a removable conventional denture prior to treatment, had normal speech before treatment. One patient could not be evaluated by the professionals because of medical impairment. In five of the six remaining patients, a mild deterioration in articulation was registered at 1 week posttreatment, and these problems remained after 4 months. Patients' subjective views reflected a dramatic improvement in speech at 1 week posttreatment for the two patients presenting with the highest degree of maxillary bone resorption. The three patients who reported completely normal speech before treatment all experienced a drop in their ability at 1 week posttreatment. Four patients displayed a similar pattern after treatment according to the professionals' opinions and the patients' subjective reports. CONCLUSION: A mild deterioration in speech can be anticipated in patients subjected to treatment with a FDP supported by multiple zygomatic implants.

Asymptomatic chronic rhinosinusitis and osteitis in patients treated with multiple zygomatic implants: a long-term radiographic follow-up.

PURPOSE: The aim of this study was to investigate implant survival and the reactions of the bone and mucosa of the maxillary sinuses in patients treated with fixed dental prostheses supported by multiple zygomatic implants. MATERIALS AND METHODS: Between 2001 and 2007, patients with extensive resorption of the basal bone of the maxilla received multiple zygomatic implants without grafts. In 2012, the maxillary sinuses were examined with cone beam computed tomography. Neo-osteogenesis at the posterior wall of the sinus was considered to be a sign of osteitis and classified as mild (3 to 4 mm), moderate (4 to 5 mm), or severe (> 5 mm). The maxillary ostium was examined and accessory ostia were registered. The sinus mucosa was evaluated according to the Lund-Mackay staging system, and the sinus was checked for fluid level and atelectasis. Patients reported any nasal- and sinus-related symptoms. RESULTS: Fourteen patients who had received 58 zygomatic implants and 13 standard implants were examined. The mean follow-up was 9.3 years, and the implant survival rates were 97% and 92% for zygomatic and standard implants, respectively. Osteitis was found in all but one patient and classified as severe in 17 of the 27 investigated sinuses. The infundibulum was obstructed in nine sinuses, and an accessory ostium was present in seven. The mucosa of the maxillary sinus showed signs of chronic rhinosinusitis in all but one patient. No fluid levels were observed. Atelectasis occurred in 15 sinuses. Twelve patients reported unaltered nasal and sinus status. CONCLUSION: Patients with extensive bone resorption in combination with voluminous maxillary sinuses and nasal cavities can experience long-term success with prostheses supported by multiple zygomatic implants. Asymptomatic chronic rhinosinusitis with osteitis and gradual collapse of the maxillary sinus cavity can be anticipated.

Modified technique using multiple zygomatic implants in reconstruction of the atrophic maxilla: a technical note.

Zygomatic implants have been in use since the 1990s for the treatment of patients with severely resorbed maxillae. Here, the authors present a modification of the standard zygomatic implant technique that uses up to 3 implants on each side of the maxilla for support of a dental prosthesis.

The positions of implant heads in relation to the fixed dental prosthesis: a comparison of multiple zygomatic implants with standard implants for the reconstruction of the atrophic maxilla.

PURPOSE: The aim of this study was to investigate the positions of dental implants at the crestal level and the occlusal level of a fixed dental prosthesis (FDP) in severely and moderately resorbed maxillae. Restorations supported by multiple zygomatic implants were compared with restorations supported by standard implants. MATERIAL AND METHODS: Between 2004 and 2007, measurements were performed on FDPs and working casts. Two groups were investigated: (1) patients with severe atrophy and extensive resorption into basal bone treated with multiple zygomatic implants (Zyg) and (2) patients with moderate atrophy with standard implants only (Stand). The areas bounded by the FDP at the implant level (A(impl)) and at the occlusal level (A(prost)) were calculated, and A(prost) -A(impl) represented the total horizontal overjet of the FDP. A(prost)/A(impl) was established as the degree of overlapping of these two areas. The transverse and sagittal dimensions at the implant level (T(impl) and S(impl)) and at the occlusal level (T(prost) and S(prost)) were also measured. T(impl)/S(impl) and T(prost)/S(prost) represented the shape of the superstructure at these respective levels. RESULTS: Seven consecutive patients in the Zyg group were matched by age and gender with seven individuals in the Stand group. In the Zyg group, 28 zygomatic and 5 standard implants were placed; in the Stand group, 41 standard implants were placed, of which 3 were lost. All patients received an FDP. T(impl) was shorter and S(impl) was longer in the Zyg group, yielding a smaller T(impl)/S(impl) in this group. The Zyg group also displayed less overjet and a smaller A(prost)/A(impl) compared to the Stand group. CONCLUSION: Multiple zygomatic implants emerged through the residual crest with a more even distribution in the sagittal plane compared to standard implants and with a better congruence with the occlusal location of the FDP.