Identification of the Pathway and Appropriate Use of Four Zygomatic Implants in the Atrophic Maxilla: A Cross-Sectional Study.

PURPOSE: This cross-sectional study aimed to identify and characterize the pathway for appropriate placement of four zygomatic implants in the severely atrophic maxilla and to group the anatomical variations of the osteotomy trajectory for anterior zygomatic implants. MATERIALS AND METHODS: CBCT images of patients presenting indications for the use of four zygomatic implants to withstand a maxillary rehabilitation were reviewed. Cross-sectional planes corresponding to the implant trajectories, designed according to a zygoma anatomy-guided approach for implants placed in the anterior and posterior maxilla, were assessed separately. The relationship of the implant osteotomy trajectory with the correlated residual alveolar bone, nasal and sinus cavities, maxillary wall, and zygomatic bone anatomies was established. RESULTS: The study population included 122 globally recruited patients, with 488 zygomatic implants, 244 of which had their starting point on the anterior incisor-canine area and 244 on the posterior premolar-molar area. The anatomy of the osteotomy path designed for the anterior implants ("A") was named and grouped into five assemblies from zygomatic anatomy-guided ZAGA A-0 to A-4, representing 2.9%, 4.5%, 19.7%, 55.7%, and 17.2% of the studied sites. Percentages for posterior implant ("P") trajectories of the osteotomy were grouped and named as ZAGA P-0 to P-4, representing 5.7%, 10.2%, 8.2%, 18.4%, and 57.4% of the sites, respectively. Approximately 70% of the population presented anatomical intra-individual differences. CONCLUSION: The trajectory of the zygomatic implant followed different anatomical pathways depending on its coronal point being anteriorly or posteriorly located, which justifies a new zygoma anatomy-guided approach classification for anteriorly placed zygomatic implants. Topographic characteristics of the anatomical structures that are cut by an anterior oblique plane joining the lateral incisor-canine area to the zygomatic bone, representing the planned anterior osteotomy path in a quadruple-zygoma indication, have not been previously reported. Adaptation of surgical procedures and implant sections/designs to individual patients' anatomical characteristics is essential to reduce early and long-term complications.

Quad Zygoma: Technique and Realities.

Four zygomatic implants may be used in patients with severe maxillary atrophy for rehabilitation with a fixed or removable prosthesis. Immediate loading is also typically performed, providing patients with a less invasive and more efficient solution for rehabilitation. Options for immediate loading are presented. The indications, contraindications, procedure, and complications are reviewed. Appropriate treatment planning and work-up are highlighted, as they are required for success in conjunction with advanced surgical skill. Scientific evidence, although lacking in quantity, suggests that the quad zygoma approach offers a predictable solution for the challenge of severe maxillary atrophy; high implant survival rates are noted.

On Implant Prosthodontics: One Narrative, Twelve Voices - 8.

No abstract available.

Five-year clinical results of immediately loaded dental implants using mandibular overdentures.

PURPOSE: The aim of this report is to present the clinical and patient-based outcomes of an immediate-loading protocol of TiUnite implants with mandibular overdentures in edentulous patients 5 years following initial placement. MATERIALS AND METHODS: The study comprised two groups of edentulous patients. In the experimental group, 35 consecutively treated patients received 70 TiUnite implants that were loaded immediately, as well as 69 Branemark machined implants as a backup treatment. One patient received one Branemark implant. The control group comprised patients who were treated previously with conventional two-stage implant procedures, but were all case matched to the intervention group and served as a historical cohort. This group included 42 patients who received 111 Branemark implants. Both groups of patients were treated with overdentures that were supported with a standardized resilient bar mechanism. Clinical and patient-based outcomes in the immediate group were recorded for the first 5 years following the initial placement of implants and were measured at various stages of treatment using two questionnaires: the Denture Satisfaction Scale and the Oral Health Impact Profile (OHIP-20). RESULTS: Just over 98% of implants were found to be successful in both groups (Fisher exact test: P = 1.000). A statistically significant improvement in patients' total, mandibular, and functional satisfaction scores was found when comparing baseline data to the data obtained 5 years following loading in the experimental group (P < .001). There were no significant differences between the 1- and 5-year total, mandibular, and functional satisfaction scores, or between baseline and 5-year maxillary denture satisfaction scores. A statistically significant and positive correlation was found between baseline and 1-year maxillary satisfaction scores (P = .002). Any improvement in the patients' quality of life (QoL) was maintained during the first 5 years of loading. CONCLUSION: The results of this longitudinal study suggest that immediate loading of two dental implants by means of bar-retained mandibular overdentures is a predictable treatment option and leads to substantial improvement in patients' satisfaction and QoL. Importantly, this mirrors the outcomes found for patients subjected to the more commonly accepted two-stage implant procedure.

Immediate loading of implants with mandibular overdentures: one-year clinical results of a prospective study.

PURPOSE: The aim of this report is to present the implant and clinical outcomes of an immediate-loading protocol of TiUnite implants with mandibular overdentures in edentulous patients. MATERIALS AND METHODS: Two groups of edentulous patients were selected. Thirty-five consecutively treated patients received 70 immediately loaded TiUnite implants and 69 Brånemark implants as backup (1 patient received 1 Brånemark implant). The control group was a historical cohort that comprised 42 patients who received 111 Brånemark implants. All overdentures were supported by a resilient bar mechanism. Implant and clinical outcomes, including maintenance events for the first year, were recorded. RESULTS: Implant success rates were in excess of 95% with both protocols. Immediately loaded implants had less bone loss than did implants loaded with the conventional protocol (Mann-Whitney U test; P = .001). Patients in the immediate-loading group required more prosthodontic maintenance, consisting of overdenture remakes and laboratory relining of prostheses (Chi-square test; P < .05). Of note, 74% of patients in the immediate-loading group needed a reline to improve the denture seal around the bar housing (Chi-square test; P < .05). CONCLUSION: The favorable implant and bone level outcomes with immediate loading attest to its biologic success. The prosthetic maintenance encountered in the immediate-loading group does not negate the clinical potential of the treatment but rather suggests that the protocol may benefit from modifications.