The Clinical Evaluation of the Dynamically Navigated Flapless Placement of Zygomatic Implants: A Randomized Controlled Trial.

PURPOSE: To assess the pain, swelling, infection, and alteration in sensation following the flapless placement of zygomatic implants guided by dynamic navigation. MATERIALS AND METHODS: A randomized controlled trial was conducted on 20 patients. In group 1, the placement of the zygomatic implants was carried out without reflecting a mucoperiosteal flap (flapless). In group 2, a mucoperiosteal flap was raised (flapped). Two zygomatic implants were placed in each patient (one on each side) under local anesthesia, guided by dynamic navigation. Postoperative evaluations included pain (using the visual analogue scale [VAS]), swelling (using standard measurements), maxillary sinus infection, and alteration of sensation (using mechanical stimuli, thermal threshold detection, and a two-point discrimination test). The assessments were carried out at 2 days, 1 week, and then 1, 2, and 3 months postoperatively. RESULTS: In group 1, all implants except for one were successfully osseointegrated. Immediate postoperative pain and swelling were both significantly greater in group 2 (P < .01). No alteration in sensation was detected in any case in the two groups. There were a total of three cases of chronic sinusitis: one in group 1 and two in group 2. CONCLUSIONS: The flapless placement of zygomatic implants guided by dynamic navigation and under local anesthesia improves postoperative recovery.

Dynamic navigation for zygomatic implant placement: A randomized clinical study comparing the flapless versus the conventional approach.

OBJECTIVES: The assessment of the accuracy of flapless placement of zygomatic implants in edentulous maxilla using dynamic navigation. METHODS: A randomized controlled trial was carried out on 20 patients. Patients were randomized into two groups, the flapless (Group 1; n=10) and the conventional (Group 2; n=10). In each case two zygomatic implants were inserted under local anaesthesia, one on the right and one on the left side guided by a dynamic navigation system. The surgical procedure was identical in the two groups except for the reflection of the mucoperiosteal flap which was eliminated in the flapless cases. Postoperative CBCT scans were used to assess the accuracy of the placement of zygomatic implants. RESULTS: Osseointegration was achieved for all the implants, except one case in the flapless group. Statistically significant differences in the accuracy of the position of the zygomatic implants was found between the flapless and the conventional groups, measured at the apex and the entry points of the implants (p < 0.01). The average apical and coronal deviations were 5 mm and 3 mm, respectively; the angular deviation was 6°, and 2 mm vertical apical disparity was detected between the planned and the achieved surgical position. Perforation of the Schneiderian membrane was noted in three cases, one in flapless group and two in the conventional group. CONCLUSIONS: Flapless placement of zygomatic implants guided by dynamic navigation offered satisfactory safety and accuracy. CLINICAL SIGNIFICANCE: This is the first clinical trial to prove the feasibility and accuracy of flapless placement of zygomatic implant with minimal morbidity. The study highlights the innovative reflection of the Schneiderian membrane under guided surgical navigation. The procedure can be performed under local anaesthesia, which offers clinical advantages. Adequate training on the use of dynamic navigation is mandatory before its use in clinical cases.

Flapless placement of zygomatic implants using dynamic navigation: an innovative technical note.

Zygomatic implants are routinely used for the rehabilitation of the midface and edentulous maxilla; the procedure is carried out under general anaesthesia and requires the direct lifting of the Schneiderian membrane. A prefabricated surgical guide is usually used to direct the position of the zygomatic implants during surgery. This proof-of-concept study explored an innovative flapless approach for placement of zygomatic implants guided by dynamic navigation. Under local anaesthesia eight zygomatic implants were placed using a flapless technique. The preplanned position of zygomatic implants was transferred to the operating theatre using dynamic navigation, which guided the sinus lift procedure and the planned osteotomy. Operative complications were recorded, the accuracy of the implant position was measured and postoperative morbidities including pain and swelling were evaluated. Surgical complications were minimal, the Schneiderian membrane was intact in all the cases except one, which required the application of resorbable collagen membrane. Satisfactory accuracy was achieved regarding the precision of implant position and angulation. One of the patients developed maxillary sinusitis three months following surgery. Postoperative pain and swelling were minimal. The dynamic navigation guided flapless placement of zygomatic implants under local anaesthesia is a feasible technique with minimal surgical complications and postoperative morbidities.

Cost-effectiveness of the Flapless Insertion of Zygomatic Implants Using Dynamic Navigation - A Retrospective Study.

Introduction: Zygomatic implants are an effective solution for rehabilitation of edentulous atrophic maxillae. However, the conventional technique of zygomatic implant placement is invasive, requires a longer healing period and is economically cumbersome. Therefore, the flapless technique of insertion of zygomatic implants using dynamic navigation system has been introduced. This study aims to compare the cost-effectiveness of flapless insertion of zygomatic implants using dynamic navigation to the conventional flap technique. Materials and Methods: The study participants were divided into two groups: Group A (n = 20) included patients treated by flapless insertion of zygomatic implants using dynamic navigation and Group B (n = 20) included patients treated with zygomatic implants using the flap technique. An analysis of the effectiveness of the implants was done using the concept of quality-adjusted prosthesis years, and an analysis of the costs was done by evaluating the treatment costs at each step. The data were collected, and analysis was done using IBM SPSS software. The Kruskal-Wallis rank-sum test was employed to analyse variations in costs and effects between the two groups. Results: The study showed that the distribution of costs varies across both the categories of the procedure. Group B shows lesser cost-effectiveness as compared to Group A. Conclusion: The technique of flapless insertion of zygomatic implants is cost-effective. However, further studies considering factors such as time and cost of productivity evaluating the cost-effectiveness should be conducted.