Comparison of sinusitis rate after sinus lift procedure and zygomatic implant surgery: a meta-analysis.

PURPOSE: To evaluate and compare the reported sinusitis occurrence after the sinus lift procedure and zygomatic implant placement. METHODS: This meta-analysis has been registered at PROSPERO. Studies were searched on six databases. Two authors screened titles and abstracts and fully analyzed the studies against the inclusion and exclusion criteria. The RoB 2.0 and the ROBINS-I tools were used to assess the quality and risk of bias of the included studies. The random-effects model was used for the meta-analysis. The prevalence of sinusitis was calculated based on the total of patients. Subgroup analysis was performed by sinus lift or zygomatic implant surgery technique. RESULTS: The search identified 2419 references. After applying the inclusion criteria, 18 sinus lift and 9 zygomatic implant placement studies were considered eligible. The pooled prevalence of sinusitis after sinus lift procedure was 1.11% (95% CI 0.30-2.28). The prevalence after zygomatic implant placement was 3.76% (95% CI 0.12-10.29). In the subgroup analysis, the lateral window approach showed a prevalence of sinusitis of 1.35% (95% CI 0.34-2.8), the transcrestal technique of 0.00% (95% CI 0.00-3.18), and the SALSA technique of 1.20% (95% CI 0.00-5.10). Regarding the techniques for zygomatic implant placement, the sinus slot technique showed a prevalence of 21.62% (95% CI 9.62-36.52) and the intrasinus technique of 4.36% (95% CI 0.33-11.08), and the prevalence after the extrasinus technique was 0.00% (95% CI 0.00-1.22). CONCLUSION: The sinusitis occurrence rate was higher after zygomatic implant placement than after sinus lift procedure and this occurrence was different depending on the used technique.

A Zygomatic Bone Study Using Virtual Dental Implant Planning Software.

This study evaluated the anatomical factors that influence the virtual planning of zygomatic implants by using cone-beam computerized tomography (CBCT) scans. CBCT scans of 268 edentulous patients were transferred to specialized implant planning software for the following measurements: maxillo-sinus concavity size (small, medium, and large), zygoma width, implant insertion angle, implant length, and implant apical anchorage. Concavity sizes found were as follows: 34.95% small, 52.30% medium, and 7.35% large. The mean insertion angle was 43.2 degrees, and the average implant apical anchorage was 9.1 mm. The most frequent implant length was 40 mm. Significant differences were found when the different types of concavities in relation to the installation angle, the distance of the apical portion of the implant in contact with the zygomatic bone, and the lateral-lateral thickness of the zygomatic bone were compared (P < .001). Medium-sized maxillary sinus concavity presented greater apical anchorage of the implant (9.7 mm) and was the most frequent type (52.30%). The zygomatic bone is a viable site for zygomatic fixtures, and the use of specialized implant planning software is an important tool to achieve predictable outcomes for zygomatic implants and allows good visualization of the relation between implants and anatomical structures.

Factors influencing implant and prosthesis survival in zygomatic implant-supported fixed rehabilitation: a retrospective study.

BACKGROUND: The aim of this retrospective study was to evaluate mid-term implant and prosthesis survival in patients with edentulous atrophic maxillae submitted to zygomatic implant-supported fixed rehabilitation and to identify possible related risk factors. METHODS: Data were collected from records of patients with edentulous atrophic maxillae, in good general health and who were rehabilitated by means of acrylic resin full-arch screw-retained prosthesis supported by at least one zygomatic implant, between the years of 2006-2017. Implant and prosthesis survival rates were calculated. The association between implant and prosthesis loss and quantitative and qualitative variables of interest was verified with t tests and Fisher's exact tests, respectively. For the significant variables in the latter, odds ratio and 95% confidence intervals were additionally calculated. RESULTS: The sample comprised 66 patients in whom 171 zygomatic implants were placed to support maxillary screw-retained full-arch prostheses. Implant and prosthesis survival rates of 94.15% and 92.4%, respectively, were observed in a mean of 3.6 years of follow-up (up to 11.7 years). Implant loss was 4.33 more likely to occur when adverse events were recorded after the procedure of implant placement (P = 0.026) and 10.31 more likely to occur in implants that had their prosthesis repaired during follow-up visits (P = 0.004). Prosthesis loss was 22.00 times more likely to occur when implants were previously lost (P < 0.001). All prostheses that were considered as failures (i.e. were replaced) had been previously submitted to laboratory repair at some point during follow-up. CONCLUSIONS: Zygomatic implant rehabilitation demonstrated to be a reliable method with good mid-term results. The occurrence of post-surgical adverse events and need for laboratory repair of the prosthesis were found to be significant risk factors for implant loss. Previous implant loss was significantly associated with prosthesis loss. These risk factors may be prevented by means of detailed planning of the rehabilitation to be carried out, including post-operative care of the patients, so that treatment success using zygomatic implants can be achieved.

Full arch rehabilitation in patients with atrophic upper jaws with zygomatic implants: a systematic review.

BACKGROUND: The main objective of this systematic review was to present the outcomes of the treatment with zygomatic implants (ZIs) in the rehabilitations of atrophic upper jaw. FINDINGS: An electronic database search in PubMed, along with a manual search, taking into account language and study period, was performed by two observers; any type of clinical trial and series that included the use of ZIs was used. In the search strategy, the following search terms were used: zygom* AND dental (Implant OR implants) AND edentulous NOT (biomechanic* OR finite element) NOT cadaver. The search was limited to English language, full text, and humans. Literature reviews and clinical case reports were not considered. Forty-two articles published between March 2003 and April 2019 were included in this analysis. The cases of 1247 patients were recovered; these patients received 2919 ZIs. Fifty-two ZIs were removed during the follow-up time. The survival rate of these implants was 98.22%, with a minimum follow-up of 1 month and a maximum of 228 months. Different surgical techniques were used to place ZIs; however, the intrasinusal technique was the most used (23 studies). Post-surgical sinusitis was the most common complication reported in the studies (39 cases). CONCLUSIONS: Based on this review, ZIs were commonly used for rehabilitation of patients with atrophic upper jaw. The survival rates presented were high, and the surgical technique is dependent on the professional experience and the local anatomy. However, it needed additional clinical evidence on bone resorption, esthetic outcomes, and physiological characteristics.

Simplificação da técnica para reabilitação de maxila atrófica com implantes zigomáticos com interface cônica interna e carregamento imediato: relato de caso / Simplification of the technique for rehabilitation of atrophic upper jaw with zygomatic implants with internal tapered interface and immediate loading: case report

A reabilitação de maxilas atróficas com implantes dentários é sempre um desafio, visto que o uso de enxertos ósseos é quase sempre necessário para estabilização dos implantes. Os implantes zigomáticos têm sido utilizados como uma opção viável ao uso de procedimentos de enxertia óssea anterior à cirurgia. A interface cônica interna apresenta gap reduzido entre implante e componente protético, mostrando resultados biológicos e estéticos satisfatórios a longo prazo. Este artigo tem como objetivo relatar a reabilitação protética imediata de uma maxila atrófica com implantes convencionais e zigomáticos com interface cônica interna como opção ao uso de enxertos ósseos prévios. Paciente com 47 anos de idade, do sexo masculino, apresentava maxila atrófica e usava uma prótese total superior. O paciente foi reabilitado com quatro implantes convencionais na região anterior e dois implantes zigomáticos cônicos internos instalados nos ossos zigomáticos. Os torques de instalação dos implantes ≥ 60 N.cm proporcionaram estabilidade primária ideal e uma prótese (protocolo) foi instalada imediatamente utilizando a técnica do assentamento passivo. O caso clínico apresentado mostrou que, após 1 ano, resultados precisos e estéticos são possíveis de alcançar com a instalação de implantes zigomáticos combinados com implantes convencionais para reabilitação de maxilas atróficas de forma imediata e sem utilização de enxerto ósseos prévios.

The rehabilitation of atrophic upper jaws with dental implants is always a challenge, since the use of bone grafts is almost always necessary to stabilize the implants. Zygomatic implants have been used as a viable option for the use of bone grafting procedures prior to surgery. The internal tapered interface presents a reduced gap between implant and prosthetic component, showing satisfactory long-term biological and aesthetic results. This article aims to report the immediate prosthetic rehabilitation of an atrophic upper jaw with conventional and zygomatic implants with an internal tapered interface as an option for the use of previous bone grafts. A 47-year-old male patient presented with an atrophic upper jaw and used an upper total prosthesis. The patient was rehabilitated with four conventional implants in the anterior region and two internal tapered zygomatic implants placed in the zygomatic bones. The implant placement torques ≥ 60 N.cm provided ideal primary stability and a prosthesis (protocol) was installed immediately using the passive fit technique. The clinical case presented showed that, after 1 year, accurate and aesthetic results are possible to achieve with the placement of zygomatic implants combined with conventional implants for the rehabilitation of atrophic upper jaws immediately and without the use of previous bone grafts.

Evaluation of Implants with Different Macrostructures in Type I Bone-Pre-Clinical Study in Rabbits.

The objective of this study was to assess the primary stability and the osseointegration process in implants with different macrostructures (Cylindrical vs. Hybrid Conical) in rabbit tibiae. Twenty-four (24) rabbits were used, divided into 3 experimental periods (2, 4 and 8 weeks) with 8 animals each. Each animal bilaterally received 2 implants from each group in the tibial metaphysis: Cylindrical Implant (CI) and Hybrid Conical Implant (HCI). All implants were assessed for insertion torque. After the experimental periods, one of the implants in each group was submitted to the removal counter-torque test and descriptive histological analysis while the other implant was used for microtomographic and histometric analysis (%Bone-Implant Contact). HCI implants showed higher insertion torque (32.93 ± 10.61 Ncm vs. 27.99 ± 7.80 Ncm) and higher % of bone-implant contact in the 8-week period (79.08 ± 11.31% vs. 59.72 ± 11.29%) than CI implants. However, CI implants showed higher values of removal counter-torque than HCI implants in the 8-week period (91.05 ± 9.32 Ncm vs. 68.62 ± 13.70 Ncm). There were no differences between groups regarding microtomographic data. It can be concluded that HCI implants showed greater insertion torque and bone-implant contact in relation to CI implants in the period of 8 weeks when installed in cortical bone of rabbits.

Immediate Oral Rehabilitation Using Dental Implants After Marginal Mandibulectomy: A Case Report.

Mandibular reconstruction techniques are always a challenge to oral and maxillofacial (OMF) surgeons. Techniques and treatment plans that offer the patient OMF rehabilitation should always be available. Technological innovations have enabled more rapid, safer, and more secure treatment than in the past. This article describes a case using a different approach. The patient was treated with marginal mandibulectomy and immediate rehabilitation with osseointegrated implants; a hybrid prosthesis was fabricated a short time thereafter. This treatment plan demonstrated its utility and efficiency in this case. An approach with fewer surgeries and OMF rehabilitation needs be considered in all cases.

Oral Rehabilitation with Zygomatic Implants in a Patient with Cleft Palate.

Edentulous patients with an atrophic maxilla associated with lip-palate fissures have unpredictable results after undergoing grafting procedures. In situations where the atrophic maxilla does not adequately allow reconstruction, the use of zygomatic implants has been indicated, and probably these implants can be indicated for the rehabilitation of patients with lip-palate fissures. This case report describes the oral rehabilitation treatment of a patient with a lip-palate cleft treated with zygomatic implants and implant-supported fixed prosthesis with two years of follow-up. A 65-year-old female patient had a lip-palate cleft and previously underwent surgery to close the cleft. The patient had a severely atrophic maxilla and had difficulty adapting to a removable total prosthesis. Due to the small amount of bone remaining and extensive fibrous tissue in the palate region, a rehabilitation with conventional implants associated with zygomatic implants was chosen. Two zygomatic implants and a conventional implant were placed on the right side, and a zygomatic implant and conventional implant were placed on the left side; these implants were later activated by a protocol-type prosthesis. The zygomatic implants provided an adequate aesthetic and functional outcome of the prosthesis in a patient with cleft palate.

Does the Length of Dental Implants Inserted in Areas of Inferior Alveolar Nerve Lateralization Interfere on Mandibular Resistance to Fracture?

The aim of this study was to compare, in vitro, the mechanical resistance to vertical displacement of the mandible after osteotomy for lateralization of the inferior alveolar nerve and installation of dental implants. One hundred eighty polyurethane mandibles were equally divided into 6 groups: G1-intact hemi-mandibles (control group), G2-hemi-mandibles after osteotomy for lateralization of the inferior alveolar nerve, G3-hemi-mandibles with installation of 3 bicortical dental implants (3.75 × 13 mm), G4-hemi-mandibles with installation of 3 dental implants that did not reach the basal cortical bone (3.75 × 11 mm), G5-hemi-mandibles after osteotomy for lateralization of the inferior alveolar nerve and installation of 3 bicortical dental implants (3.75 × 13 mm) and G6-hemi-mandibles after osteotomy for lateralization of the inferior alveolar nerve and installation of 3 dental implants that did not reach the basal cortical bone (3.75 × 11 mm). The specimens were subjected to linear loading tests. The highest mean value of maximum load was found in G1 (412.36N ±â€Š11.99), followed by G2 (396.87N ±â€Š23.94), G3 (319.63N ±â€Š57.28), G4 (303.34N ±â€Š18.25), G5 (231.75N ±â€Š63.64) and G6 (228.13N ±â€Š20.75). Based on this data, it can be concluded that the bicorticalization (or not) of the implants was not a statistically significant risk factor for the vertical displacement of polyurethane hemi-mandibles.

Proposta de protocolo tomográfico para planejamento cirúrgico de implante zigomático / Tomographic protocol proposal for zygomatic implants surgical planning

O objetivo deste trabalho foi apresentar uma proposta de um protocolo de planejamento cirúrgico para implantes zigomáticos, por meio de imagens tomográficas inseridas em software de planejamento virtual. As etapas do protocolo foram descritas por meio de relato de caso clínico de paciente desdentado total superior candidato à reabilitação com ancoragem zigomática. A tomografia pré-operatória foi analisada no software de planejamento CoDiagonostiX (Dental Wings, Chemnitz, Alemanha). Uma vez obtidas medidas lineares, angulares e de volume das estruturas anatômicas envolvidas, o planejamento virtual de implantes zigomáticos foi realizado. Concluiu-se que o software de planejamento de implantes zigomáticos com possibilidade de obtenção de medidas lineares, angulares e de volume das estruturas anatômicas representa uma ferramenta importante que permite maior segurança e previsibilidade (AU).

The objective of this paper was to present a proposal of zygomatic implants surgical planning protocol through tomographic images inserted in virtual planning software. The protocol stages were described through a clinical case report of an upper total edentulous patient, candidate for zygomatic anchorage rehabilitation. Preoperative tomography was analyzed in the CoDiagonostiX planning software (Dental Wings, Chemnitz, Germany). As linear, angular and volume measurements of the anatomical structures involved were obtained, the virtual zygomatic implant planning was performed. It was concluded that zygomatic implant planning software which allows to obtain linear, angular, and volume measurements of anatomical structures represents an important tool that allows greater security and predictability (AU).

Utilização da malha de titânio para a regeneração óssea guiada da região anterior da maxila simultânea à instalação de implantes ­ relato de caso / Titanium mesh use for anterior maxilla guided bone regeneration simultaneous to implant placement ­ case report

O objetivo desse relato de caso foi descrever um protocolo de tratamento de maxila atrófica com elevação bilateral de soalho de seio maxilar na região posterior associado à regeneração óssea guiada por meio da utilização de malha de titânio e utilização de enxerto ósseo xenógeno na região anterior da maxila. Paciente do sexo feminino, 48 anos, tinha como queixa a desadaptação das próteses total superior e parcial inferior. No exame clínico, foi constatada a necessidade de enxertia óssea, pois a paciente apresentava maxila atrófica. Foi executada a regeneração óssea guiada na região anterior por meio do uso de malha de titânio e membrana de colágeno reabsorvível associada à instalação de implantes e preenchimento dos espaços com osso bovino desproteinizado. Na região posterior, foi realizada a elevação de soalho de seio maxilar associada à instalação de implantes e preenchimento da cavidade sinusal com osso bovino desproteinizado. Após 8 meses, verificou-se estabilidade das áreas enxertadas e as próteses definitivas foram instaladas. Concluiu-se que a aplicação da ROG, associada à malha de titânio e enxerto de osso bovino desproteinizado, foi eficaz para o aumento da disponibilidade óssea vertical e horizontal de maxila atrófica na região anterior quando executada no mesmo momento cirúrgico da instalação dos implantes (AU).

The aim of this case report was to describe an atrophic maxilla treatment protocol with bilateral maxillary sinus floor elevation in the posterior region associated to guided bone regeneration using titanium mesh and xenogenous bone graft in the maxilla anterior region. A 48-year-old female patient complained about total upper and lower partial dentures misfit. Clinical examination revealed the need for bone grafting due to patient atrophic maxilla. Guided bone regeneration was performed in the anterior region through titanium mesh use and reabsorbable collagen membrane associated to implants installation and spaces filling with deproteinized bovine bone. In the posterior region, maxillary sinus floor elevation was performed associated to implant installation and filling of the sinusal cavity with deproteinized bovine bone. After 8 months, the stability of the grafted areas was confirmed and the final prostheses were installed. It can be concluded that the application of guided bone regeneration with titanium mesh and deproteinized bovine bone graft was effective to increase the vertical and horizontal bone availability of the atrophic maxilla in the anterior region when performed at the same surgical time of implant installation (AU).

Avaliação histológica e tomográfica do enxerto xenógeno em bloco para o preenchimento do seio maxilar / Histological and tomographic evaluation of the xenograft block for filling the maxillary sinus

O objetivo desse estudo foi avaliar, por meio de exame tomográfico e histológico, o comportamento do enxerto de osso bovino desproteinizado em cirurgias de elevação de soalho de seio maxilar. A amostra foi constituída por 7 pacientes do gênero feminino que necessitavam de instalação de implantes osseointegrados para reabilitação do rebordo posterior edêntulo total ou parcial da maxila e apresentavam pneumatização do seio maxilar com necessidade de aumento vertical através de técnicas de enxertia. Os pacientes foram submetidos à cirurgia de elevação de soalho de seio maxilar, sendo que a cavidade sinusal foi preenchida com enxerto bovino desproteinizado em forma de bloco que foi mantido fixo dentro do seio maxilar por meio de um parafuso de fixação do enxerto. Após 6 meses do procedimento cirúrgico, foi executada uma avaliação tomográfica para verificação do aumento da disponibilidade de tecido ósseo e análise histométrica das biópsias para avaliação da composição do tecido reparado. Verificou-se que houve aumento da altura do rebordo alveolar. Antes do procedimento cirúrgico era de 4,10 ± 2,03 mm e no momento da instalação dos implantes era de 19,04 ± 2,45 mm. Em termos de composição do tecido enxertado, foi verificado que houve a presença de 15,66% de tecido ósseo, 28,83% de biomaterial e 55,49% de tecido mole. Dessa forma, concluiu-se que a utilização de blocos de osso bovino desproteinizado em cirurgias de elevação de seio maxilar foi eficiente no aumento da disponibilidade óssea, o que permitiu a instalação de implantes (AU).

The aim of this study was to evaluate, by means of tomographic and histological examination, the behavior of deproteinized bovine bone graft blocks in maxillary sinus floor elevation surgeries. The sample consisted of 7 female patients who requires the installation of osseointegrated implants for rehabilitation of the posterior or total edentulous maxilla, that presented pneumatization of the maxillary sinus with the need for vertical increase through grafting techniques. Patients underwent maxillary sinus floor elevation surgery and the sinus cavity was filled with a deproteinized bovine graft in the form of ablock that was kept fixed inside the maxillary sinus by means of a graft ixation screw. After 6 months of the surgical procedure, a tomographic evaluation was performed to evaluate the increase of the availability of bone tissue and histometric analysis of the biopsies to evaluate the composition of the repaired tissue. It was verified that there was an increase in the height of the alveolar ridge. Before the surgical procedure was 4.10 ± 2.03 mm and at the moment of the installation of the implants was 19.04 ± 2.45 mm. In terms of the composition of the grafted tissue, it was verified that 15.66% of bone tissue was present, 28.83% of biomaterial, and 55.49% of soft tissue. Thus, it can be concluded that the use of deproteinized bovine bone blocks in maxillary sinus surgeries was efficient in increasing the bone availability that allowed the implantation of implants (AU).

Real Versus Virtual Position of Single Implants Installed in Premaxilla via Guided Surgery: A Proof of Concept Analyzing Positional Deviations.

The aim of this research letter was to report the results of a pilot study designed to compare the real and virtual position of implants placed using computer-guided flapless implant surgery for single restorations in the premaxilla. A total of 8 patients (2 men and 6 women) with a mean age of 40 years old (range: 32-73 years) had a total of 11 implants inserted using a tooth-supported stereolithographic guide. After implant placement, the positions (coronal, central, and apical) and angulation of the implants installed in relation to those planned were determined via the superposition of pre- and postoperative 3-dimensional models using Dental Slice software (Bioparts, Brasília, Brazil). The mean angular deviation was 2.54° ± 0.71°. The deviations found for the coronal, central, and apical positions were 1.3 ± 0.77 mm, 1.49 ± 0.58 mm, and 2.13 ± 1.32 mm, respectively.

Histological analysis of the use of biphasic ceramics based on hydroxyapatite and B-tricalcium phosphate in maxillary sinus floor elevation surgery: pilot study / Análise histológica do uso da cerâmica bifásica a base de hidroxiapatita e B-tricálcio fosfato em cirurgia de elevação de assoalho de seio maxilar: estudo piloto

Objective: To evaluate the bone repair associated with the use of biphasic ceramics based on hydroxyapatite and β-tricalcium phosphate (HA/TCP) in the procedures of maxillary sinus membrane elevation in human beings. Material and method: Ten patients with a residual bone ridge in the posterior maxillary region between 3 mm and 5 mm in height were selected and indicated for procedures of bone grafting associated with maxillary sinus lift procedure. The maxillary sinuses were filled with HA/TCP, and after 8 months, the implants were implanted and a bone biopsy was collected with the aid of a trephine drill, which was then submitted to histological analysis for the evaluation of the composition of the grafted area. Result: The histological description analysis of the biopsies revealed the presence of vital and immature bone tissue, juxtaposed to the biomaterial. Histomorphometric analysis showed that the biopsy composition was in average 28.8%, 27.4%, and 43.6% of bone tissue, biomaterial, and soft tissue, respectively. Conclusion: The areas grafted with HA/TCP presented the adequate amount of bone formation that allowed the implantation of the implants. The success of the grafting procedure with this biomaterial was associated with its osteoconduction potential that allowed the formation of bone tissue in close contact with HA/TCP.

Objetivo: Avaliar o reparo ósseo associado ao uso da cerâmica bifásica a base de hidroxiapatita e β-tricálcio fosfato (HA/TCP) nos procedimentos de elevação da membrana do seio maxilar em humanos. Material e método: Foram selecionados 10 pacientes com rebordo ósseo residual entre 3 mm e 5 mm de altura na região posterior da maxila e que tinham indicação para procedimentos de enxertia óssea associado ao levantamento de seio maxilar. Os seios maxilares foram preenchidos com HA/TCP, e após 8 meses, foi executado a instalação dos implantes e nesse momento foi realizada a coleta de um fragmento ósseo com auxílio de uma broca trefina, o qual foi submetido à análise histológica da área enxertada. Resultado: A análise histológica das biópsias revelou a presença de tecido ósseo vital e imaturo, justaposto ao biomaterial. A análise histomorfométrica revelou percentuais de 28,8%, 27,4% e 43,6% para tecido ósseo, biomaterial e tecido mole, respectivamente. Conclusão: As áreas enxertadas com a HA/TCP apresentaram quantidade adequada de formação óssea que permitiu a instalação dos implantes. O sucesso do procedimento de enxertia com esse biomaterial esteve associado ao seu potencial de osteocondução que permitiu a formação de tecido ósseo em íntimo contato com a HA/TCP.

Mandibular angle fractures treated with a single miniplate without postoperative maxillomandibular fixation: A retrospective evaluation of 50 patients.

OBJECTIVE: This retrospective study evaluated the use of a single miniplate for the treatment of mandibular angle fractures (MAF). METHODS: Fifty patients with 53 MAF were treated by open reduction and internal fixation with the use of a single miniplate and were analyzed in this study. RESULTS: Five patients with MAF had postoperative complications that required additional procedures. Three patients had postoperative infection, one patient complained of malocclusion in the first postoperative week, and one patient had miniplate exposure three months after surgery. Every additional procedure was performed in the office under local anesthesia without disruption of the initial fracture treatment. Postoperative maxillomandibular fixation (MMF) was performed in four patients. Treatment of MAF using a single miniplate was effective, with low morbidity and with low rates of postoperative complications. MAF can be treated without MMF, and stability is improved when long miniplates are used. CONCLUSIONS: The use of a single miniplate is therefore encouraged. However, postoperative MMF should be considered with the presence of little contact between bone segments, malocclusion, or extensive tooth loss.

Avaliação da satisfação de reabilitações com implantes zigomáticos / Satisfaction of rehabilitation with zygomatic implants

Introdução: A reabilitação oral de pacientes com atrofia óssea maxilar representa um grande desafio por estes pacientes apresentarem comprometimento da qualidade de vida, dificuldades alimentares, complicações nutricionais, dificuldades sociais e emocionais. Propostas de reabilitações de maxilas mutiladas e/ou atróficas com próteses totais fixas implantossuportadas, utilizando implantes zigomáticos, foram relatadas. Objetivo: O objetivo deste estudo foi avaliar o grau de satisfação dos pacientes reabilitados com implantes zigomáticos e convencionais, em função de carga imediata com prótese do tipo protocolo através de um estudo retrospectivo, por meio de questionário respondido pelos pacientes. Material e método: Foram incluídos dezenove pacientes, tratados na clínica do Instituto Latino Americano de Pesquisa e Ensino Odontológico (ILAPEO) em Curitiba, PR (Brasil), entre dezembro de 2005 e junho de 2010. Os pacientes foram reabilitados com 41 implantes zigomáticos e 73 implantes convencionais, todos do tipo cone Morse. As próteses, tipo híbridas, foram instaladas em carga imediata. Resultado: O índice de satisfação encontrado foi de 100%. Conclusão: Pode-se concluir que esta técnica de reabilitação restabelece fatores primordiais ao ser humano como mastigação, fonética e estética. Os pacientes relataram satisfação com o resultado do tratamento, conseguindo desenvolver atividades sociais dentro da normalidade, elevando sua autoestima.

Introduction: Rehabilitation of patients with atrophic maxilla is challenging. Atrophic maxilla patients present compromised quality of life, impaired function, deficient nutrition, social and emotional difficulties. The rehabilitation of atrophic maxilla by zygomatic fixtures has been previously proposed. Objective: This retrospective study evaluated the degree of satisfaction of patients rehabilitated by immediately loaded conventional and zygomatic fixtures supporting full-arch fixed dental prosthesis. A satisfaction questionnaire was used for patient assessment. Material and method: Nineteen patients treated at the Latin American Institute for Dental Research and Education (ILAPEO) between December 2005 and June 2010 were evaluated. Patients were rehabilitated with 41 zygomatic implants and 73 conventional implants under immediate load. Result: All assessed patients were completely satisfied with the provided rehabilitation. Conclusion: It can be concluded that rehabilitation with zygomatic fixtures is capable of restoring function, phonetics, and esthetic for patients with atrophic maxilla. The patients were satisfied with the treatment outcomes and showed increased self-esteem after the rehabilitation.

Use of miniplates as a method for orthodontic anchorage: a case report.

INTRODUCTION:: Temporary anchorage devices (TADs) have been developed to be used as direct adjuncts in orthodontic treatment and have facilitated treatment of more complex orthodontic cases, including patients with dental impaction. OBJECTIVES:: This clinical case reports the applicability of TADs in the orthodontic treatment of a patient with impacted mandibular second molars. Surgical and orthodontic procedures related to the use of miniplates were also discussed in this study. CONCLUSIONS:: The use of temporary anchorage devices, such as miniplates, can be suggested as an alternative to treat patients with impacted mandibular second molars.

Use of miniplates as a method for orthodontic anchorage: a case report

ABSTRACT Introduction: Temporary anchorage devices (TADs) have been developed to be used as direct adjuncts in orthodontic treatment and have facilitated treatment of more complex orthodontic cases, including patients with dental impaction. Objectives: This clinical case reports the applicability of TADs in the orthodontic treatment of a patient with impacted mandibular second molars. Surgical and orthodontic procedures related to the use of miniplates were also discussed in this study. Conclusions: The use of temporary anchorage devices, such as miniplates, can be suggested as an alternative to treat patients with impacted mandibular second molars.

RESUMO Introdução: os dispositivos de ancoragem temporária vêm sendo desenvolvidos para uso como coadjuvantes no tratamento ortodôntico. Esses dispositivos facilitam o tratamento ortodôntico de casos mais complexos, incluindo pacientes com dentes impactados. Objetivos: o presente relato de caso reporta a aplicabilidade dos dispositivos de ancoragem temporária no tratamento ortodôntico de um paciente com segundos molares inferiores impactados. Os procedimentos cirúrgicos e ortodônticos relacionados ao uso das miniplacas também são discutidos nesse estudo. Conclusões: o uso de dispositivos de ancoragem temporária, tais como as miniplacas, pode ser sugerido como uma alternativa no tratamento de pacientes com segundos molares inferiores impactados.

Simplifying the Treatment of Bone Atrophy in the Posterior Regions: Combination of Zygomatic and Wide-Short Implants-A Case Report with 2 Years of Follow-Up.

The rehabilitation of maxillary and mandibular bone atrophy represents one of the main challenges of modern oral implantology because it requires a variety of procedures, which not only differ technically, but also differ in their results. In the face of limitations such as deficiencies in the height and thickness of the alveolar structure, prosthetic rehabilitation has sought to avoid large bone reconstruction through bone grafting; this clinical behavior has become a treatment system based on evidence from clinical scientific research. In the treatment of atrophic maxilla, the use of zygomatic implants has been safely applied as a result of extreme technical rigor and mastery of this surgical skill. For cases of posterior mandibular atrophy, short implants with a large diameter and a combination of short and long implants have been recommended to improve biomechanical resistance. These surgical alternatives have demonstrated a success rate similar to that of oral rehabilitation with the placing of conventional implants, allowing the adoption of immediate loading protocol, a decrease in morbidity, simplification and speed of the treatment, and cost reduction. This case report presents complete oral rehabilitation in a patient with bilateral bone atrophy in the posterior regions of the maxilla and mandible with the goal of developing and increasing posterior occlusal stability during immediate loading.

Associação de implantes osseointegráveis e cirurgia ortognática na reabilitação total maxilar / Association of dental implants and orthognathic surgery in total maxillary rehabilitation

A reabilitação oral com implantes osseointegráveis (IO) em pacientes com severa atrofia maxilar é um desafio e, geralmente, o resultado é uma prótese com grande compensação, apresentando biomecânica desfavorável e dificuldade de higienização. Nesses casos, a associação da cirurgia ortognática à reabilitação com IO pode ser uma alternativa viável. Este trabalho descreve alguns casos clínicos de pacientes portadores de osso maxilar atrófico com relação maxilo-mandibular desfavorável, em que se optou pela associação dos IO e da cirurgia ortognática. A sequência reabilitadora foi composta de procedimentos reconstrutivos inlay e/ ou onlay (quando indicados), instalação de implantes osseointegráveis, confecção de prótese sem compensação em classe III e cirurgia ortognática bimaxilar para obtenção da oclusão ideal. Após o acompanhamento desses casos, pôde-se concluir que a reabilitação com implantes e cirurgia ortognática se mostra uma alternativa segura e previsível em caso de edentulismo total superior com grande discrepância maxilo-mandibular (AU).

Oral rehabilitation with osseointegrated implants (OI) in patients with severe maxillary atrophy is a challenge and, generally, the result is a prosthesis with great compensation, presenting unfavorable biomechanics and difficulty of oral hygiene. In these cases, orthognathic surgery and OI association can be a viable alternative. This paper describes some clinical cases of patients with atrophic maxilla and unfavorable maxillomandibular relationship, treated with OI and orthognathic surgery association. The rehabilitation sequence was composed by reconstructive inlay/onlay procedures (when indicated), osseointegrated implants installation and prosthesis manufacturing with outclass III compensation and bimaxillary orthognathic surgery to achieve ideal occlusion. After follow-up of these cases, it can be concluded that the rehabilitation using dental implants and orthognathic surgery shows to be a safe and predictable alternative in cases of complete upper edentulism with great maxillomandibular discrepancy (AU).