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The use of zygomatic implants for prosthetic rehabilitation of the severely resorbed maxilla
Author(s) -
Aparicio Carlos,
Ouazzani Wafaa,
Hatano Naoki
Publication year - 2008
Publication title -
periodontology 2000
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.725
H-Index - 122
eISSN - 1600-0757
pISSN - 0906-6713
DOI - 10.1111/j.1600-0757.2008.00259.x
Subject(s) - medicine , maxilla , dentistry , orthodontics , rehabilitation , citation , periodontology , library science , physical therapy , computer science
In many patients conventional implant treatment cannot be performed in the edentulous maxilla because of extensive bone resorption and the presence of extensive maxillary sinuses, leading to inadequate amounts of bone tissue for anchorage of the implants. The treatment option for these patients has often been some type of bone-augmentation procedure in order to increase the volume of load-bearing bone. Traditionally, the atrophic maxilla has been treated with large bone grafts from the iliac crest, a procedure that requires general anesthesia. The bone grafts have been used as onlays, in combination with a Le Fort I osteotomy, or as maxillary sinus inlays. Implants have been inserted simultaneously or after an initial healing period. Long-term follow-up studies have shown varying degrees of implant survival in grafted bone. A recent literature review based on 23 publications revealed an overall survival rate of 82– 84% after a follow-up time from 12 to 60 months (38). A 10% higher survival rate was seen for implants placed after initial healing of the bone graft than if the implants were placed simultaneously with the bone graft. It can be argued that bone-augmentation procedures are resource demanding, take a long time and may present risks for morbidity of the donor site of the bone graft. It is also obvious that failure rates are higher in grafted than in nongrafted maxillae (17). One alternative to bone grafting that has been considered in the atrophied maxilla is the use of the zygomatic fixture (3, 12, 17). The Brånemark zygomatic fixture is the result of developments of reconstructive techniques for prosthetic rehabilitation of patients with extensive defects of the maxilla caused by tumor resections, trauma and congenital defects (22, 26). The bone of the zygomatic arch was used for anchorage of a long fixture, which, together with ordinary fixtures, could be used as an anchor for epistheses, prostheses and obturators. The technique has enabled sufficient rehabilitation of these patients, with restored function and improved esthetics as a result, and thus has given many patients back a normal social life. The purpose of the present article is to describe the surgical and prosthetic technique, new developments and the clinical outcome zygomatic implantology, based on the literature and on our own experience.