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JOURNAL OF APPLIED DENTAL AND MEDICAL SCIENCES

VOL . 1 ISSUE 1 APR-JUN 2015

SHORT COMMUNICATION

Zygomatic Bone Implants: A meta-analysis

Tarun Kumar1,Gagan Puri2, Konidena Aravinda3, Amandeep Chopra4

1 ,2,3
Department of Oral Medicine and Radiology, Swami Devi Dyal Hospital and Dental College,
Panchkula
4
Department of Public Health Dentistry, National Dental College and Hospital, Dera Bassi, Punjab

ARTICLE INFO ABSTRACT

Article history: Now a day, dental implants are being used successfully in the management
Received 20st May 2015 of missing teeth. The technique requires adequate bone height specially in
Received in revised form 23rd May2015 case of maxillary edentulous patients where the procedure is more
Accepted 6th June 2015 complicated due to its proximity to the maxillary antrum. The research put
forward the concept of zygomatic bone implants to manage such patients.
Keywords: The purpose of the present article is to describe the zygomatic
Zygoma, Resorbed Ridges, Zygomatic implantology with special emphasis on case selection, radiological aspect
Bone Implants and Radiology. and clinical outcomes based on the literature.

INTRODUCTION: anesthesia. The bone grafts have been used as onlays, in

combination with a Le Fort I osteotomy, or as maxillary
Replacement of missing teeth is one of the common sinus inlays. Implants have been inserted simultaneously
complaint for which the patient visits the dentist. There or after an initial healing period. Long-term follow-up
are basically three techniques to manage these conditions studies have shown varying degrees of implant survival
in mouth i.e. removable denture, tooth supported fixed in grafted bone. A recent literature review based on 23
denture and implant supported fixed dentures. Every publications revealed an overall survival rate of 82– 84%
technique has its own advantages and disadvantages. after a follow-up time from 12 to 60 months.1 A 10%
Implant supported fixed treatment is preferred by the higher survival rate was seen for implants placed after
patients because favourable outcomes. In many patients initial healing of the bone graft than if the implants were
conventional implant treatment cannot be performed in placed simultaneously with the bone graft. It can be
the edentulous maxilla because of extensive bone argued that bone-augmentation procedures are resource
resorption and the presence of extensive maxillary demanding, take a long time and may present risks for
sinuses, leading to inadequate amounts of bone tissue for morbidity of the donor site of the bone graft. It is also
anchorage of the implants. The treatment option for these obvious that failure rates are higher in grafted than in
patients has often been some type of bone-augmentation nongrafted maxillae.2
procedure in order to increase the volume of load-
bearing bone. Traditionally, the atrophic maxilla has One alternative to bone grafting that has been considered
been treated with large bone grafts from the iliac crest. in the atrophied maxilla is the use of the zygomatic
This procedure is more invasive and requires general implants.3 The zygomatic fixture is the result of

* Corresponding author. Dr.Tarun Kumar, Department of Oral Medicine and Radiology, Swami Devi Dyal Hospital and Dental College, Panchkula

Email Address: drtarunomr@gmail.com

 ZYGOMATIC BONE IMPLANTS:A META ANALYSIS ;1(2015) 63–68 64

developments of reconstructive techniques for prosthetic alveolar crest. All of these aspects can be pre-planned
rehabilitation of patients with extensive defects of the with the use of 3D reconstruction and available softwares
maxilla caused by tumor resections, trauma and with advanced imaging techniques, prior to surgery. A
congenital defects.4 The bone of the zygomatic arch was new technique, including extrasinus passage of the
used for anchorage of a long fixture, which, together implant, has been evaluated with promising results.7 It
with ordinary fixtures, could be used as an anchor for facilitates an optimal positioning of the zygomatic
epistheses, prostheses and obturators. The technique has fixture head in relation to the alveolar crest and the
enabled sufficient rehabilitation of these patients, with occlusal table of the prosthetic construction.
restored function and improved esthetics as a result, and
thus has given many patients back a normal social life. Zygomatic Implant design
The purpose of the present article is to describe the The original zygomatic fixture is a self-tapping titanium
concept of the zygomatic implantology with emphasis on implant with a machined surface and is available in
case selection, radiological aspect and clinical outcomes lengths from 30 to 52.5 mm. The threaded apical part has
based on the literature. a diameter of 4 mm and the crestal part has a diameter of
4.5 mm. The implant head has an angulation of 45° and
Case selection for zygomatic implant an inner thread for connection of Branemark System
The zygomatic bone has a pyramidal shape and contains abutments. Zygomatic fixtures are currently
dense cortical and trabecular bone.5,6 According to a commercially available from at least three different
cadaver study, the mean length of available bone in this companies that offer implants with an oxidized rough
region is about 14 mm.6 In general, zygomatic fixtures surface, a smooth midimplant body, a wider neck at the
can be used in patients with severely resorbed edentulous alveolar crest and a 55° angulation of the implant head.
maxillary arches posterior to canine region (i.e. <4 mm
bone height distal to the canines), but with sufficient Clinical outcome of using the zygomatic implant
amounts of bone in the anterior region. Together with In a literature review of 18 studies presenting clinical
conventional implants in the anterior region of maxilla, outcomes with the zygomatic fixture were found (Table
the zygomatic fixture offers anchorage for a fixed bridge 1). The publications included 537 patients and 1056
using less invasive surgery compared with bone- zygomatic implants and 1174 other implants, with a
augmentation procedures. For patients with smaller bone follow-up of 6 months– 12 years. A total of 18
volumes in the anterior part of the maxilla, the zygomatic zygomatic implants and 72 other implants were reported
implant can be used in conjunction with a bone- as failures, giving an overall survival rate of 98.29% for
augmentation procedure of the anterior segment. In this zygomatic implants and 93.87% for other implants.
way, fewer bone grafts are needed for the augmentation However, it should be noted that some studies in part
procedure. Zygomatic implants are also indicated when cover the same patient groups and therefore the true
contraindications exist for harvesting of the iliac crest numbers of unique patients and implants are not known
bone graft. The main advantage with the technique is that in detail. Nevertheless, the data show that the zygomatic
it can be performed as an outpatient procedure under implant technique is highly predictable and results in
local anesthesia and conscious sedation. However, for better clinical outcomes than other implants.
better comfort for the patient, the routine procedure is
usually performed under general anesthesia. Conclusion
To conclude zygomatic implants are very useful in the
management of the severely resorbed maxilla, regardless
Radiological Aspect: of whether it is totally edentulous or partially edentulous
The radiology plays a big role in the case selection of the individuals. Imaging modalities like CBCT and CT
present modality. Starting from the intraoral peiapical drastically improved the accessibility of the surgeon to
radiographs, can be used to estimate the remaining have proper case selection and overview of the technique
thickness of the floor of maxillary sinus in the first molar prior to surgery. A review of literature showed that good
area. Panoramic view can be used just for the screening clinical outcome can be achieved by proper knowledge
of patients for overall look of sinus anatomy (Figure 1 of emerging these three dimensional imaging modalities.
and 2), remaining alveolar bone height and the remaining
thickness of alveolar bone between sinus floor and References:
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How to cite this article: Kumar T,Puri G,Aravinda

K,Chopra A.Zygomatic Bone Implants:A Meta Analysis. J App.
Dent. Med. Sci. 2015; 1(1):63-68.

Source of Support: Nil, Conflict of Interest: None declared.

Journal Of Applied Dental and Medical Sciences 1(1);2015

 ZYGOMATIC BONE IMPLANTS:A META ANALYSIS ;1(2015) 63–68 67

Table 1: Clinical outcomes of Zygomatic Implants

Study Reference No. of Time period Total No. of Total no. of Total No. Total
No. Patients of Follow up Zygomatic Faliures of Other no. of
Implants implants Faliures
Branemark et al. 3 81 1-10 164 4 ? ?
Parel et al. 8 27 1-12 65 0 ? ?
Bedrossian et al. 9 22 34 months 44 0 80 7
Vrielinck et al. 10 29 < 2years 46 3 80 9
Boyes-Varley et al. 11 45 6-30 months 77 0 ? ?
Malevez et al. 12 55 0.-4 years 103 0 194 16
Hirsch et al. 13 66 1 year 124 3 ? ?
Branemark et al. 14 28 5-10 years 52 3 106 29
Becktor et al. 15 16 1-6 years 31 3 74 3
Penarrocha et al. 16 5 1-1.5 years 10 0 16 0
Farzad et al. 17 11 1.5-4 years 22 0 42 1
Ahlgren et al. 18 13 1-4 years 25 0 46 0
Aparicio et al. 19 69 0.5-5 years 131 0 304 2
Bedrossian et al. 20 14 >12 months 28 0 55 0
Chow et al. 21 5 10 months 10 0 20 0
Duarte et al. 22 12 30 months 48 2 - -
Penarrocha et al. 23 21 12-45 40 0 89 2
months
Davo et al. 24 18 6-29 months 36 0 68 3

Figure:

Figure 1: Pre-operative OPG of a case of partial edentulism treated with Zygomatic implant (Arrow
showing the remaining thickness of floor of sinus).

Journal Of Applied Dental and Medical Sciences 1(1);2015

 ZYGOMATIC BONE IMPLANTS:A META ANALYSIS ;1(2015) 63–68 68

Figure 2: Post-operative OPG of a case of partial edentulism treated with Zygomatic implant.

Figure 3: Tomographic section showing the estimation of path of the zygomatic implant (arrow)

Figure 4: Clinical photograph showing a lateral window of the maxillary sinus for visual control of
implant insertion.

Journal Of Applied Dental and Medical Sciences 1(1);2015