Zygomatic implant placement with flapless computer-guided surgery: a proposed clinical protocol

Area of Science:

• Oral and Maxillofacial Surgery
• Dental Implantology
• Image-Guided Surgery

Background:

• Severe maxillary atrophy presents challenges for conventional dental implant placement.
• Zygomatic implants offer a solution for edentulous patients with significant bone loss.
• Image-guided surgery enhances precision in complex implant procedures.

Purpose of the Study:

• To describe an innovative image-guided surgical procedure for zygomatic implant placement.
• To present a novel clinical approach for guiding osteotomies in zygomatic implant surgery.
• To evaluate the efficacy of this technique in patients with severe maxillary atrophy.

Main Methods:

• A two-phase treatment involving conventional premaxillary implants followed by zygomatic implants.
• Utilized cone-beam computed tomography (CBCT) for anatomical evaluation and surgical planning.
• Employed a mucosa-supported stereolithographic surgical guide with an innovative intrasinus device for precise zygomatic implant placement.
• Performed flapless surgery for zygomatic implant placement.

Main Results:

• A total of 25 implants were placed (17 premaxillary, 7 zygomatic, 1 pterygoid).
• Two premaxillary implants failed but were replaced before the zygomatic phase; no zygomatic implants failed.
• Follow-up (4-39 months) demonstrated favorable esthetic, phonetic, and functional results.

Conclusions:

• The described image-guided zygomatic implant procedure shows encouraging results for severe maxillary atrophy.
• Accurate zygomatic implant positioning was achieved, aligning with pre-operative planning.
• Further research, including randomized clinical trials, is necessary to confirm the procedure's predictability.