Computer-Guided Approach for Placement of Zygomatic Implants: Novel Protocol and Surgical Guide

Area of Science:

• Oral and Maxillofacial Surgery
• Dental Implantology
• Biomedical Engineering

Background:

• Zygomatic implant placement is complex due to vital anatomical structures.
• Accurate presurgical planning is crucial for successful outcomes.
• Existing methods may have limitations in precision and control.

Purpose of the Study:

• To introduce a novel protocol for zygomatic implant placement.
• To utilize 3-dimensional (3D) computed tomography (CT)/cone-beam (CB)CT and 3D printing for surgical guide fabrication.
• To enhance accuracy and control during zygomatic implant surgery.

Main Methods:

• Utilized large field of view CT/CBCT for maxillary arch assessment and receptor site planning.
• Fabricated novel CT/CBCT-derived surgical guides using 3D printing technology.
• Performed in-scale maxilla and zygomatic bone models for surgical simulation and implant replica placement.
• Incorporated guidance for sinus fenestration within the surgical template.

Main Results:

• Compared preoperative virtual implant positions with postoperative positions using merged CT datasets.
• Quantified accuracy via sophisticated software, measuring apical, coronal, and angular deviations.
• Observed deviations from the virtual plan to actual implant positions ranging from 2-3 mm, with angular deviations between 1.88-4.55 degrees.

Conclusions:

• The novel surgical guide facilitated precise control over the drilling protocol, aiding visualization and limiting angular deviation.
• Satisfactory correspondence was achieved between planned and placed zygomatic implants.
• The protocol demonstrated safety, with no damage to adjacent vital anatomical structures, supporting its viability as a treatment alternative.