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Oral and Maxillofacial Surgery

, Volume 17, Issue 2, pp 81–93 | Cite as

Survival and complications of zygomatic implants: a systematic review

  • Bruno Ramos ChrcanovicEmail author
  • Mauro Henrique Nogueira Guimarães Abreu
Review Article

Abstract

Purpose

This systematic review attempted to answer the focused questions: “What is the survival rate of zygomatic implants (ZIs)?” and “What are the most common complications related to surgery of zygomatic implants?”

Methods

An electronic search without date or language restrictions was undertaken in PubMed in March 2012. Titles and abstracts from these results (n = 123) were read for identifying studies that meet the eligibility criteria. Eligibility criteria included studies reporting clinical series of zygomatic implants (ZIs). Because of the scarcity of articles with high-level grades of evidence, all articles, including studies with few case reports, were considered for inclusion. All reference lists of the selected and review studies were hand-searched for additional papers that might meet the eligibility criteria. Simple case report articles were not included. Review articles without original data were excluded. Quantitative data extracted from the included studies that provided data for the period of failure of ZIs were used for the calculation of interval survival rate during each follow-up period and cumulative survival rate (CSR) over a 12-year period.

Results

Thirty-seven studies were identified without repetition and five more studies were included by hand-searching, giving a total of 42; 12 evaluated the use of ZI applied with immediate function protocols and 3 for rehabilitating patients after maxillary resections for tumor ablations. These latter three studies showed smaller ZI success. Postoperative complications reported were as follows: 70 cases of sinusitis, 48 of soft tissue infection, 15 of paresthesia, and 17 cases of oroantral fistulas. However, this number may be underestimated, since most of the studies did not mention the presence or absence of these complications. Most ZI failures were detected at the abutment connection phase (6 months after the surgery of implant placement) or before. The CSR over a 12-year period was 96.7 %.

Conclusions

Despite the high survival rate observed, there is an impending need for conducting randomized controlled clinical trials to test the efficacy of these implants in comparison with the other techniques to treat the atrophic maxilla. Thus, the findings reported in the review must be interpreted with considerable caution. Moreover, more studies with longer follow-up periods involving adequate number of ZIs are needed. This will help to obtain a better understanding of the survival of ZIs in a long term. It is suggested that multicenter, randomized controlled clinical trials and longer clinical studies should be implemented in this area, before recommending routine use of ZIs for patients could be given. The placement of zygomatic implants requires very experienced surgeons because it is not risk free since delicate anatomic structures such as the orbita and brain may be involved.

Keywords

Atrophic maxilla Maxillary sinus Zygomatic implant Success rate Survival rate Complications 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Cooper LF (2009) The current and future treatment of edentulism. J Prosthodont 18:116–122PubMedCrossRefGoogle Scholar
  2. 2.
    Becktor JP, Isaksson S, Abrahamsson P, Sennerby L (2005) Evaluation of 31 zygomatic implants and 74 regular dental implants used in 16 patients for prosthetic reconstruction of the atrophic maxilla with cross-arch fixed bridges. Clin Implant Dent Relat Res 7:159–165PubMedCrossRefGoogle Scholar
  3. 3.
    Malevez C, Abarca M, Durdu F, Daelemans P (2004) Clinical outcome of 103 consecutive zygomatic implants: a 6–48 months follow-up study. Clin Oral Implants Res 15:18–22PubMedCrossRefGoogle Scholar
  4. 4.
    Pham AV, Abarca M, De Mey A, Malevez C (2004) Rehabilitation of a patient with cleft lip and palate with an extremely edentulous atrophied posterior maxilla using zygomatic implants: case report. Cleft Palate Craniofac J 41:571–574PubMedCrossRefGoogle Scholar
  5. 5.
    Gómez E, González T, Arias J, Lasaletta L (2008) Three-dimensional reconstruction after removal of zygomatic intraosseous haemangioma. Oral Maxillofac Surg 12:159–162PubMedCrossRefGoogle Scholar
  6. 6.
    Chrcanovic BR, do Amaral MB, Marigo HA, Freire-Maia B (2010) An expanded odontogenic myxoma in maxilla. Stomatologija 12:122–128PubMedGoogle Scholar
  7. 7.
    Chrcanovic BR, Freire-Maia B (2010) Maxillary sinus aplasia. Oral Maxillofac Surg 14:187–191PubMedCrossRefGoogle Scholar
  8. 8.
    Beier US, Salinas T, Puelacher W (2012) Resection of a primary oral malignant melanoma and rehabilitative management using nasolabial flap: a case report. Oral Maxillofac Surg 16:141–145PubMedCrossRefGoogle Scholar
  9. 9.
    Graves S, Mahler BA, Javid B, Armellini D, Jensen OT (2011) Maxillary all-on-four therapy using angled implants: a 16-month clinical study of 1110 implants in 276 jaws. Dent Clin N Am 55:779–794PubMedCrossRefGoogle Scholar
  10. 10.
    Bidra AS, Huynh-Ba G (2011) Implants in the pterygoid region: a systematic review of the literature. Int J Oral Maxillofac Surg 40:773–781PubMedCrossRefGoogle Scholar
  11. 11.
    Weingart D, Bublitz R, Petrin G, Kälber J, Ingimarsson S (2005) Kombination der Sinusliftoperation mit der lateralen Kieferkammaugmentation. Ein Behandlungskonzept zur chirurgischprothetischen Rehabilitation der extremen Oberkieferalveolarkammatrophie. Mund Kiefer Gesichtschir 9:317–323PubMedCrossRefGoogle Scholar
  12. 12.
    Scarano A, Degidi M, Perrotti V, Piattelli A, Iezzi G (2012) Sinus augmentation with phycogene hydroxyapatite: histological and histomorphometrical results after 6 months in humans. A case series. Oral Maxillofac Surg 16:41–45PubMedCrossRefGoogle Scholar
  13. 13.
    Maló P, de Araújo NM, Rangert B (2007) Short implants placed one-stage in maxillae and mandibles: a retrospective clinical study with 1 to 9 years of follow-up. Clin Implant Dent Relat Res 9:15–21PubMedCrossRefGoogle Scholar
  14. 14.
    Langer B, Langer L, Hermann I, Jorneus L (1993) The wide fixture: a solution for special bone situations and a rescue for the compromised implant. Int J Oral Maxillofac Implants 8:400–408PubMedGoogle Scholar
  15. 15.
    Hirsch JM, Ohrnell LO, Henry PJ, Andreasson L, Brånemark PI, Chiapasco M, Gynther G, Finne K, Higuchi KW, Isaksson S, Kahnberg KE, Malevez C, Neukam FW, Sevetz E, Urgell JP, Widmark G, Bolind P (2004) A clinical evaluation of the zygoma fixture: one year of follow-up at 16 clinics. J Oral Maxillofac Surg 62:22–29PubMedCrossRefGoogle Scholar
  16. 16.
    Aparicio C, Ouazzani W, Garcia R, Arevalo X, Muela R, Fortes V (2006) A prospective clinical study on titanium implants in the zygomatic arch for prosthetic rehabilitation of the atrophic edentulous maxilla with a follow-up of 6 months to 5 years. Clin Implant Dent Relat Res 8:114–122PubMedCrossRefGoogle Scholar
  17. 17.
    Kahnberg KE, Henry PJ, Hirsch JM, Ohrnell LO, Andreasson L, Brånemark PI, Chiapasco M, Gynther G, Finne K, Higuchi KW, Isaksson S, Malevez C, Neukam FW, Sevetz E Jr, Urgell JP, Widmark G, Bolind P (2007) Clinical evaluation of the zygoma implant: 3-year follow-up at 16 clinics. J Oral Maxillofac Surg 65:2033–2038PubMedCrossRefGoogle Scholar
  18. 18.
    Bedrossian E (2010) Rehabilitation of the edentulous maxilla with the zygoma concept: a 7-year prospective study. Int J Oral Maxillofac Implants 25:1213–1221PubMedGoogle Scholar
  19. 19.
    Davó R, Pons O, Rojas J, Carpio E (2010) Immediate function of four zygomatic implants: a 1-year report of a prospective study. Eur J Oral Implantol 3:323–334PubMedGoogle Scholar
  20. 20.
    Sartori EM, Padovan LE, de Mattias Sartori IA, Ribeiro PD Jr, de Souza G, Carvalho AC, Goiato MC (2012) Evaluation of satisfaction of patients rehabilitated with zygomatic fixtures. J Oral Maxillofac Surg 70:314–319PubMedCrossRefGoogle Scholar
  21. 21.
    Parel SM, Brånemark PI, Ohrnell LO, Svensson B (2001) Remote implant anchorage for the rehabilitation of maxillary defects. J Prosthet Dent 86:377–381PubMedCrossRefGoogle Scholar
  22. 22.
    Schmidt BL, Pogrel MA, Young CW, Sharma A (2004) Reconstruction of extensive maxillary defects using zygomaticus implants. J Oral Maxillofac Surg 62:82–89PubMedCrossRefGoogle Scholar
  23. 23.
    Esposito M, Worthington HV, Coulthard P (2005) Interventions for replacing missing teeth: dental implants in zygomatic bone for the rehabilitation of the severely deficient edentulous maxilla. Cochrane Database Syst Rev 19:CD004151Google Scholar
  24. 24.
    Candel Martí E, Carrillo García C, Peñarrocha Oltra D, Peñarrocha M (2011) Rehabilitation of atrophic posterior maxilla with zygomatic implants: review. J Oral Implantol. doi: 10.1563/AAID-JOI-D-10-00126
  25. 25.
    Moher D, Liberati A, Tetzlaff J, The ADG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097PubMedCrossRefGoogle Scholar
  26. 26.
    Bedrossian E, Rangert B, Stumpel L, Indresano T (2006) Immediate function with the zygomatic implant: a graftless solution for the patient with mild to advanced atrophy of the maxilla. Int J Oral Maxillofac Implants 21:937–942PubMedGoogle Scholar
  27. 27.
    Chow J, Hui E, Lee PK, Li W (2006) Zygomatic implants: protocol for immediate occlusal loading: a preliminary report. J Oral Maxillofac Surg 64:804–811PubMedCrossRefGoogle Scholar
  28. 28.
    Davó R, Malevez C, Rojas J (2007) Immediate function in the atrophic maxilla using zygoma implants: a preliminary study. J Prosthet Dent 97:S44–S51PubMedCrossRefGoogle Scholar
  29. 29.
    Duarte LR, Filho HN, Francischone CE, Peredo LG, Brånemark PI (2007) The establishment of a protocol for the total rehabilitation of atrophic maxillae employing four zygomatic fixtures in an immediate loading system—a 30-month clinical and radiographic follow-up. Clin Implant Dent Relat Res 9:186–196PubMedCrossRefGoogle Scholar
  30. 30.
    Davó R, Malevez C, Rojas J, Rodríguez J, Regolf J (2008) Clinical outcome of 42 patients treated with 81 immediately loaded zygomatic implants: a 12- to 42-month retrospective study. Eur J Oral Implantol 1:141–150PubMedGoogle Scholar
  31. 31.
    Maló P, Nobre Mde A, Lopes I (2008) A new approach to rehabilitate the severely atrophic maxilla using extramaxillary anchored implants in immediate function: a pilot study. J Prosthet Dent 100:354–366PubMedCrossRefGoogle Scholar
  32. 32.
    Balshi SF, Wolfinger GJ, Balshi TJ (2009) A retrospective analysis of 110 zygomatic implants in a single-stage immediate loading protocol. Int J Oral Maxillofac Implants 24:335–341PubMedGoogle Scholar
  33. 33.
    Aparicio C, Ouazzani W, Aparicio A, Fortes V, Muela R, Pascual A, Codesal M, Barluenga N, Manresa C, Franch M (2010) Extrasinus zygomatic implants: three year experience from a new surgical approach for patients with pronounced buccal concavities in the edentulous maxilla. Clin Implant Dent Relat Res 12:55–61PubMedCrossRefGoogle Scholar
  34. 34.
    Aparicio C, Ouazzani W, Aparicio A, Fortes V, Muela R, Pascual A, Codesal M, Barluenga N, Franch M (2010) Immediate/early loading of zygomatic implants: clinical experiences after 2 to 5 years of follow-up. Clin Implant Dent Relat Res 12:e77–e82PubMedCrossRefGoogle Scholar
  35. 35.
    Landes CA (2005) Zygoma implant-supported midfacial prosthetic rehabilitation: a 4-year follow-up study including assessment of quality of life. Clin Oral Implants Res 16:313–325PubMedCrossRefGoogle Scholar
  36. 36.
    Landes CA, Paffrath C, Koehler C, Thai VD, Stübinger S, Sader R, Lauer HC, Piwowarczyk A (2009) Zygoma implants for midfacial prosthetic rehabilitation using telescopes: 9-year follow-up. Int J Prosthodont 22:20–32PubMedGoogle Scholar
  37. 37.
    Brånemark P-I (1998) The zygomaticus fixture: clinical procedures, 1st edn. Nobel Biocare AB, Gothenburg, p 1Google Scholar
  38. 38.
    Ferrara ED, Stella JP (2004) Restoration of the edentulous maxilla: the case for the zygomatic implants. J Oral Maxillofac Surg 62:1418–1422PubMedCrossRefGoogle Scholar
  39. 39.
    Migliorança RM, Coppede A, Dias Rezende RC, de Mayo T (2011) Restoration of the edentulous maxilla using extrasinus zygomatic implants combined with anterior conventional implants: a retrospective study. Int J Oral Maxillofac Implants 26:665–672PubMedGoogle Scholar
  40. 40.
    Wu YQ, Zhang ZY, Zhang ZY, Sun J, Huang W, Hu YJ, Zhang CP (2005) Zygomatic implants anchorage for the rehabilitation of maxillary defects. Shanghai Kou Qiang Yi Xue 14:210–214PubMedGoogle Scholar
  41. 41.
    Boyes-Varley JG, Howes DG, Davidge-Pitts KD, Brånemark I, McAlpine JA (2007) A protocol for maxillary reconstruction following oncology resection using zygomatic implants. Int J Prosthodont 20:521–531PubMedGoogle Scholar
  42. 42.
    King MA, Casarett GW, Weber DA (1979) A study of irradiated bone: I. Histopathologic and physiologic changes. J Nucl Med 20:1142–1149PubMedGoogle Scholar
  43. 43.
    Parel SM, Tjellström A (1991) The United States and Swedish experience with osseointegration and facial prostheses. Int J Oral Maxillofac Implants 6:75–79PubMedGoogle Scholar
  44. 44.
    Aparicio C, Ouazzani W, Hatano N (2008) The use of zygomatic implants for prosthetic rehabilitation of the severely resorbed maxilla. Periodontol 2000 47:162–171Google Scholar
  45. 45.
    Nkenke E, Hahn M, Lell M, Wiltfang J, Schultze-Mosgau S, Stech B, Radespiel-Tröger M, Neukam FW (2003) Anatomic site evaluation of the zygomatic bone for dental implant placement. Clin Oral Implants Res 14:72–79PubMedCrossRefGoogle Scholar
  46. 46.
    Ivanoff CJ, Sennerby L, Lekholm U (1996) Influence of mono- and bicortical anchorage on the integration of titanium implants. A study in the rabbit tibia. Int J Oral Maxillofac Surg 25:229–235PubMedCrossRefGoogle Scholar
  47. 47.
    Ahlgren F, Størksen K, Tornes K (2006) A study of 25 zygomatic dental implants with 11 to 49 months' follow-up after loading. Int J Oral Maxillofac Implants 21:421–425PubMedGoogle Scholar
  48. 48.
    Farzad P, Andersson L, Gunnarsson S, Johansson B (2006) Rehabilitation of severely resorbed maxillae with zygomatic implants: an evaluation of implant stability, tissue conditions, and patients' opinion before and after treatment. Int J Oral Maxillofac Implants 21:399–404PubMedGoogle Scholar
  49. 49.
    Petruson B (2004) Sinuscopy in patients with titanium implants in the nose and sinuses. Scand J Plast Reconstr Surg Hand Surg 38:86–93PubMedCrossRefGoogle Scholar
  50. 50.
    Vrielinck L, Politis C, Schepers S, Pauwels M, Naert I (2003) Image-based planning and clinical validation of zygoma and pterygoid implant placement in patients with severe bone atrophy using customized drill guides. Preliminary results from a prospective clinical follow follow-up study. Int J Oral Maxillofac Surg 32:7–14PubMedCrossRefGoogle Scholar
  51. 51.
    Brånemark PI, Grondahl K, Ohrnell LO, Nilsson P, Petruson B, Svensson B, Engstrand P, Nannmark U (2004) Zygoma fixture in the management of advanced atrophy of the maxilla: technique and long-term results. Scand J Plast Reconstr Surg Hand Surg 38:70–85PubMedCrossRefGoogle Scholar
  52. 52.
    Zwahlen RA, Grätz KW, Oechslin CK, Studer SP (2006) Survival rate of zygomatic implants in atrophic or partially resected maxillae prior to functional loading: a retrospective clinical report. Int J Oral Maxillofac Implants 21:413–420PubMedGoogle Scholar
  53. 53.
    Davó R (2009) Zygomatic implants placed with a 2-stage procedure: a 5-year retrospective study. Eur J Oral Implantol 2:115–124PubMedGoogle Scholar
  54. 54.
    Stiévenart M, Malevez C (2010) Rehabilitation of totally atrophied maxilla by means of four zygomatic implants and fixed prosthesis: a 6–40-month follow-up. Int J Oral Maxillofac Surg 39:358–363PubMedCrossRefGoogle Scholar
  55. 55.
    Al-Nawas B, Wegener J, Bender C, Wagner W (2004) Critical soft tissue parameters of the zygomatic implant. J Clin Periodontol 31:497–500PubMedCrossRefGoogle Scholar
  56. 56.
    Reychler H, Olszewski R (2010) Intracerebral penetration of a zygomatic dental implant and consequent therapeutic dilemmas: case report. Int J Oral Maxillofac Implants 25:416–418PubMedGoogle Scholar
  57. 57.
    Davó R, Malevez C, López-Orellana C, Pastor-Bevia F, Rojas J (2008) Sinus reactions to immediately loaded zygomatic implants: a clinical and radiological study. Eur J Oral Implantol 1:53–60PubMedGoogle Scholar
  58. 58.
    Timmenga NM, Raghoebar GM, Liem RS, van Weissenbruch R, Manson WL, Vissink A (2003) Effects of maxillary sinus floor elevation surgery on the maxillary sinus physiology. Eur J Oral Sci 111:189–197PubMedCrossRefGoogle Scholar
  59. 59.
    Jung JH, Choi BH, Zhu SJ, Lee SH, Huh JY, You TM, Lee HJ, Li J (2006) The effects of exposing dental implants to the maxillary sinus cavity on sinus complications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102:602–605PubMedCrossRefGoogle Scholar
  60. 60.
    Doud Galli SK, Lebowitz RA, Giacchi RJ, Glickman R, Jacobs JB (2001) Sinusitis complicating sinus lift surgery. Am J Rhinol 15:181–186PubMedCrossRefGoogle Scholar
  61. 61.
    Peñarrocha M, García B, Martí E, Boronat A (2007) Rehabilitation of severely atrophic maxillae with fixed implant-supported prostheses using zygomatic implants placed using the sinus slot technique: clinical report on a series of 21 patients. Int J Oral Maxillofac Implants 22:645–650PubMedGoogle Scholar
  62. 62.
    Chow J, Wat P, Hui E, Lee P, Li W (2010) A new method to eliminate the risk of maxillary sinusitis with zygomatic implants. Int J Oral Maxillofac Implants 25:1233–1240PubMedGoogle Scholar
  63. 63.
    Peñarrocha M, Uribe R, García B, Martí E (2005) Zygomatic implants using the sinus slot technique: clinical report of a patient series. Int J Oral Maxillofac Implants 20:788–792PubMedGoogle Scholar
  64. 64.
    Sato FR, Sawazaki R, Berretta D, Moreira RW, Vargas PA, de Almeida OP (2010) Aspergillosis of the maxillary sinus associated with a zygomatic implant. J Am Dent Assoc 141:1231–1235PubMedGoogle Scholar
  65. 65.
    Barone A, Santini S, Sbordone L, Crespi R, Covani U (2006) A clinical study of the outcomes and complications associated with maxillary sinus augmentation. Int J Oral Maxillofac Implants 21:81–85PubMedGoogle Scholar
  66. 66.
    Chrcanovic BR, Oliveira DR, Custódio AL (2010) Accuracy evaluation of computed tomography-derived stereolithographic surgical guides in zygomatic implant placement in human cadavers. J Oral Implantol 36:345–355PubMedCrossRefGoogle Scholar
  67. 67.
    Bedrossian E, Stumpel L 3rd, Beckely ML, Indresano T (2002) The zygomatic implant: preliminary data on treatment of severely resorbed maxillae. A clinical report. Int J Oral Maxillofac Implants 17:861–865PubMedGoogle Scholar
  68. 68.
    Boyes-Varley JG, Howes DG, Lownie JF (2003) The zygomaticus implant protocol in the treatment of the severely resorbed maxilla. SADJ 58(106–109):113–114Google Scholar
  69. 69.
    Nakai H, Okazaki Y, Ueda M (2003) Clinical application of zygomatic implants for rehabilitation of the severely resorbed maxilla: a clinical report. Int J Oral Maxillofac Implants 18:566–570PubMedGoogle Scholar
  70. 70.
    Aghabeigi B, Bousdras VA (2007) Rehabilitation of severe maxillary atrophy with zygomatic implants: clinical report of 4 cases. Br Dent J 202:669–675PubMedCrossRefGoogle Scholar
  71. 71.
    Mozzati M, Monfrin SB, Pedretti G, Schierano G, Bassi F (2008) Immediate loading of maxillary fixed prostheses retained by zygomatic and conventional implants: 24-month preliminary data for a series of clinical case reports. Int J Oral Maxillofac Implants 23:308–314PubMedGoogle Scholar
  72. 72.
    Pi Urgell J, Revilla Gutiérrez V, Gay Escoda CG (2008) Rehabilitation of atrophic maxilla: a review of 101 zygomatic implants. Med Oral Patol Oral Cir Bucal 13:E363–E370PubMedGoogle Scholar
  73. 73.
    Bothur S, Garsten M (2010) Initial speech problems in patients treated with multiple zygomatic implants. Int J Oral Maxillofac Implants 25:379–384PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Bruno Ramos Chrcanovic
    • 1
    Email author
  • Mauro Henrique Nogueira Guimarães Abreu
    • 2
  1. 1.Belo HorizonteBrazil
  2. 2.Department of Community and Preventive Dentistry, School of DentistryUniversidade Federal de Minas GeraisBelo HorizonteBrazil

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