The Challenges of Zygomatic Implants
Featured Products Promotional FeaturesPosted by: Dental Design 22nd April 2022
The placing of zygomatic implants has been a widely discussed topic in dentistry and this is usually because the procedure is very complex. Surgeon and patient can both face significant challenges associated with the procedure.
What Causes These Scenarios?
When it comes to identifying patients who might be suitable for the placement of zygomatic implants, looking at the actual anatomy of their atrophic maxilla and their health more generally can be a good indicator of the level of risk your patient may be at.
Osteoporosis is a disease that develops when the mineral density and bone mass decreases and the structure of the bone changes.[i] This can lead to bones becoming weakened over time and ultimately increases the risk of damage to the bone. Most people are unaware that they are suffering from osteoporosis until they injure themselves.
While osteoporosis can result in edentulism it’s not the only cause of tooth loss. Patients who lead a particularly unhealthy lifestyle, such as one that includes heavily smoking or drinking, are at a greater risk of developing periodontal disease and potentially losing teeth as a result.[ii] Disuse atrophy that takes place after tooth loss is a progressive physiological phenomenon that is usually made worse by denture wear. In severe cases the resorption of the jawbone leads to gross alveolar bone atrophy which would mean that routine dental rehabilitation even with shorter implants would not be possible. In such cases Zygomatic implant therapy is indicated as an alternative to undertaking extensive bone regenerative surgery and grafting.[iii]
In other scenarios, you might see a patient who is almost at the end of what would have been an already long journey. Head and neck cancer is the eighth most common cancer in the UK and makes up 3% of new cancer cases each year.[iv] It’s more commonly diagnosed in males but, of course, females are affected too. In the most severe cases, partial or full maxillectomies necessitate extensive prosthetic rehabilitation to restore function and aesthetics. Zygomatic implants have been found to be highly effective for the rehabilitation of oncology or severe trauma cases where there is often no other alternative. One study showed that, out of forty-nine patients who received this treatment, the survival rate of the implants was over 90% after 60 months.[v] Zygomatic implants are also used increasingly for the replacement of failing full arch conventional implant restorations which would otherwise require staged bone grafting surgeries.
Everyone Will be Challenged
While your patient may be suitable for a zygomatic implant procedure there are complications that should be considered. The most common complication reported is maxillary sinus infections caused by oral-antral communications that occur when zygomatic implants are placed within the sinus cavity without an effective seal separating the perforation from the oral cavity.[vi] Patients can also experience local complications and collateral surgical injuries such as paraesthesia, bruising, labial laceration and damage to the orbit.
In particular, there is a risk of infection occurring in the orbital area.[vii] This can be due to aseptic necrosis which can occur for a variety of reasons. One case treated this problem by simply cutting off the part of the implant that extruded after the bone had resorbed, as well as treating the infection.vi This was successful but the aesthetic outcome was not as pleasing as it would have been if the infection had not become so severe – ensuring that your patients are aware of how to spot the early signs of infection after their procedure could combat this. Any signs of pain or discomfort should be reported immediately by the patient.
Taking your patients general health into consideration will inform the aftercare they’ll need to minimise the risk of complications and ensure the success of their procedure. For instance, smoking is a significant risk factor especially potentiated by a history of periodontal disease and or chronic sinus disease. In one case, a 45-year-old male smoker was treated with two zygomatic implants and short anterior implants.vi Five years after the surgery they were found to have developed periodontitis, which smoking is a known risk factor of, and had to undergo more major surgery.
There are a variety of complications that clinician and patient can face throughout this procedure and the healing process. Generally, when it comes to zygomatic implants the treatment planning and experience of the surgeon needs to be top quality.
Avoiding Great Mistakes
It’s common knowledge in the dental profession that zygomatic implant procedures are highly complex. If you’re interested in getting the best outcomes for your patients, referring them to the ZAGA Centre for Oral-Maxillofacial and Dental Implant Reconstruction could be the best solution all-round. This centre is part of a global network of clinics that use the ZAGA-Straumann Zygomatic implants which have been developed after years of experience and research to minimise the complications and to enhance the predictability and success of zygomatic implant procedures. This philosophy provides an evidence-based understanding of the technique which focuses on an extra-sinus approach. The clinic’s focus is the best interests of your patient and ensuring that treatment outcomes meet the patient’s needs and expectations to the greatest extent.
Overall, placing zygomatic implants comes with an array of risks and complications. Both patient and clinician need to be fully prepared every step of the way to ensure the best outcomes are reached. However, referring to the experts can help avoid any unnecessary stress.
Please contact Professor Ucer at ucer@icedental.institute or Mel Hay at mel@mdic.co
01612 371842
[i] National Institute of Arthritis and Musculoskeletal and Skin Diseases (2018). Osteoporosis Overview | NIH Osteoporosis and Related Bone Diseases National Resource Center. [online] Nih.gov. Available at: https://www.bones.nih.gov/health-info/bone/osteoporosis/overview [Accessed 8 Feb. 2022].
[ii] nhs.uk. (2018). Gum Disease – Complications. [online] Available at: https://www.nhs.uk/conditions/gum-disease/complications/ [Accessed 8 Feb. 2022].
[iii] Bandela, V. (2015). Osteoporosis: Its Prosthodontic Considerations – A Review. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH.
[iv] Cancer Research UK. (2017). Head and Neck Cancers Incidence Statistics. [online] Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/head-and-neck-cancers/incidence#heading-Zero [Accessed 8 Feb. 2022].
[v] Butterworth, C.J. (2019). Primary vs Secondary Zygomatic Implant Placement in Patients With Head and Neck Cancer- A 10-year Prospective Study. Head & Neck.
[vi] Molinero-Mourelle, P., Baca-Gonzalez, L., Gao, B., Saez-Alcaide, L., Helm, A. and Lopez-Quiles, J. (2016). Surgical complications in zygomatic implants: A systematic review. Medicina Oral Patología Oral y Cirugia Bucal.
[vii] Tzerbos, F., Bountaniotis, F., Theologie-Lygidakis, N., Fakitsas, D. and Fakitsas, I. (2016). Complications of Zygomatic Implants: Our Clinical Experience with 4 Cases. Acta Stomatologica Croatica, 50(3), pp.251–257.
