Life-changing treatments for edentulous patients
Featured Products Promotional FeaturesPosted by: Dental Design 10th December 2024
Edentulism is a widespread condition, affecting 12% of adults in the UK.[i] According to the 2021 adult oral health survey report, 5% of over-16s in the country are edentate, and edentulism becomes much more prevalent as people get older.[ii] With an ageing population, this figure will almost certainly remain high.
Loss of function, as well as changes to the patient’s appearance and ability to communicate can be psychologically damaging and physically limiting.[iii] Many edentulous patients experience social isolation and poorer overall quality of life.[iv] Restorative implant treatment can be completely life-changing for patients as well as a source of immense satisfaction for clinicians. However, the treatment of a severely atrophic maxilla requires a high level of skill, and careful planning to be successful.[v]
Determining an appropriate clinical strategy when there is significant bone loss can be assisted by pre-treatment evaluations, such as the Bedrossian classification of the maxilla.[vi] In this model, an assessment of the patient’s available bone and its relative quality is made from a panoramic radiograph. The assessment considers bone in 4 zones: I, canine to canine; II, the bicuspids; III, the molars; and IV, the zygoma. This approach also examines the relationship between the alveolar processes, the nasal floor and the maxillary sinuses. Options are carefully considered, and decisions are informed by the presence or absence of available bone in these areas.[vii]
Some innovative surgical options for patients – an overview
If conventional bone augmentation and implant treatments are not possible or appropriate, there are various innovative and increasingly predictable surgical options which can be considered.
Short implants are designed for cases with limited bone height, providing stability without the need for extensive bone grafting.[viii] Tilted implants can be placed at an angle to engage available bone in the posterior maxilla, often reducing the necessity for sinus lifts.[ix] 3D printed customised implants can be created to fit the specific anatomy of the patient. The latter technology is rapidly developing, and is opening up a new and exciting set of possibilities for restoring aesthetics and function for patients.[x]
Trans-sinus implants are positioned through the maxillary sinus, and can be beneficial in cases of significant bone loss. This treatment can be suggested when there is atrophy in Bedrossian zones I and II, when there is a concave anterior sinus wall anatomy, and when there is adequate crestal bone height available.[xi]
Pterygoid implants pass through the maxillary tuberosity and the pyramidal process of the palatine bone, subsequently connecting with the pterygoid process of the sphenoid bone. Pterygoid implants can be placed to support implants in zones I and IV, and can increase the anterior-posterior spread of the final restoration.vii
Zygomatic implants (ZI) make use of the zygomatic bone to support a prosthetic device – generally without requiring a bone graft. They are an effective treatment for patients with significant bone loss from complete or partial maxillectomy, as well as for those with severe maxillary atrophy, who cannot undergo bone grafting. The classic procedure employs a single implant placed in each zygomatic bone, which transverses the maxillary sinus and is splinted to conventional implants in the anterior region.[xii]
Patients without adequate anterior maxillary bone can be treated using the quad ZI procedure, where 2 zygomatic implants are placed bilaterally and then splinted, creating a stable distribution of forces which makes them appropriate for immediate loading.[xiii] The unilateral approach adds a single zygomatic implant in one side, splinted to standard anterior implants.iii
The Zygomatic Anatomy-Guided Approach (ZAGA) focuses on patient-specific therapy applicable to all types of atrophic maxillary anatomy. The concept dictates that the placement of ZIs is guided by both anatomical and prosthetic requirements.[xiv]
Although surgical insertion of a zygomatic implant is complex, and has potential complications, when implemented correctly by clinician with adequate training and experience it can be considered less invasive than bone augmentation procedures.iii
A deep understanding of facial anatomy
Clinicians looking to incorporate these advanced procedures into their practice require proper training from experts who possess a thorough understanding of the latest innovations and techniques. Given the complexity of facial anatomy and the potential for damage to sensitive structures, training should fully address established risk mitigation strategies. In addition to practical instruction on each procedure, clinicians must also gain a complete understanding of the benefits and risks associated with each option.
Eminent specialist oral surgeon, Professor Cemal Ucer, provides just such an opportunity at the ICE Postgraduate Dental Institute and Hospital. The 2-day course, ‘Hands-on Training in Zygomatic, Nazalus, Trans-Sinus, and Pterygoid Implants offers comprehensive advanced surgical training in both novel and conventional techniques, aimed at delivering truly transformative outcomes for patients.
Edentulism is a debilitating condition that can have significant and far-reaching consequences for patients. Gaining the skills and confidence to provide safe and reliable treatment options for a severely atrophic maxilla enables clinicians to offer their patients truly life-changing opportunities.
Please contact Professor Ucer at ucer@icedental.institute or Mel Hay at mel@mdic.co
01612 371842
[i] Prevalence of edentulism in people 20+ years. World Health Organisation. April 2023. Available at: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-edentulism-in-people-20–years. Accessed September 2024
[ii] Adult oral health survey 2021: self-reported health of teeth and gums. Gov.uk. January 2024. Available at: https://www.gov.uk/government/statistics/adult-oral-health-survey-2021/adult-oral-health-survey-2021-self-reported-health-of-teeth-and-gums Accessed September 2024.
[iii] Shah RJ, Diwan FJ, Diwan MJ, Chauhan VJ, Agrawal HS, Patel GC. A study of the emotional effects of tooth loss in an edentulous Gujarati population and its association with depression. J Indian Prosthodont Soc. 2015 Jul-Sep;15(3):237-43. doi: 10.4103/0972-4052.161564. PMID: 26929519; PMCID: PMC4762342.
[iv] André Hajek, B. Kretzler, H.-H. König, Oral Health, Loneliness and Social Isolation. A Systematic Review and Meta-Analysis, The Journal of nutrition, health and aging, Volume 26, Issue 7, 2022, Pages 675-680, ISSN 1279-7707, https://doi.org/10.1007/s12603-022-1806-8.
[v] Aalam AA, Krivitsky-Aalam A, Kurtzman GM, Mahesh L. The severely atrophic maxilla: Decision making with zygomatic and pterygoid dental implants. J Oral Biol Craniofac Res. 2023 Mar-Apr;13(2):202-206. doi: 10.1016/j.jobcr.2023.01.008. Epub 2023 Jan 13. PMID: 37065973; PMCID: PMC10091142.
[vi] E. Bedrossian (Ed.), Implant treatment planning for the edentulous patient: a graftless approach to immediate loading, Mosby Elsevier, Missouri (2011), pp. 37-40
[vii] Guido Cudia, Luigi Tomaselli, Enrica Giammarinaro, Nicola Baldini,
On the pterygoid implant savior for failed implant-rehabilitations – A surgical case series with technical notes, Oral and Maxillofacial Surgery Cases, Volume 10, Issue 1, 2024, 100348, ISSN 2214-5419, https://doi.org/10.1016/j.omsc.2024.100348.
[viii][viii] Jain N, Gulati M, Garg M, Pathak C. Short Implants: New Horizon in Implant Dentistry. J Clin Diagn Res. 2016 Sep;10(9):ZE14-ZE17. doi: 10.7860/JCDR/2016/21838.8550. Epub 2016 Sep 1. PMID: 27790598; PMCID: PMC5072098.
[ix] Cavalli, Nicolò, Barbaro, Bruno, Spasari, Davide, Azzola, Francesco, Ciatti, Alberto, Francetti, Luca, Tilted Implants for Full-Arch Rehabilitations in Completely Edentulous Maxilla: A Retrospective Study, International Journal of Dentistry, 2012, 180379, 6 pages, 2012. https://doi.org/10.1155/2012/180379
[x] Pradíes G, Morón-Conejo B, Martínez-Rus F, Salido MP, Berrendero S. Current applications of 3D printing in dental implantology: A scoping review mapping the evidence. Clin Oral Implants Res. 2024 Aug;35(8):1011-1032. doi: 10.1111/clr.14198. Epub 2023 Nov 6. PMID: 37929684.
[xi] Aalam AA, Krivitsky-Aalam A, Zelig D, Oh S, Holtzclaw D, Kurtzman GM. Trans-sinus dental implants, for immediate placement when insufficient alveolar height is present: an alternative to zygomatic implants – surgical case series. Ann Med Surg (Lond). 2023 Jan 23;85(1):51-56. doi: 10.1097/MS9.0000000000000201. PMID: 36742123; PMCID: PMC9893428.
[xii] Polido WD, Machado-Fernandez A, Lin WS, Aghaloo T. Indications for zygomatic implants: a systematic review. Int J Implant Dent. 2023 Jul 1;9(1):17. doi: 10.1186/s40729-023-00480-4. PMID: 37391575; PMCID: PMC10313639.
[xiii] Davó R, David L. Quad Zygoma: Technique and Realities. Oral Maxillofac Surg Clin North Am. 2019 May;31(2):285-297. doi: 10.1016/j.coms.2018.12.006. PMID: 30947849.
[xiv] Carlos Aparicio, Waldemar D. Polido, Hooman M. Zarrinkelk, THE ZYGOMA ANATOMY-GUIDED APPROACH FOR PLACEMENT OF ZYGOMATIC IMPLANTS. Atlas of the Oral and Maxillofacial Surgery Clinics. September 2021
