Professional Documents
Culture Documents
Case Report: Rehabilitation of Posterior Maxilla With Zygomatic and Dental Implant After Tumor Resection: A Case Report
Case Report: Rehabilitation of Posterior Maxilla With Zygomatic and Dental Implant After Tumor Resection: A Case Report
Case Report: Rehabilitation of Posterior Maxilla With Zygomatic and Dental Implant After Tumor Resection: A Case Report
Case Report
Rehabilitation of Posterior Maxilla with Zygomatic and
Dental Implant after Tumor Resection: A Case Report
Copyright © 2013 Faysal Ugurlu et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Zygomatic implants have been used for dental rehabilitation in patients with insufficient bone in the posterior upper jaw, due to, for
example, tumor resection, trauma, or atrophy. Zygomatic implants are an alternative to complex free or vascularized bone grafting
and distraction osteogenesis. A 42-year-old male patient with a severe defect in the right posterior maxilla, starting from the first
canine region, which had occurred after tumor resection 3 years earlier, was referred to our department. One zygomatic implant
(Brenemark System, Nobel Biocare, Goteborg, Sweden) to the zygoma and one dental implant to the canine region were placed.
After a 5-month osseointegration period, a fixed denture was fabricated and adapted to the implants. Although the surgical and
prosthetic procedures for zygoma implants are not easy, the final outcomes can be successful with appropriate planning.
Sinusitis has been reported by a number of authors [19, [7] L. K. Cheung, Q. Zhang, Z. G. Zhang, and M. C. M. Wong,
20]. The incidence was 14–30%. In some cases, patients with “Reconstruction of maxillectomy defect by transport distrac-
an oroantral fistula may develop suppuration with or without tion osteogenesis,” International Journal of Oral and Maxillofa-
sinusitis. Treatment involves the administration of antibiotics cial Surgery, vol. 32, no. 5, pp. 515–522, 2003.
and/or repositioning soft tissue, without removal of the stable [8] E. Nyström, H. Nilson, J. Gunne, and S. Lundgren, “Recon-
zygomatic implant. Causes of sinusitis include perforation of struction of the atrophic maxilla with interpositional bone
the sinus membrane and leakage at the level of the maxilla grafting/Le Fort I osteotomy and endosteal implants: a 11–16
year follow-up,” International Journal of Oral and Maxillofacial
due to a hole in the zygomatic implant, leading to migration
Surgery, vol. 38, no. 1, pp. 1–6, 2009.
of bacteria from the mouth to the sinus [16]. In the present
[9] R. G. Triplett and S. R. Schow, “Autologous bone grafts and
case, no sinusitis or oroantral fistula occurred.
endosseous implants: complementary techniques,” Journal of
The zygomatic implant-supported prosthesis requires Oral and Maxillofacial Surgery, vol. 54, no. 4, pp. 486–494, 1996.
special care due to the biomechanical forces that affect
[10] M. Del Fabbro, T. Testori, L. Francetti, and R. Weinstein,
the long-term stability of an implant-supported restoration. “Systematic review of survival rates for implants placed in the
Use of a stiff prosthesis is necessary because flexing of the grafted maxillary sinus,” International Journal of Periodontics
materials can cause deformation and deviation, resulting in and Restorative Dentistry, vol. 24, no. 6, pp. 565–577, 2004.
loss of implant or loosening of the junction between the [11] L. Vrielinck, C. Politis, S. Schepers, M. Pauwels, and I. Naert,
prosthesis and fixation. The success rates of implants in the “Image-based planning and clinical validation of zygoma and
zygomatic bone vary from 95% to 97% with 12–124 months pterygoid implant placement in patients with severe bone
of follow-up observation [21, 22], and the patient satisfaction atrophy using customized drill guides. Preliminary results from
rate is 80% 1 year after installation of the prosthesis [23]. a prospective clinical follow-up study,” International Journal of
Oral and Maxillofacial Surgery, vol. 32, no. 1, pp. 7–14, 2003.
4. Conclusions [12] K. Lal, G. S. White, D. N. Morea, and R. F. Wright, “Use
of stereolithographic templates for surgical and prosthodontic
Zygoma implants are a unique alternative for rehabilitation implant planning and placement. Part I. The concept,” Journal
of the posterior maxilla after tumor resection or trauma. Due of Prosthodontics, vol. 15, no. 1, pp. 51–58, 2006.
to both the anatomical intricacies of the zygomatic bone and [13] R. Ewers, K. Schicho, G. Undt et al., “Basic research and 12 years
the implant length, the placement of zygoma implants still of clinical experience in computer-assisted navigation technol-
ogy: a review,” International Journal of Oral and Maxillofacial
represents a challenge to prosthodontists. To minimize the
Surgery, vol. 34, no. 1, pp. 1–8, 2005.
risks of surgery, 3D reconstruction, preoperative planning,
[14] L. R. Duarte, H. N. Filho, C. E. Francischone, L. G. Peredo, and
registration, surgical implant guidance, and a motion track-
P. I. Brånemark, “The establishment of a protocol for the total
ing algorithm should be used. rehabilitation of atrophic maxillae employing four zygomatic
fixtures in an immediate loading system—a 30-month clinical
References and radiographic follow-up,” Clinical Implant Dentistry and
Related Research, vol. 9, no. 4, pp. 186–196, 2007.
[1] L. Vrielinck, C. Politis, S. Schepers, M. Pauwels, and I. Naert, [15] P. Maló, M. de Araujo Nobre, and I. Lopes, “A new approach to
“Image-based planning and clinical validation of zygoma and rehabilitate the severely atrophic maxilla using extramaxillary
pterygoid implant placement in patients with severe bone anchored implants in immediate function: a pilot study,” Journal
atrophy using customized drill guides. Preliminary results from of Prosthetic Dentistry, vol. 100, no. 5, pp. 354–366, 2008.
a prospective clinical follow-up study,” International Journal of [16] M. Stiévenart and C. Malevez, “Rehabilitation of totally atro-
Oral and Maxillofacial Surgery, vol. 32, no. 1, pp. 7–14, 2003. phied maxilla by means of four zygomatic implants and fixed
[2] Y. Uchida, M. Goto, T. Katsuki, and T. Akiyoshi, “Measurement prosthesis: a 6-40-month follow-up,” International Journal of
of the maxilla and zygoma as an aid in installing zygomatic Oral and Maxillofacial Surgery, vol. 39, pp. 358–363, 2010.
implants,” Journal of Oral and Maxillofacial Surgery, vol. 59, no. [17] B. Al-Nawas, J. Wegener, C. Bender, and W. Wagner, “Critical
10, pp. 1193–1198, 2001. soft tissue parameters of the zygomatic implant,” Journal of
[3] S. M. Parel, P. I. Brånemark, L. O. Ohrnell, and B. Svensson, Clinical Periodontology, vol. 31, no. 7, pp. 497–500, 2004.
“Remote implant anchorage for the rehabilitation of maxillary [18] M. Stiévenart and C. Malevez, “Rehabilitation of totally atro-
defects,” Journal of Prosthetic Dentistry, vol. 86, no. 4, pp. 377– phied maxilla by means of four zygomatic implants and fixed
381, 2001. prosthesis: a 6-40-month follow-up,” International Journal of
[4] J. Clavero and S. Lundgren, “Ramus or chin grafts for maxillary Oral and Maxillofacial Surgery, vol. 39, pp. 358–363, 2010.
sinus inlay and local onlay augmentation: comparison of donor [19] J. P. Becktor, S. Isaksson, P. Abrahamsson, and L. Sennerby,
site morbidity and complications,” Clinical Implant Dentistry “Evaluation of 31 zygomatic implants and 74 regular dental
and Related Research, vol. 5, no. 3, pp. 154–160, 2003. implants used in 16 patients for prosthetic reconstruction of the
[5] M. J. Yaremchuk, “Vascularized bone grafts for maxillofacial atrophic maxilla with cross-arch fixed bridges,” Clinical Implant
reconstruction,” Clinics in Plastic Surgery, vol. 16, pp. 29–39, Dentistry and Related Research, vol. 7, no. 3, pp. 159–165, 2005.
1989. [20] C. Malevez, M. Abarca, F. Durdu, and P. Daelemans, “Clinical
[6] M. Sjöström, L. Sennerby, H. Nilson, and S. Lundgren, “Recon- outcome of 103 consecutive zygomatic implants: a 6-48 months
struction of the atrophic edentulous maxilla with free iliac crest follow-up study,” Clinical Oral Implants Research, vol. 15, no. 1,
grafts and implants: a 3-year report of a prospective clinical pp. 18–22, 2004.
study,” Clinical Implant Dentistry and Related Research, vol. 9, [21] J. P. Urgell, V. R. Gutiérrez, and C. G. Escoda, “Rehabilitation of
no. 1, pp. 46–59, 2007. atrophic maxilla: a review of 101 zygomatic implants,” Medicina
Case Reports in Dentistry 5
International Journal of
Biomaterials
Pain
Research and Treatment
Hindawi Publishing Corporation Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014
Journal of
Environmental and
Public Health
Submit your manuscripts at
http://www.hindawi.com
Journal of
Computational and
Mathematical Methods Journal of Advances in Journal of Anesthesiology
in Medicine
Hindawi Publishing Corporation
Oral Oncology
Hindawi Publishing Corporation
Orthopedics
Hindawi Publishing Corporation
Drug Delivery
Hindawi Publishing Corporation
Research and Practice
Hindawi Publishing Corporation
http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014 http://www.hindawi.com Volume 2014
Journal of
Dental Surgery