Minimally invasive implants

30 June 2024

Cemal Ucer explains the benefits of ultrasound technology in zygomatic implant surgery.

Zygomatic implants are now increasingly in demand to treat a severely atrophic maxilla. This is no surprise, given the stunning results that can be achieved for partially or fully edentulous patients needing to restore their function and aesthetics.

A limited number of restorative options are open to patients once an advanced level of bone resorption has taken place. Low maxillary bone density associated with physiological bone remodelling and resorption can prevent implant placement without alveolar ridge and/or sinus augmentation. Although they are a good solution for many patients, and the field is developing in fascinating ways to reduce the impact as well as associated risks for patients, bone grafts are still not without some pitfalls.

Recent advances in zygomatic implantology have made this procedure an increasingly appealing addition to the skillset of oral surgeons, as it enables them to restore dental function where there is not adequate bone for standard implants. Zygomatic implants typically require just one surgical procedure and allow for immediate loading, which considerably shortens rehabilitation time and removes many of the risks compared to alternative treatments.

Despite the complexity of the procedure and the skill level required, zygomatic implants are now considered a relatively minimally invasive solution. In recent years, the small number of post-zygomatic implant complications identified in studies is a testament to the skill of existing implant surgeons utilising the treatment.

Complications are rare today but can be serious. A potentially devastating outcome is orbital trauma, mitigated by selecting the appropriate size and direction of the implant into the zygoma. Accurate 3D pre-operative planning and appropriate surgical skills, as well as precision and accuracy, are also vital. The complexity of the zygomatic bone and overall maxillofacial structure means that any intervention poses risks to blood vessels and nerves, again requiring a high level of expertise to negotiate. Biological complications, such as maxillary sinusitis and buccal mucosal recession, can be mitigated using innovative new surgical techniques.

Cutting-edge expertise in zygomatic implant procedures to treat a severely resorbed maxilla is a real advantage in the quickly expanding field of implantology. This includes a familiarity with the newest and most appropriate technology to maximise patient outcomes.

Piezoelectric surgery – the benefits of precision, powered by ultrasound

Piezoelectric surgery has been developed principally for use in bone surgery. The ultrasound-driven technology is based on the high frequency vibration of a metallic tip which can cut bone without damaging soft tissue. Selective cutting and minimal operative invasion reduces bleeding as well as the risk of perforating the Schneider membrane.

Although the principles behind piezoelectric surgery have been around for over 70 years, there has been a recent boom in the development of technology and techniques because of its myriad advantages.

Particularly in the field of maxillofacial and implant surgery, piezosurgical devices have been lauded for precise, safe and effective osteotomies. They have been shown to be particularly effective in techniques like sinus lift, ridge splitting and bone harvesting, which may be used if the alveolar ridge is inadequate.

Micrometric cutting offers superior precision with no bone loss, and requires significantly less force than conventional drilling, meaning superior control. Further control over the surgical site is made possible because of the ‘cavitation effect’, where bubbles are created from the physiological salt solution, leading to implosion and generating a shock wave that enables precise micro-coagulation and less bleeding.

The lack of necrosis in the cut area accelerates bone regeneration, so patients heal faster and are less likely to experience complications. Studies have also identified an antiseptic effect, as cells are stimulated by oxygen released with the piezoelectric vibrations, and the lack of air-water spray generated with rotary instruments removes the risk of emphysema.

Piezoelectric surgery and zygomatic implants, the minimally invasive combination

Innovations in piezoelectric surgery and new developments in implant surgery make zygomatic implants an even safer option for patients. The Minimally Invasive Piezo Technique was designed to minimise the risks of zygomatic implants using piezoelectric technology. It was developed by leading oral surgeon, Andrea Tedesco in Italy, and first presented in the UK at the Zygomatic 2019 Conference in London.

Andrea and I will share our knowledge in an upcoming course at the ZAGA centre Manchester/ ICE Postgraduate Dental Institute, Manchester. The course will provide intensive hands-on surgical experience in the use of zygomatic, nazalus, trans-sinus and pterygoid implants for the treatment of severely atrophic maxilla. Delegates will receive training in the conventional, as well as the Zygomatic Minimally Invasive Technique (Z.M.I.T) with piezoelectric instrumentation and will have access to the most state-of-the-art facilities to explore the latest techniques with the highest possible level of guidance.

Those who wish to introduce zygomatic implants into their practice will benefit from incorporating the most current techniques to minimise the risk of collateral damage occurring to vital anatomical structures, including the surrounding blood vessels and nerves. Having optimal skills in this most cutting-edge area of dentistry will mean clinicians can offer more patients with limited options a real reason to smile.


References are available on request.