A look at how to tackle some of the common complications.
The introduction of zygomatic implants in the rehabilitation of edentulous atrophic maxilla has been revolutionary for patients who otherwise cannot receive effective treatment. The surgery has been developed continuously since its introduction in the 1990s, becoming a reliable procedure with success rates averaging 96 per cent across various studies.
The restoration of missing maxillary anterior teeth has a dramatic effect on a patient’s quality of life. Without this treatment option, affected patients could experience a detrimental impact on confidence and self-esteem and difficulty when eating solid foods. The alternative approach to zygomatic implants requires a bone graft. This can be daunting as a procedure for patients and often extends the treatment time due to a necessary delay following a traditional grafting procedure for implant placement. A zygomatic implant returns a patient’s masticatory function sooner, facilitating faster recovery and achieving a greater quality of life with a less invasive approach. This could improve pre-procedure acceptance and post-procedure satisfaction rates amongst those considering surgery.
The implementation of zygomatic implants is a difficult process, and the practitioner should be experienced in implant surgery before moving into this field. Whilst the success rates for zygomatic implants are high, the patient experience could be improved further by addressing some of the most common complications that appear in post-treatment reviews. These regularly include rhinosinusitis and failed osseointegration, amongst others.
Prevention of rhinosinusitis
Rhinosinusitis is classified as an inflammation of the nasal cavity and paranasal sinuses. A zygomatic implant’s conventional protrusion through the maxillary sinus provides an obvious link to potential rhinosinusitis infection; one cause could be a perforation occurring in the sinus membrane, in turn introducing bacteria from the mouth. Standard sterilisation of implants and the necessary equipment minimises the risk of infection, but the greatest prevention technique could lie in the placement of the implants by the oral surgeon.
Continuous research into zygomatic implants has produced a variety of blueprints for methods that could be appropriate for any given patient. Each should take into account the unique distribution of bone for those with an atrophic maxilla. Research into an extra-sinus approach for implants has suggested a reduction in post-operative pain and swelling and a healthier maxillary sinus, when compared to zygomatic implants following an intra-sinus placement.
The extra-sinus technique has been further refined by the Zygomatic Anatomy-Guided Approach (ZAGA), wherein a practitioner takes an anatomically and prosthetically driven approach to treatment. Each zygomatic implant placement considers a patient’s anatomical structure, refraining from entering the maxillary sinus where possible. By minimising the contact between the implant and maxillary sinuses, patients display fewer symptoms of rhinosinusitis compared to those that undergo conventional methods. The technique in general is designed to reduce complications associated with traditional zygoma placement concepts.
Improving osseointegration
Another common complication of zygomatic implant treatment is failed osseointegration. Atrophic maxilla issues do not prevent patients from having a successfully osseointegrated implant, provided the bone mass in the implant area is dense enough. If an implant fails, it could be a result of contamination or overheating during the drilling of the implant site.
Decontamination is a basic necessity in any dental procedure. In zygomatic procedures contaminated equipment, implants or even saliva could cause a complete failure of osseointegration. The appropriate precautions should be taken as with any oral surgery, including full decontamination of equipment and the sterilisation of the implant. Research has proposed the use of a rubber dam in some dental implant placement procedures to control salivatory contamination. Without effective care, treatment failure can cause the patient a great loss of time and money.
Failed osseointegration is also possible because of localised bone necrosis. It can occur as a result of improper management of the implant placement procedure. Over-torquing or overheating during the drilling process can result in thermal necrosis. The level of friction created by the drill results in a high thermal output, which, if not controlled, disrupts the cellular membrane of localised bone cells, killing them. Prevention of this is possible with an appropriately applied cooling irrigation, which minimises the temperature increase on the implant site. By mitigating the risk of bone necrosis, the oral surgeon creates the appropriate conditions for the implant to fuse with the zygomatic bone.
Maximising results in a procedure as notoriously difficult as zygomatic implants is challenging for clinicians. An experienced and competent professional should have the right tools available to create the best conditions for a successful implant treatment.
The SZ-75 Zygoma Surgical Handpiece from W&H provides a solution. Specifically designed for zygomatic implants, its unique and ergonomic angulation allows for improved access to the most difficult areas to reach in the zygomatic bone. The SZ-75 provides optimal cooling efficiency with an external spray at the base of the bur, preventing the implant site from overheating to provide the best conditions for successful osseointegration. When paired with the Implantmed from W&H, oral surgeons are provided with safe and stable control over any zygomatic implant placement procedure.
Zygomatic implants have permanently changed the landscape of atrophic maxilla rehabilitation, and are continuing to develop over time as knowledge and experience around the procedure expands. As techniques and equipment evolve, complications can be minimised and more patients can enjoy a greater quality of life that would not otherwise be possible.
For more information call 01727 874990, email office.uk@wh.com or visit www.wh.com/en_uk
References available on request.