Rehabilitation Of Severe Atrophic Maxila with Zygomatic and Pterygoid Implants: Case Report

Abstract

Background: The absence of dental elements results in progressive bone resorption of the maxilla, leading to vertical bone loss with a gradual decrease in medullary bone, thereby hindering the rehabilitative process using osseointegrated implants. Zygomatic fixation protocols combined with pterygoid implants have proven to be viable alternatives for maxillary bones with severe bone resorption.

Objective: describe, through a case report, the treatment protocol for atrophic maxilla using zygomatic fixation implants, complemented by pterygomaxillary implants through an immediate loading system over a twelve-month follow-up period.

Results: All implants showed clinical and radiographic signs of osseointegration, and no pathology was detected.

Conclusions: The technique appears to be effective without requiring, in this specific case, any prior procedures for reconstruction of the atrophic maxilla.

Keywords:

Dentistry, Dental Implants, Zygoma, Mouth Rehabilitation

References

Emami E, de Souza RF, Kabawat M, Feine JS. The impact of edentulism on oral and general health. Int J Dent. 2013;2013:498305.

Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants. 1986;1(1):11-25.

Balaji VR, Lambodharan R, Manikandan D, Deenadayalan S. Pterygoid Implant for Atrophic Posterior Maxilla. J Pharm Bioallied Sci. 2017;9(Suppl 1):S261-S263.

Sjöström M, Sennerby L, Lundgren S. Bone graft healing in reconstruction of maxillary atrophy. Clin Implant Dent Relat Res. 2013;15(3):367-379.

Aparicio C, Manresa C, Francisco K, et al. Zygomatic implants: indications, techniques and outcomes, and the zygomatic success code. Periodontol 2000. 2014;66(1):41-58.

Lemos CA, Ferro-Alves ML, Okamoto R, Mendonça MR, Pellizzer EP. Short dental implants versus standard dental implants placed in the posterior jaws: A systematic review and meta-analysis. J Dent. 2016;47:8-17.

Silva LD, de Lima VN, Faverani LP, de Mendonça MR, Okamoto R, Pellizzer EP. Maxillary sinus lift surgery-with or without graft material? A systematic review. Int J Oral Maxillofac Surg. 2016;45(12):1570-1576.

Soto-Penaloza D, Zaragozí-Alonso R, Penarrocha-Diago M, Penarrocha-Diago M. The all-on-four treatment concept: Systematic review. J Clin Exp Dent. 2017;9(3):e474-e488.

Branemark, P. I. Osseointegrated protheses in skeletal repair and reconstruction. J Oral and Maxillofac Surg, p. 47-57, 1989.

Nary, Hugo Filho. Principais indicações das fixações zigomáticas como alternativa cirúrgica no tratamento da maxila atrófica. In: FRANCISCHONE, et al. Osseointegração e o tratamento multidisciplinar. São Paulo: Quintessence, 2006.

Nag PVR, Dhara V, Puppala S, Bhagwatkar T. Treatment of the Complete Edentulous Atrophic Maxilla: The Tall Tilted Pin Hole Placement Immediate Loading (TTPHIL)-ALL TILT™ Implant Option. J Contemp Dent Pract. 2019;20(6):754-763.

Almeida PHT, Cacciacane SH, Junior AA. Extra-long transnasalimplants as alternative for Quad Zygoma: Case report. Annals of Medicine and Surgery. 2021;68:102635.

Matsumoto, M. A.; Filho, H. N.; DE Camargos, L. S. K. Fixações zigomáticas: uma análise de 10 anos de emprego clínico. Osseointegração, p. 199-214, 2009.

Pellegrino G, Lizio G, Basile F, Stefanelli LV, Marchetti C, Felice P. Dynamic Navigation for Zygomatic Implants: A Case Report about a Protocol with Intraoral Anchored Reference Tool and an Up-To-Date Review of the Available Protocols. Methods Protoc. 2020;3(4):75.

Garcia, GFF, Veras, GM, de Vargas, GJ, Rosa, M., Pohlmann, FS, & Manfro, R. (2024). Cirurgia guiada para instalação de implantes convencionais no osso zigomático pela técnica facco - nota técnica. Revista Brasileira de Revisão de Saúde , 7 (1), 3168–3176.

Nunes M, de Araújo Nobre M, Camargo V. All-on-4 Hybrid with Extra-Long Transnasal Implants: Descriptions of the Technique and Short-Term Outcomes in Three Cases. J Clin Med. 2024;13(11):3348.

Bidra AS, Huynh-Ba G. Implants in the pterygoid region: a systematic review of the literature. Int J Oral Maxillofac Surg. 2011;40(8):773-781.

Gracher AHP, de Moura MB, da Silva Peres P, Thomé G, Padovan LEM, Trojan LC. Full arch rehabilitation in patients with atrophic upper jaws with zygomatic implants: a systematic review. Int J Implant Dent. 2021;7(1):17.

Heboyan A, Lo Giudice R, Kalman L, Zafar MS, Tribst JPM. Stress Distribution Pattern in Zygomatic Implants Supporting Different Superstructure Materials. Materials (Basel). 2022;15(14):4953.

Curi MM, Cardoso CL, Ribeiro Kde C. Retrospective study of pterygoid implants in the atrophic posterior maxilla: implant and prosthesis survival rates up to 3 years. Int J Oral Maxillofac Implants. 2015;30(2):378-383.

Araujo RZ, Santiago Júnior JF, Cardoso CL, Benites Condezo AF, Moreira Júnior R, Curi MM. Clinical outcomes of pterygoid implants: Systematic review and meta-analysis. J Craniomaxillofac Surg. 2019;47(4):651-660.