Analog-digital workflow for complex rehabilitation of severe maxillary atrophy with zygomatic implants: a clinical case
- Authors: Dibirov T.M.1, Drobyshev A.Y.1, Gvetadze R.S.1, Kharazyan E.A.1, Arutyunov S.D.1
-
Affiliations:
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
- Issue: Vol 27, No 4 (2023)
- Pages: 323-334
- Section: Case reports
- URL: https://journals.rcsi.science/1728-2802/article/view/253509
- DOI: https://doi.org/10.17816/dent472090
- ID: 253509
Cite item
Abstract
Patients with a complete lack of teeth, severe maxillary atrophy and midface deformity create the most unfavorable conditions for their rehabilitation according to traditional protocols, including bone grafting, sinus lifting and implantation, which forms a complex clinical challenge. Today, zygomatic implants are successfully used as an alternative option for rehabilitation of patients with severe upper jaw atrophy, allowing to reduce the volume of surgical interventions, as well as to shorten the rehabilitation period. Until now, the question of finding an optimal treatment protocol with the use of zygomatic implants remains relevant.
We proposed an integrated protocol of rehabilitation of patients with severe maxillary atrophy, based on the use of analog-digital diagnostic tools and treatment outcome planning, as well as including the stages of surgical and prosthetic treatment using the developed technology of zygomatic implant placement and immediate loading with prosthetic jaw prosthesis constructions.
This work presents a clinical case of the patient (62 years old), whose rehabilitation was performed in accordance with her own protocol: preoperative digital planning according to computer tomography data (Blue Sky Bio Plan, USA), virtual modeling and manufacturing of surgical template for positioning four zygomatic implants (Nobel Biocare, USA), installation of zygomatic implants and immediate fixation of temporary dental prosthesis. Based on the results of follow-up examinations, including X-ray assessment of the zygomatic bones over a period of 6 years, no complications were detected.
Full Text
##article.viewOnOriginalSite##About the authors
Timur M. Dibirov
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
Email: rumit.05@mail.ru
ORCID iD: 0000-0003-0876-928X
md, cand. sci. (med.)
Russian Federation, 20/1 Delegatskaya street, 127473 MoscowAleksey Yu. Drobyshev
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
Email: Dr.Drobyshev@gmail.com
ORCID iD: 0000-0002-1710-6923
md, dr. sci. (med.), professor
Russian Federation, 20/1 Delegatskaya street, 127473 MoscowRamaz Sh. Gvetadze
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
Email: gvetadze-rs@msmsu.ru
ORCID iD: 0000-0003-0508-7072
md, dr. sci. (med.), professor
Russian Federation, 20/1 Delegatskaya street, 127473 MoscowEdvard A. Kharazyan
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
Email: edwardkharazian@hotmail.com
ORCID iD: 0009-0008-6750-7080
Russian Federation, 20/1 Delegatskaya street, 127473 Moscow
Sergey D. Arutyunov
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
Author for correspondence.
Email: sd.arutyunov@mail.ru
ORCID iD: 0000-0001-6512-8724
md, dr. sci. (med.), professor
Russian Federation, 20/1 Delegatskaya street, 127473 MoscowReferences
- Arutyunov AS, Shanidze ZL, Tsareva EV, Arutyunov SD. Prosthodontic treatment of edentulous patients with postoperative mandibular defects of oncological origin. Stomatologiya. 2018;97(1):54–58. (In Russ). doi: 10.17116/stomat201897154-58
- Arutyunov SD, Agapov VS, Dallakyan VF, et al. Rehabilitation of patients with defects of the maxilla with medical devices on dental implants. The Dental Institute. 2003;(4):42–43. (In Russ).
- Gadjikuliev AA. Reabilitatsiya bol’nykh s defektami verkhnei chelyusti s ispol’zovaniem lechebnykh apparatov na implantatakh [dissertation]. Moscow; 2002. Available from: https://elibrary.ru/item.asp?id=49218916 (In Russ).
- Grachev IF. Optimizatsiya planirovaniya ortopedicheskoi stomatologicheskoi pomoshchi bol’nym s chelyustno-litsevymi defektami v sovremennykh usloviyakh (na primere Orlovskoi obl.) [dissertation]. Moscow; 2008. Available from: https://www.elibrary.ru/item.asp?id=16174041 (In Russ).
- Al-Moraissi EA, Altairi NH, Abotaleb B, et al. What is the most effective rehabilitation method for posterior maxillas with 4 to 8 mm of residual alveolar bone height below the maxillary sinus with implant-supported prostheses? A frequentist network meta-analysis. J Oral Maxillofac Surg. 2019;77(1):70.e1–70.e33. doi: 10.1016/j.joms.2018.08.009
- Stacchi C, Rapani A, Lombardi T, et al. Does new bone formation vary in different sites within the same maxillary sinus after lateral augmentation? A prospective histomorphometric study. Clin Oral Implants Res. 2022;33(3):322–332. doi: 10.1111/clr.13891
- Arutyunov AS, Kitsul IS, Arytyunov SD, Makarevich AA. The methodological basis of studying quality of life of patients with maxillofacial defects. Russian Journal of Dentistry. 2009;(3):51–54. (In Russ).
- Arutyunov AS, Kitsul IS, Sedrakyan AN, et al. Quality of life of maxillofacial cancer patients after prosthetic dentistry rehabilitation. Journal of N.N. Blokhin Russian Cancer Research Center RAMS. 2010;21(2):29–37. (In Russ).
- Gazazyan VV. Nauchno-metodicheskie podkhody k upravleniyu kachestvom chelyustno-litsevogo protezirovaniya [dissertation]. Moscow; 2011. Available from: https://www.elibrary.ru/item.asp?id=49298165 (In Russ).
- Kravtsov DV. Kliniko-mikrobiologicheskoe obosnovanie i otsenka effektivnosti primeneniya zubochelyustnykh protezov-obturatorov iz razlichnykh konstruktsionnykh materialov [dissertation]. Moscow; 2012. Available from: https://www.elibrary.ru/item.asp?id=22319283 (In Russ).
- Makarevich AA. Kachestvo zhizni chelyustno-litsevykh onkologicheskikh bol’nykh posle ortopedicheskoi stomatologicheskoi reabilitatsii [dissertation]. Moscow; 2009. Available from: https://elibrary.ru/item.asp?id=48704932 (In Russ).
- Davó R, David L. Quad zygoma: technique and realities. Oral Maxillofac Surg Clin North Am. 2019;31(2):285–297. doi: 10.1016/j.coms.2018.12.006
- Rosenstein J, Dym H. Zygomatic implants: a solution for the atrophic maxilla: 2021 update. Dent Clin North Am. 2021;65(1):229–239. doi: 10.1016/j.cden.2020.09.015
- Dibirov T, Drobyshev A. Rehabilitation of patients with use of the zygomatic implants. Int J Oral Maxillofac Surg. 2019;48:216. doi: 10.1016/j.ijom.2019.03.667
- Aparicio C. A proposed classification for zygomatic implant patient based on the zygoma anatomy guided approach (ZAGA): a cross-sectional survey. Eur J Oral Implantol. 2011;4(3):269–275.
- Javed F, Romanos GE. The role of primary stability for successful immediate loading of dental implants. A literature review. J Dent. 2010;38(8):612–620. doi: 10.1016/j.jdent.2010.05.013
- Moy PK, Aghaloo T. Risk factors in bone augmentation procedures. Periodontol 2000. 2019;81(1):76–90. doi: 10.1111/prd.12285
- Ramezanzade S, Yates J, Tuminelli FJ, et al. Zygomatic implants placed in atrophic maxilla: an overview of current systematic reviews and meta-analysis. Maxillofac Plast Reconstr Surg. 2021;43(1):1. doi: 10.1186/s40902-020-00286-z
- Fernández-Ruiz JA, Sánchez-Siles M, Guerrero-Sánchez Y, et al. Evaluation of quality of life and satisfaction in patients with fixed prostheses on zygomatic implants compared with the all-on-four concept: a prospective randomized clinical study. Int J Environ Res Public Health. 2021;18(7):3426. doi: 10.3390/ijerph18073426
- Esposito M, Worthington HV. Interventions for replacing missing teeth: dental implants in zygomatic bone for the rehabilitation of the severely deficient edentulous maxilla. Cochrane Database Syst Rev. 2013;2013(9):CD004151. doi: 10.1002/14651858.CD004151.pub3
- Lan K, Wang F, Huang W, et al. Quad zygomatic implants: a systematic review and meta-analysis on survival and complications. Int J Oral Maxillofac Implants. 2021;36(1):21–29. doi: 10.11607/jomi.8417
- Varghese KG, Gandhi N, Kurian N, et al. Rehabilitation of the severely resorbed maxilla by using quad zygomatic implant-supported prostheses: a systematic review and meta-analysis. J Prosthet Dent. 2021;S0022-3913(21):00628-4. doi: 10.1016/j.prosdent.2021.11.007
- Aparicio C, Ouazzani W, Garcia R, et al. A prospective clinical study on titanium implants in the zygomatic arch for prosthetic rehabilitation of the atrophic edentulous maxilla with a follow-up of 6 months to 5 years. Clin Implant Dent Relat Res. 2006;8(3):114–122. doi: 10.1111/j.1708-8208.2006.00009.x
- Goker F, Grecchi E, Del Fabbro M, Grecchi F. Clinical outcome of 302 zygomatic implants in 110 patients with a follow-up between 6 months and 7 years. Clin Implant Dent Relat Res. 2020;22(3):415–423. doi: 10.1111/cid.12909