Immediate Oral Rehabilitation With Quad Zygomatic Implants: Ultrasonic Technique vs Conventional Drilling
Inserting zygomatic implants is a challenging surgery and requires special care and great precision. Piezoelectric surgery offers several advantages: more precise bone cutting with improved intraoperative visibility and a low temperature increase. The aim of this case-control study was to evaluate whether ultrasonic instruments can be as effective as standard drilling instruments for zygomatic implant surgery in terms of clinical outcomes. Ninety-two patients with atrophic maxilla were included in the study. Implant sites were prepared with the ultrasonic technique (test group = 47 patients) or traditional drilling (control group = 45 patients). In total, 368 zygomatic implants were inserted (202 with the extrasinus technique, 77 with the sinus slot technique, and 89 with the Brånemark technique). Complete arch provisional prostheses were delivered 3 to 5 hours after the surgical operations. The mean follow-up after surgery was 24 months (range = 12–32 months). The primary outcome evaluations were based on implant survival rates and postoperative complications. Operative time and surgeon's stress were evaluated as secondary outcomes. Implant survival rate was 100% in the test and 98.89% in the control group. Postoperative complications were seen in 9 patients (4 in the test and 5 in the control group); the difference was not statistically significant. Operative time was longer in the test group; however, surgeons were more comfortable using ultrasonic instruments. Within the limitations of this preliminary study, the ultrasonic technique was a feasible alternative to traditional drilling for zygomatic implant surgery.
(a) Representative preoperative tomography of a patient showing the left side of the maxillary bone. (b) Representative preoperative tomography of the patient showing the right side of the maxillary bone
Figure 2. Photos of the 3-dimensional (3D) reconstruction model used to plan the localization of the zygomatic implants from different angles (model of a test group patient). (a) Right side profile view of the 3D model. (b) Frontal view of the 3D model. (c) Inferior view of the 3D model. (d) Left side profile view of the 3D model. Figure 3. Photos of the 3D reconstruction model used to plan the localization of the zygomatic implants from different angles (model of a control group patient). (a) Frontal view of the 3D model. (b) Right side profile view of the 3D model. (c) Left side profile view of the 3D model. (d) Inferior view of the 3D model.
Figure 4. Sequence of surgical drills used in control-group patients. Figure 5. Set of ultrasonic working tips used in test-group patients. Figure 6. Representative intraoperative images of the sequence of zygomatic implants inserted in a test-group patient. (a) Anterior zygomatic implant site preparation ultrasonic working tips. (b) Insertion of the anterior zygomatic implant. (c) Posterior implant site preparation ultrasonic working tips. (d) Two fully threaded zygomatic implants inserted. (e) Two zygomatic implants with both abutments placed. Figure 7. Intraoperative view of a case-group patient in which the partially threaded quad zygomatic implants have been inserted with the extra-sinus technique.
Figure 8. Postoperative panoramic radiographs of a patient with quad zygomatic implants inserted (view of a test-group patient). Figure 9. Postoperative panoramic radiographs with quad zygomatic implants inserted (view of a control-group patient). Figure 10. Postoperative photos of a test-group patient. (a) Postoperative panoramic radiograph. (b) Panoramic radiograph with final prosthesis. (c) Frontal view of the patient's smile with final prosthesis. (d) Frontal highlighted view of the final prosthesis.
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