Revolutionizing Maxillary Rehabilitation: Zygomatic Implants Addressing Severe Alveolar Atrophy.

This case report describes the care given to a 58-year-old male patient with severe upper jaw atrophy. The treatment strategy involved utilizing zygomatic implants in conjunction with endosteal implants to rehabilitate both the maxilla and mandible. Temporary prostheses were used during the healing phase, followed by the fabrication and placement of final prostheses. The utilization of zygomatic implants offers advantages such as immediate stabilization and function without the need for extensive bone grafting. This approach not only reduces treatment time and costs but also enhances patient outcomes. Furthermore, guided surgical techniques are increasingly employed to ensure precise implant placement, optimizing prosthetic support.

Additively manufactured custom-made subperiosteal implant rehabilitation for severely atrophic maxillary molar area: A technical note.

Implant-prosthetic rehabilitations of severely atrophic posterior maxillary sectors currently is challenging, often requiring multiple surgeries and long rehabilitation times. Recently, graftless techniques (e.g. zygomatic, pterygoid and nasal implants) have gained popularity as they offer a reduction in rehabilitation time, aligning more closely with patient preferences but may not be feasible for sectorial rehabilitations. Subperiosteal implants, suggested for full-arch rehabilitations of atrophic maxilla, haven't been explored for sectorial rehabilitations. In this report we present the case of a patient with maxillary molar edentulism, rehabilitated with a subperiosteal implant.

Full-arch rehabilitation of severely atrophic maxilla with additively manufactured custom-made subperiosteal implants: A multicenter retrospective study.

The aim of this retrospective study was to analyze a series of patients who underwent full-arch rehabilitation of the atrophic maxilla using additively manufactured subperiosteal implants, between August 2018 and January 2023, at the Universities of Sassari and Poznan. In total, 36 patients and 72 implants were included, with no implants lost during follow-up, and a success rate of 90.3%. Seven (9.7%) of the implants showed class 1 exposure. Bleeding on probing was detected in 10.4% of the abutments at 6 months, 7.9% at 1 year, 10% at 2 years, 7% at 3 years, and 11.4% at 4 years. No significant bone resorption under the abutments was detected during the whole observation period. Based on the findings from this study, additively manufactured subperiosteal implants could represent a safe and reliable technique for full-arch rehabilitation in patients with severe maxillary atrophy.

All-on-4 Concept With Use Of Zygoma Implants for Rehabilitation in the Severely Atrophied Maxilla With a Definitive Immediate Restoration.

This case report of a 45-year-old patient at initial presentation shows an illustration of the limitations of periodontal maintenance therapy and subsequent implant prosthetic therapy. In close consultation with the patient, treatment strategies were adopted to maximize the preservation of prognostically questionable teeth. Eight years later, the patient had a highly atrophied maxilla that could be successfully restored with implants. This was achieved with 2 zygoma implants and 2 anterior conventional implants, which were immediately loaded according to the All-on-4 concept and immediately provided with a definitive prosthetic restoration. The case report demonstrates to the general practitioner that using zygoma implants in such constellations may offer a solution to achieve a fixed, rapid, and financially acceptable prosthetic rehabilitation.

Evaluation of Quality of Life and Satisfaction with Fixed Prostheses on Zygomatic Implants vs All-on-Four Concept: A Randomized Clinical Study.

AIM: To compare between the rehabilitation of atrophied maxilla with fixed prosthesis using two posterior zygomatic implants and two conventional anterior implants or four implants inserted according to the all-on-four concept regarding the patient quality of life and satisfaction after one year of prosthesis insertion. MATERIALS AND METHODS: Thirty-six patients with atrophic edentulous maxillae were randomized into two groups: Group I (rehabilitated with fixed prostheses supported by two zygomatic and two conventional implants in the anterior region) and group II (fixed prostheses on four implants in the anterior region following an all-on-four concept). One year after the placement of the definitive prostheses, patients completed oral health impact profile-14 and satisfaction questionnaires. RESULTS: All patients were satisfied regarding retention, stability, occlusion, comfort, cleaning, speaking, chewing, bolus quality, appearance, handling, prosthesis apart, and embarrassing, with no significant significance between two groups except satisfaction with surgical procedures and healing period. CONCLUSIONS: Using two distally tilted zygomatic implants or all-on-four concept to rehabilitate atrophied maxilla by fixed detachable prosthesis could be considered a promising functional and esthetic treatment option regarding the patient satisfaction. CLINICAL SIGNIFICANCE: Traditionally, treatment of maxillary atrophied ridges was done by bone grafting or sinus-lifting techniques; however, using all-on-four concept or zygomatic implants was a successful treatment as it has high success rates and highly satisfied by the patients. How to cite this article: Nagib MA, Ibrahim AM, Abdel-Rahman FH, et al. Evaluation of Quality of Life and Satisfaction with Fixed Prostheses on Zygomatic Implants vs All-on-Four Concept: A Randomized Clinical Study. J Contemp Dent Pract 2024;25(2):141-147.

Management of a severely atrophic maxilla using concentrated platelet-rich fibrin block. A case report.

Tooth loss often leads to significant alveolar bone resorption, presenting a challenge for dental implant placement. This case report presents the effectiveness of concentrated platelet-rich fibrin (C-PRF) in combination with bone allograft for horizontal bone augmentation in a severely atrophic maxilla. A 33-year-old female patient with extensive bone loss in the upper anterior maxilla was treated in two stages. The initial stage involved horizontal bone augmentation using a mixture of C-PRF and bone allograft. This was followed, 5 months later, by dental implant placement. The preparation of C-PRF, surgical procedure, and postoperative care are thoroughly described. Post-treatment Cone Beam Computed Tomography showed an increase in alveolar bone thickness from 2.4-3.4 mm pre-operatively to 6.3-7.3 mm, demonstrating the procedure's effectiveness in achieving adequate bone volume for implant placement. The use of C-PRF with allograft in horizontal bone augmentation shows promise in enhancing bone regeneration, especially in a severely atrophic maxilla.

Clinical performance of additively manufactured subperiosteal implants: a systematic review.

PURPOSE: The aim of this study was to assess implant survival and complications rate of modern subperiosteal implants (CAD designed and additively manufactured). METHODS: A systematic review was conducted using three electronic databases; Medline (Pubmed), Cochrane library, and SCOPUS, following the PRISMA statement recommendations to answer the PICO question: "In patients with bone atrophy (P), do additively manufactured subperiosteal implants (I), compared to subperiosteal implants manufactured following traditional approaches (c), present satisfactory implant survival and complication rates (O)? The study was pre-registered in PROSPERO (CRD42023424211). Included articles quality was assessed using the "NIH quality assessment tools". RESULTS: Thirteen articles were finally selected (5 cohort studies and 8 case series), including 227 patients (121 female / 106 male; weighted mean age 62.4 years) and 227 implants. After a weighted mean follow-up time of 21.4 months, 97.8% of implants were in function (5 failures reported), 58 implants (25.6%) presented partial exposure, 12 patients (5.3%) suffered soft tissue or persistent infection. Fracture of the interim prosthesis was reported in 8 of the155 patients (5.2%) in which the use of a provisional prosthesis was reported. A great heterogeneity was found in terms of study design and methodological aspects. For this reason, a quantitative analysis followed by meta-analysis was not possible. CONCLUSIONS: Within the limitations of this study, modern additively manufactured subperiosteal implants presented a good survival in the short-time, but a noticeable number of soft-tissue related complications were reported. Further studies are needed to assess the clinical behavior in the medium- and long-term.

Technique-Related Survival Rate and Complications of Zygomatic Implant Placement: A Systematic Review and Meta-Analysis.

PURPOSE: To assess the survival rate (SR) and probability of postoperative complications at both the implant and patient level for each of the four surgical techniques for zygomatic implant (ZI) placement: Brånemark, sinus slot, extrasinus, and extramaxillary. MATERIALS AND METHODS: A systematic literature review and meta-analysis of clinical studies that reported the survival rate and postoperative ZI complications for the rehabilitation of atrophic edentulous maxillae was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. Two independent reviewers consulted four databases during the literature search: MEDLINE (PubMed), Google Scholar, Clinicaltrials.gov, and LILACS. Duplicate articles were eliminated. RESULTS: A total of 35 studies were included in the meta-analysis. Subgroup analysis showed that study design (prospective vs retrospective) had no significant impact (P = .10) on the outcomes. The SR was highest for the Brånemark and extrasinus techniques (100%) and lowest for the sinus slot technique (94%; 95% CI = 86% to 102%). The extramaxillary (38%; 95% CI = 1% to 3%) and the Brånemark (29%; 95% CI = 15% to 44%) techniques resulted in the highest occurrence of patient-level complications. Moreover, the extramaxillary technique showed the highest percentage of prothesis-related complications (44%; 95% CI = 27% to 62%). CONCLUSIONS: ZI placement was demonstrated to be a reliable technique for the rehabilitation of severely atrophic maxillae, irrespective of the surgical technique evaluated. Accurate case and surgical protocol selection is of paramount importance to reduce technique-related postoperative complications.

Semi-autonomous two-stage dental robotic technique for zygomatic implants: An in vitro study.

OBJECTIVE: To assess the feasibility and accuracy of a semi-autonomous two-stage dental robotic technique for zygomatic implants. METHODS: Twenty-six zygomatic implants were designed and randomly divided into two groups using 10 three-dimensionally printed resin models with severe maxillary atrophy. In one group, the conventional drilling technique was used, in the other group, the drilling process for the alveolar ridge section (first stage) was completed, after which drilling for the zygoma section (second stage) was done. Based on preoperative planning combined with postoperative cone-beam computed tomography (CBCT), coronal, apical, depth, and angle deviations were measured. Zygomatic implant placement technique-related deviations (sinus slot, intrasinus, and extrasinus) were also recorded and analyzed. RESULTS: The two-stage technical group's coronal, apical, depth, and angle deviations were 0.57 ± 0.19 mm, 1.07 ± 0.48 mm, 0.30 ± 0.38 mm, and 0.91 ± 0.51°, respectively. The accuracy of the two-stage technique was significantly higher than that of the conventional one-stage technique (p < 0.05). The apical deviation in the intrasinus group was 1.12 ± 0.56 mm, which was significantly better than that in the other two groups (p < 0.05). The angle deviation in the sinus slot group was 1.96 ± 0.83°, which was significantly worse than that in the other two groups (p < 0.05). CONCLUSION: Using the semi-autonomous two-stage dental robotic technique for zygomatic implants is feasible and is more accurate than using the conventional one-stage technique. CLINICAL SIGNIFICANCE: The two-stage technique enabled the semi-autonomous robot to overcome the mouth-opening restriction for zygomatic implants and improved accuracy.

Effect of the buccal fat pad in the prevention of zygomatic implant surgery postoperative complications: A pilot study

Background: Zygomatic implants have been used to treat severe atrophy maxilla. Since its description, the technique has been improved in order to reduce patient morbidity as well as prosthesis rehabilitation time. Despite the improvements in the procedure, zygomatic implant treatments still have complications related to the peri-implant soft-tissue; a probing depth greater than 6 millimeter (mm) and a prevalence of bleeding on probing of 45% have been described. The mobilization of the buccal fat has been used to manage different oral and maxillofacial soft-tissue pathologies. The aim of this study was to assess whether the buccal fat pad might prevent mucosal dehiscence and avoid potential postoperative complications when is placed covering the body part of the zygomatic implants. Material and methods: In this pilot study, 7 patients were enrolled and a total of 28 zygomatic implants were placed and evaluated during a 12-month follow-up period. Surgical sites were randomly divided into two groups before implant placement: control group (A; in which no buccal fat pad was applied) and experimental group (B). Peri-implant soft tissue thickness difference, pain using a Visual Analog Scale (VAS), swelling, hematoma, buccal soft tissue healing and sinusitis, were evaluated. The implant survival rate was determined according the Aparicio success criteria and compared between the control and experimental procedure. Results: A nonstatistical difference was found between groups regarding to pain. The experimental group showed higher soft-tissues thickness (p= 0.03) and the implant survival rate was 100% in both groups. Conclusions: The mobilization of the buccal fat pad to cover the body of the zygomatic implants increases peri-implant soft-tissue thickness, without increasing the postoperative pain. (AU)

Modificaciones en el diseño de los implantes subperiósticos personalizados para evitar complicaciones. Presentación de una serie de casos y revisión de la literatura / Design modifications in subperiosteal implants to avoid complications. Presentation of a case series study and literature review

Introducción: La reabsorción severa del maxilar en pacientes totalmente edéntulos en ocasiones imposibilita la colocación de implantes endoóseos estándares para rehabilitar la ausencia de dientes. Para este tipo de atrofias tan severas se patentaron en 1938 en Suecia los implantes subperiósticos. Este tipo de implantes subperiósticos personalizados (ISP) han tenido excelentes resultados a lo largo de estos últimos años pero no están exentos de complicaciones. El objetivo de nuestro estudio es describir las principales complicaciones con este tipo de implantes y cuáles han sido las modificaciones que hemos realizado en el diseño de los mismos para intentar evitarlas.Material y método: Diseñamos un estudio de seguimiento retrospectivo de 15 pacientes con atrofia severa del maxilar superior tratados en 2 centros privados con un ISP en los años 2021 y 2022. Resultados: Los 8 primeros pacientes fueron tratados con un ISP bilateral y los 7 restantes con dos ISP uno a cada lado del maxilar. Todos los pacientes fueron rehabilitados con una prótesis provisional atornillada a las 48 horas de la cirugía y sustituida a los 3 meses por una prótesis fija definitiva. En 5 pacientes (33,33 %) tuvimos complicaciones postoperatorias menores. Conclusiones: A pesar de las limitaciones del estudio consideramos que el uso de ISP en pacientes con atrofia severa del maxilar es un tratamiento predecible y con excelentes resultados. La exposición es la principal complicación en nuestra serie de casos y consideramos que el uso de ISP dobles individuales y de una guía de corte minimizan el riesgo de que aparezca. (AU)

Introduction: Severe resorption of the maxilla in fully edentulous patients sometimes makes it impossible to place standard endoosseous implants to rehabilitate the absence of teeth. For such severe atrophies subperiosteal implants were patented in 1938 in Sweden. This type of subperiosteal implants have had excellent results over the last few years but are not without complications. The aim of our study is to describe the main complications with this type of implants and witch modifications have been made trying to avoid them. Material and method: We designed a retrospective follow-up study of 15 patients with severe upper jaw atrophy treated in 2 private centers with a customized subperiosteal implant in 2021 and 2022, to which we apply a few modifications in the design of the same. Results: First eight patients were treated with a single bilateral subperiosteal implant and the remaining seven with two subperiosteal implants, one on each side of the maxilla. All patients were treated with a temporary prosthesis bolted 48 hours after surgery and replaced at three months with a definitive prosthesis. In five patients (33.33%), we had minor postoperative complications. Conclusions: Despite the limitations of the study, we think that the use of customized subperiosteal implants in patients with severe maxillary atrophy is a predictable treatment with excellent results. Exposure is the main complication in our case series and we consider that the use of individual double subperiosteal implant and a bone cutting guide help to minimize the risk of this complication. (AU)

Accuracy of Zygomatic Implant Placement Using a Full Digital Planning and Custom-Made Bone-Supported Guide: A Retrospective Observational Cohort Study.

The aim of the study was to evaluate the accuracy of zygomatic implant placement using customized bone-supported laser-sintered titanium templates. Pre-surgical computed tomography (CT) scans allowed to develop the ideal virtual planning for each patient. Direct metal laser-sintering was used to create the surgical guides for the implant placement. Post-operative CT scans were taken 6 months after surgery to assess any differences between the planned and placed zygomatic implants. Qualitative and quantitative three-dimensional analyses were performed with the software Slicer3D, recording linear and angular displacements after the surface registration of the planned and placed models of each implant. A total of 59 zygomatic implants were analyzed. Apical displacement showed a mean movement of 0.57 ± 0.49 mm on the X-axis, 1.1 ± 0.6 mm on the Y-axis, and 1.15 ± 0.69 mm on the Z-axis for the anterior implant, with a linear displacement of 0.51 ± 0.51 mm on the X-axis, 1.48 ± 0.9 mm on the Y-axis, and 1.34 ± 0.9 mm on the Z-axis for the posterior implant. The basal displacement showed a mean movement of 0.33 ± 0.25 mm on the X-axis, 0.66 ± 0.47 mm on the Y-axis, and 0.58 ± 0.4 mm on the Z-axis for the anterior implant, with a linear displacement of 0.39 ± 0.43 mm on the X-axis, 0.42 ± 0.35 mm on the Y-axis, and 0.66 ± 0.4 mm on the Z-axis for the posterior implant. The angular displacements recorded significative differences between the anterior implants (yaw: 0.56 ± 0.46°; pitch: 0.52 ± 0.45°; roll: 0.57 ± 0.44°) and posterior implants (yaw: 1.3 ± 0.8°; pitch: 1.3 ± 0.78°; roll: 1.28 ± 1.1°) (p < 0.05). Fully guided surgery showed good accuracy for zygomatic implant placement and it should be considered in the decision-making process.

Evaluation of surgical techniques in survival rate and complications of zygomatic implants for the rehabilitation of the atrophic edentulous maxilla: a systematic review.

PURPOSE: To assess the outcome [zygomatic implant (ZI) survival] and complications of the original surgical technique (OST) and an Anatomy-Guided approach (AGA) in the placement of ZI in patients with severely atrophic maxillae. METHODS: Two independent reviewers conducted an electronic literature search from January 2000 to August 2022. The inclusion criteria were articles reporting at least five patients with severely atrophic edentulous maxilla undergoing placement OST and/or AGA, with a minimum of 6 months of follow-up. Number of patients, defect characteristics, number of ZI, implant details, surgical technique, survival rate, loading protocol, prosthetic rehabilitation, complications, and follow-up period were compared. RESULTS: Twenty-four studies comprised 2194 ZI in 918 patients with 41 failures. The ZI survival rate was 90.3-100% in OST and 90.4-100% in AGA. Probability of complications with ZI with OST was as follows: sinusitis, 9.53%; soft tissue infection, 7.50%; paresthesia, 10.78%; oroantral fistulas, 4.58%; and direct surgical complication, 6.91%. With AGA, the presenting complications were as follows: sinusitis, 4.39%; soft tissue infection, 4.35%; paresthesia, 0.55%; oroantral fistulas, 1.71%; and direct surgical complication, 1.60%. The prevalence of immediate loading protocol was 22.3% in OST and 89.6% in the AGA. Due to the heterogeneity of studies, statistical comparison was only possible after the descriptive analysis. CONCLUSIONS: Based on the current systematic review, placing ZI in severely atrophic edentulous maxillae rehabilitation with the OST and AGA is associated with a high implant survival rate and surgical complications within a minimum of 6 months follow-up. Complications, including sinusitis and soft tissue infection around the implant, are the most common. The utilization of immediate loading protocol is more observed in AGA than in OST.

The use of zygomatic implants in severe maxillary atrophy: a systematic and meta-analysis review of randomised clinical trials / El uso de implantes zigomáticos para atrofia maxilar severa: una revisión sistemática y meta-análisis de ensayos clínicos aleatorizados

SUMMARY: Conventional implant treatment cannot always be used to rehabilitate edentulous patients with advanced maxillary atrophic. Zygomatic dental implants have been used over the past 20 years as an alternative treatment solution to bone grafting. The purpose of this meta-analysis is to evaluate the implant and prosthetic survival rate in non-oncologic patients with a severely atrophic maxilla. This review also aims to better understand the rate of peri-operative complications in this cohort of patients. A multi-database (PubMed, MEDLINE, EMBASE, and CINAHAL) focused systematic search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Any randomised control trials studies involving human participants treated with zygomatic osseous implants were included. After eliminating duplicates, a total of 4 studies met the inclusion criteria for this meta-analysis review. With all the studies included there was a total of 174 patients treated with zygomatic osseous implants. The overall implant success rate was 98.03 %. The prosthetic success rate was 96.4 %. The most frequent peri-operative complication was sinusitis. Based on the limited data available in literature, zygomatic dental implants represent a valid alternative to bone augmenting procedure. However, they are not without risks and longer follow-ups are required to confirm the validity of the treatment in long term.

Los tratamientos convencionales con implantes no siempre pueden ser usados para rehabilitar pacientes edentulos con atrofia maxilar avanzada. Los implantes dentales zigomáticos son usados por los pasados 20 años como alternativa de tratamiento a las reconstrucciones óseas. El objetivo de este meta-análisis es evaluar la sobrevida de implantes y prótesis en pacientes no oncológicos con maxila severamente atrófica. Esta revisión también pretende entender al promedio de complicaciones peri operatorias en esta cohorte de pacientes. Una búsqueda sistemática en bases de datos múltiples (PubMed, MEDLINE, EMBASE y CINAHAL) fue desarrollada de acuerdo a recomendaciones de Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Cualquier estudio clínico aleatorizado de participantes humanos donde se utilizaron los implantes zigomáticos fueron incluidos. Después de eliminar duplicados, un total de 4 estudios cumplieron los criterios de inclusión para esta meta análisis. Con todos los estudios incluidos se obtuvieron 174 pacientes tratados con implantes zigomáticos. El promedio de éxito fue de 98,03 %. El promedio de éxito de la rehabilitación fue de 96,4 %. La complicación mas frecuente fue la sinusitis. Basados en los datos limitados en la literatura, los implantes zigomáticos representan una alternativa valida a los procedimientos de aumento óseo. Sin embargo, estos no están libres de riesgos y seguimientos de mayores periodos son necesarios para confirmar la validez de los tratamientos en el largo plazo.

Retrospective cohort assessment of survival and complications of zygomatic implants in atrophic maxillae.

OBJECTIVES: To report on zygomatic implant (ZI) survival rate and associated complications through a longitudinal retrospective cohort assessment. MATERIAL AND METHODS: A total of 940 ZIs (rough: 781, machined: 159; immediate loading: 454, delayed loading: 486) and 451 standard implants (rough: 195, machined: 256; immediate loading: 58, delayed loading: 393) were placed in 302 adult patients with atrophic maxilla from December 1998 till September 2020. Following data collection reported complications were grouped based on their origin as infectious/ non-infectious biological and mechanical. Statistical analysis was performed to identify risk factors and preceding complications leading to implant loss (P < 0.05). RESULTS: The survival rate of ZI was found to be 89.9% and the average time between implant placement and an eventual loss was 4.8 years. The mean ZI follow-up period was 7.9 ± 4.9 years. Amongst the infectious biological complications, sinusitis was the most reported (n = 138) occurring at a mean follow-up time-point of 4.5 years, whereas infraorbital nerve hypoesthesia occurred more frequently in the non-infectious biological category (n = 8, meantime: 0.3 years). The prosthetic screw fracture was the most reported complication of mechanical origin (n = 29, meantime: 4 years). Furthermore, sinusitis, standard implant loss, zygomatic/peri-zygomatic region infection, and oroantral communication were significantly associated with ZI loss. CONCLUSIONS: ZI placement offered a high survival rate for the rehabilitation of severely atrophied maxilla with most losses occurring within the first 5 years at follow-up. The most frequently observed complication was sinusitis which tends to develop several years following implant placement.

Orthodontic and dentofacial orthopedic treatments in patients with ectodermal dysplasia: a systematic review.

OBJECTIVE: The objective of this systematic review was to determine the orthodontic and dentofacial orthopedic treatments carried out in patients with ectodermal dysplasia to facilitate functional and aesthetic rehabilitation. METHODS: The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. We systematically searched PubMed, Web of Science, Scopus, Scielo, LILACS, EBSCOhost and Embase databases up to 6 January 2022. We included articles describing patients with any type of ectodermal dysplasia who received orthodontic or dentofacial orthopedic treatment to facilitate functional and aesthetic oral rehabilitation. The search was not restricted by language or year of publication. The quality of the studies was assessed using the Joanna Briggs Institute Quality Assessment Scale of the University of Adelaide for case series and case reports. The review was registered at the University of York Centre for reviews (CRD42021288030). RESULTS: Of the initial 403 studies found, 29 met the inclusion criteria. After applying the quality scale, 23 were left for review-21 case reports and 2 case series. The initial age of patients ranged from 34 months to 24 years. Thirteen studies were on hypohidrotic and/or anhidrotic ectodermal dysplasia, of which two were X-chromosome linked. In one study, the patient had Wiktop syndrome, and in nine the type of ectodermal dysplasia was not specified. The duration of treatment was 7 weeks to 10 years. The treatments described were: fixed orthodontic appliances or simple acrylic plates designed for tooth movement, including leveling and aligning, closing of diastemata, retraction of impacted teeth in the dental arch; clear aligners; fixed and/or removable appliances for the correction of skeletal and/or dentoalveolar relationships; palatal expanders in combination with face masks for orthopedic traction of the maxilla; and orthognathic surgery. Only three studies provided cephalometric data. CONCLUSION: The level of evidence of the articles reviewed was low and most orthopedic and dentofacial orthodontic treatments described were focused on correcting dental malpositioning and jaw asymmetries and not on stimulating growth from an early age. Studies with greater scientific evidence are needed to determine the best treatment for these patients.

Specially designed and CAD/CAM manufactured allogeneic bone blocks using for augmentation of a highly atrophic maxilla show a stable base for an all-on-six treatment concept: a case report.

BACKGROUND: In terms of a highly atrophic maxilla, bone augmentation still remains very challenging. With the introduction of computer-aided design/computer-aided manufacturing (CAD/CAM) for allogeneic bone blocks, a new method for the treatment of bone deficiencies was created. This case report demonstrates the successful use of two specially designed and CAD/CAM manufactured allogeneic bone blocks for a full arch reconstruction of a highly atrophic maxilla with an all-on-six concept. CASE PRESENTATION: We report the case of a 55-year-old male patient with a highly atrophic maxilla and severe bone volume deficiencies in horizontal and vertical lines. In order to treat the defects, the surgeon decided to use a combination of two allogeneic bone blocks and two sinus floor augmentations. The bone blocks were fabricated from the data of a cone beam computed tomography (CBCT) using CAD/CAM technology. After the insertion of the two bone blocks and a healing period of 7 months, six dental implants were placed in terms of an all-on-six concept. The loading of the implants took place after an additional healing time of 7 months with a screw-retained prosthetic construction and with a milled titanium framework with acrylic veneers. CONCLUSION: The presented procedure shows the importance of the precise design of CAD/CAM manufactured allogeneic bone blocks for the successful treatment of a highly atrophic maxilla. Proper soft-tissue management is one of the key factors to apply this method successfully.

Peri-zygomatic infection associated with zygomatic implants: A retrospective longitudinal cohort study.

OBJECTIVES: The main objective of this retrospective, longitudinal, cohort study was to describe the occurrence of peri-zygomatic infection (PZI) as a complication associated with zygomatic implant (ZI) placement in a period of 22 years. MATERIALS AND METHODS: A retrospective search was carried out in the department of oral and maxillofacial surgery of Saint John's hospital in Genk, Belgium. Patients that had a severely atrophic fully or partially edentulous maxilla, and at least one ZI placed, were included. RESULTS: A total of 302 eligible patients, underwent ZI surgery between 1998 and 2020. From a total of 940 ZI, 45 were associated with the development of PZI. PZI was located in the upper portion of the cheek in relation to the external corner of the eye, one or two centimeters under the lower lid. The total number of affected patients was 25 (8.3%), who had a mean age of 58.1 years. In this subset, PZI occurred in 15 cases on the right side, in eight cases on the left side, and in two cases bilaterally. Ultimately, 16 ZI were lost in the PZI site. The mean time since the implant placement to the diagnosis of PZI was 1.9 years (SD ±2.4) and to the ZI removal of 3.8 years (SD ±3.7). After implant removal, the PZI symptomatology dissipated in all patients. CONCLUSION: Peri-zygomatic infection should be informed to the patients as a possible complication after ZI placement. Once identified, it should be acknowledged as a risk factor for ZI failure.

Dental Implants Survival After Nasal Floor Elevation: A Systematic Review.

The aim of this work is to assess the clinical outcomes of implants placed after a nasal floor elevation procedure. A systematic review was conducted using 4 electronic databases: MEDLINE (PubMed), Cochrane Library, Directory of Open Access Journals, and Scopus, following the PRISMA (Preferred Reporting Items for Systematic Reviews) statement recommendations to answer the PICO (Population, Intervention, Comparison, Outcome) question: "In patients undergoing dental implant placement in the maxillary anterior region (P), Do implants placed after nasal floor elevation (I) have a different survival (O) from those implants placed without grafting procedures (C)? The study was pre-registered in PROSPERO (CRD42021229479). Included article quality was assessed using the "NIH quality assessment tool", "The Newcastle-Ottawa scale," and "JBI critical appraisal tools for case reports." Twelve articles were finally selected, including 151 patients and 460 implants. The weighted mean follow-up was 32.2 months, and the weighted survival rate after this period was 97.64% (range: 89.2%-100%). No statistical differences could be inferred between the treatments performed in 1- or 2-stage, following a lateral approach or a transcrestal approach or using different grafting materials. A great heterogeneity was found in study design and methodological aspects. For this reason, a quantitative analysis followed by meta-analysis was not possible. Within the limitations of this study, implants placed after a nasal floor elevation present a good survival and a low range of complications. In absence of randomized studies, the level of evidence was low, attending the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) system and based on the study quality level, the strength of evidence attending the SORT (Strength Of Recommendation Taxonomy) was B.

Augmentation of Narrow Anterior Alveolar Ridge Using Autogenous Block Onlay Graft in a Pediatric Patient: A Case Report.

Tooth loss due to trauma often triggers residual alveolar resorption to a greater degree in the sagittal direction leading to atrophy. However, in a pediatric patient, if this defect is left untreated, it can cause further atrophy leading to collapse of the arch. In the maxillary anterior area, this is also of esthetic concern. Hence, it is viable to reconstruct the alveolar defects and restore the alveolar anatomy with superior quality of bone while the patient is still in growing phase to avoid any structural and dental malformation, as well as to provide a more novel treatment like dental implant at a later stage when growth ceases. Modes for successfully augmenting the bone are diverse. Among these, barrier membrane with guided bone regeneration, distraction osteogenesis, and bone block graft is ubiquitous. The current case report deals with the management of horizontal atrophic anterior maxillary region using autologous block bone graft harvested from mandibular symphysis, to augment the alveolar ridge and aid in esthetic and functional restoration of alveolar anatomy by restoring the defect with the bone of superior quality as well as preparing the site for receiving implant prosthesis in future when growth ceases. How to cite this article: Bhandary M, Hegde AM, Shetty R, et al. Augmentation of Narrow Anterior Alveolar Ridge Using Autogenous Block Onlay Graft in a Pediatric Patient: A Case Report. Int J Clin Pediatr Dent 2021;14(2):311-314.