Zygomatic implants are a specialized technique used to rehabilitate patients with atrophied maxillae, where the bone quantity is inadequate for traditional implant placement. This surgical procedure aims to provide a predictable solution for tooth replacement in such cases.
The insertion path of a zygomatic implant follows the natural contour of your upper jaw, starting from the back near the roof of your mouth and anchoring in the dense bone of the cheekbone area. This ensures that the implant is stable and secure, providing a reliable solution for dental restoration.
However, it is important to be aware that like any surgical intervention, zygomatic implants come with potential complications that should be discussed with your dentist before proceeding with the treatment.
Understanding Zygomatic Implants
When patients have atrophied maxillae, traditional bone augmentation procedures, such as block bone grafting or sinus floor elevation (bone augmentation), are often required before implant placement. However, these procedures can be complex and involve multiple interventions.
Zygomatic implants offer a less invasive and more predictable alternative to address the challenge of inadequate bone quantity.
- Design features
Zygomatic implants are specifically designed for atrophied maxillae. They have a unique shape with a 45-degree-angled head, a wider diameter of 4.5 mm, and a length ranging from 30 to 50 mm.
- Placement
When placing a zygomatic implant, it follows a specific path inside your mouth. This path begins at the back of your upper jaw, near the roof of your mouth, and follows along the bony ridge called the zygomatic alveolar crest. From there, it extends towards the cheekbone area known as the malar body.
By anchoring the implant in this area, it gains excellent stability. The dense bone structure of the malar body provides a solid foundation for the implant, helping it stay securely in place.
This insertion technique is particularly useful for people who have experienced bone loss in their upper jaw, making it challenging to use traditional implants. The zygomatic implant’s path and anchorage in the malar body overcome this problem by utilizing the strong bone structure that remains in the cheekbone area.
Immediate vs. Late Complications from Zygomatic implants
Complications from zygomatic implants can be categorized as immediate or late.
- Immediate complications
Immediate complications occur after the surgery and are influenced by factors like the surgeon’s experience, technique used, anatomical conditions, and individual factors. Examples of immediate complications include:
- Swelling around the eyes
- Nosebleeds
- Tingling sensations
- Burns on the skin or inside the mouth
These complications generally have a good prognosis and can be managed effectively.
- Late complications
On the other hand, late complications require careful attention and treatment based on the specific location of the issue. Some examples of late complications are:
- The loss of implant fixation or osseointegration
- Communication between the mouth and the sinus cavity
- Openings in the oral mucosa
- Chronic sinusitis and other sinus-related problems
- Exposure of the implant in the palate
- Inflammation of the mucosa surrounding the implant (mucositis)
- Infection around the implant (peri-implantitis).
7 Potential Complications of Zygomatic Implants
Numerous studies have acknowledged that while zygomatic implants offer an effective solution, they are not without complications, including:
1. Sinusitis
Sinusitis has been reported in different studies, with prevalence rates ranging from 3.9% to 19.4% in patients who have undergone zygomatic implant placement. It is characterized by inflammation of the sinus membrane. This complication can arise due to factors such the body reacting to the implant as a foreign body, the (Schneiderian membrane) thin tissue lining the sinus getting damaged, or (lack of osseointegration) the implant not properly bonding with the surrounding bone.
2. Loss of Fixation
Loss of fixation refers to when the zygomatic implant becomes loose or unstable. The success of the fixation depends on the contact between the implant and the zygomatic bone. If there is not enough bone contact, or if complications arise with the bone in the area, the implant may become unstable or fail. In some cases, the loss of fixation may result in the need for bone reconstruction.
3. Loss of osseointegration (Non-Osseointegrated Implants)
Non-osseointegration refers to the failure of the implant to fully integrate with the surrounding bone, and has a prevalence ranging from 1.5% to 9.7%. Several factors can contribute to this, including overheating, contamination during surgery, trauma to the implant site, insufficient bone quantity or quality, lack of primary stability during implant placement, and improper immediate loading.
4. Local Infections and Mucositis
Local infections and mucositis are closely related to the occurrence of sinusitis and the lack of osseointegration, with a prevalence ranging from 3.6% to 4%. This can be caused by factors like surface infections, limited contact between the implant and the bone, and poor healing of the surrounding tissues. These complications can lead to inflammation and discomfort around the implant area.
5. Fistula at Implant Level
Fistula at the implant level refers to the presence of an abnormal opening or connection between the oral cavity (mouth) and the sinus. This has reported incidence rates ranging from 1.5% to 29%. This can occur when the implant fails to fully integrate with the bone or if there is a breakdown of the surrounding tissues due to functional forces or trauma during surgery. Fistulas can increase the risk of sinus infections and other complications.
6. Paresthesia
Paresthesia refers to abnormal sensations, like tingling or numbness, experienced by patients in the surrounding areas of the implant due to nerve affection. Following zygomatic implant placement, some cases of paresthesia have been reported due to nerve involvement during the implant placement, although the majority of them resolve within 3 to 8 weeks post-intervention.
7. Bruising and Labial Laceration
Bruising may occur as a temporary complication after the surgery. It is typically self-limited and associated with the postoperative period. Although a common postoperative occurrence, it is often underreported as a complication. It typically resolves on its own and is associated with the normal healing process. Labial laceration, another possible complication, has been reported in few cases. It is a less common complication that involves injury to the lip tissue during the implant placement.
Resolving the Complications
Keep in mind that these complications are not experienced by all patients who receive zygomatic implants. The overall success rate of zygomatic implants is high, and complications can be managed effectively with proper care and treatment. Regular follow-up visits with the dental professional are crucial for monitoring the implant’s condition and addressing any potential issues promptly.
Final Thoughts
Rehabilitation with zygomatic implants is a well-established treatment option for patients with inadequate bone quantity in the maxilla. However, it is crucial that this technique is performed by experienced professionals with a thorough understanding of conventional implants.
Sinusitis and lack of osseointegration are the most frequent complications associated with zygomatic implants, thought the othera may still occur. By understanding these risks and discussing them with patients before treatment, dental professionals can ensure optimal treatment outcomes and patient safety in zygomatic implant rehabilitation.
Reference
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116118/
https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0719-01072017000300176
