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Background The objectives of our study were to evaluate zygomatic implants placed according to quad zygoma protocol in the severely absorbed maxilla on cone-beam computed tomography (CBCT) scans using virtual implant placement program and to compare the variables according to gender. The secondary objectives were to examine the intra and extra-sinus pathways of anterior and posterior implants. Materials and methods 56 zygomatic bones from 28 patients were examined using CBCT scans. A total of 112 zygomatic implants were evaluated to zygomatic bone-implant contact (zBIC) lenght, the relationship zygomatic implants between the maxillary sinus and zygomaticofacial foramen (ZFF) were compared and analyzed by gender on virtually placed anterior and posterior implants on the three-dimensional reconstruction images. Results The average zBICs length in males was found to be 11.77 ± 3.47 mm, in females 11.23 ± 2.61 mm. Although the zBIC lenghts of anterior implants were reported to be higher than those of posterior implants, no significant differences were found, respectively ( p  > 0.05). Among the anterior and posterior zygomatic implants classified according to ZAGA classification, ZAGA 3 (%55,3) and ZAGA 4 (%50) were most common reported, respectively. ZFF contact was significantly higher in implants with an anterior exit profile ( p  < 0.05). No statistically significant differences were found between gender-related parameters that were investigated ( p  > 0.05). Conclusion BIC length was not affected by gender or implant position. Most of the zygomatic implants were placed extrasinus trajectory. Anteriorly placed zygomatic implants presented high risk for ZFF contact. Trial registration Not applicable.

Background This in vitro study compared the stability of different fixation method combinations for the zygomatic complex after simulated L-shaped osteotomy reduction malarplasty, a common facial contouring surgery in East Asia with high postoperative complications due to poor fixation methods. Materials and Methods The study used 108 zygoma replicas with various fixation methods combinations in the zygomatic body (L-shaped plate with short wing on zygoma and on the maxilla, two bicortical screws, one bicortical screw with L-shaped plate, square plate, and rectangular plate) and zygomatic arch (Mortise–Tenon structure, 3-hole plate, and Mortise–Tenon structure plus short screw). The failure force under incremental load was applied through the Instron tensile machine to a well-stabilized model using a rubber band simulating the masseter muscle and recorded the increasing force digitally. ANOVA test was used for comparison between recorded values ( P < 0.05). Results The results showed that the most stable combination was a six-hole rectangular plate and a Mortise–Tenon structure plus one short screw (358.55 ± 51.64 N/mm2). The results also indicated that the placement vector of the fixation methods around the L-shaped osteotomy and the use of the two-bridge fixation method were important factors in enhancing the stability of the zygomatic complex. Conclusion The study suggested that surgeons should choose appropriate fixation methods based on these factors to reduce postoperative complications and improve surgical outcomes. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Purpose: No published research has compared patients’ quality of life and satisfaction with fixed prostheses supported by zygomatic implants with those supported by all-on-four prostheses. The aim of this study was to evaluate patients’ quality of life and satisfaction with fixed prostheses on zygomatic implants compared with the all-on-four concept. Materials and Methods: A total of 80 patients with atrophic edentulous maxillae were randomized into two groups: Group 1 (rehabilitated with fixed prostheses supported by 2–4 zygomatic and 2–4 conventional implants in the anterior region) and Group 2 (fixed prostheses on four implants in the anterior region following an all-on-four concept). One year after placement of the definitive prostheses, patients completed OHIP-14 and satisfaction questionnaires. Results: In all seven domains of the OHIP-14 and in the overall scores, a worse quality of life was found in Group 2 patients, with statistically significant differences between the two groups (p ≤ 0.05). Patients with zygomatic implants were more satisfied with their prostheses, with a statistically significant difference (p < 0.001). Conclusions: According to the results of this study, rehabilitation of patients with edentulous atrophic maxillae with prostheses supported by zygomatic implants combined with anterior implants provided better patient quality of life and satisfaction than prostheses supported by four implants.

In principle, to achieve the most natural and harmonious rejuvenation of the face, all changes that result from the aging process should be corrected. Traditionally, soft tissue lifting and redraping have constituted the cornerstone of most facial rejuvenation procedures. Changes in the facial skeleton that occur with aging and their impact on facial appearance have not been well appreciated. Accordingly, failure to address changes in the skeletal foundation of the face may limit the potential benefit of any rejuvenation procedure. Correction of the skeletal framework is increasingly viewed as the new frontier in facial rejuvenation. It currently is clear that certain areas of the facial skeleton undergo resorption with aging. Areas with a strong predisposition to resorption include the midface skeleton, particularly the maxilla including the pyriform region of the nose, the superomedial and inferolateral aspects of the orbital rim, and the prejowl area of the mandible. These areas resorb in a specific and predictable manner with aging. The resultant deficiencies of the skeletal foundation contribute to the stigmata of the aging face. In patients with a congenitally weak skeletal structure, the skeleton may be the primary cause for the manifestations of premature aging. These areas should be specifically examined in patients undergoing facial rejuvenation and addressed to obtain superior aesthetic results. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Purpose To evaluate the radioanatomical measurements of the zygoma as a guide for treatment planning of quad zygomatic implant placement. Methods This cross sectional study was carried on 17 patients of 34 zygomatic regions reported with atrophic maxilla for placement of zygomatic implants. The zygomatic implants were placed virtually in a quad approach using “Real Guide” version 3.0” and, the following parameters were assessed at 20 points in antero- superior, antero-inferior, postero-superior and postero-inferior regions. The thickness of zygomatic bone, Installation angle of zygomatic implants, Length of the installed zygomatic implants and Distance between the zygomatic implants on each side were measured using Cone Beam Computed Tomography (CBCT) on a virtual planning software “Materialise Mimics” version 15. Results The mesial implant can be emerged in antero-superior region and the distal implant can be emerged in antero-inferior region on the right side zygoma since the maximum thickness of zygomatic bone was seen in D2, A1, A3 and D4 directions. Similarly in the left side of zygoma, the mesial implant can emerge in postero-superior region and distal implant can be emerge in postero-inferior region since the maximum thickness was seen in D2 and A3 directions ( P  > 0.05). The installation angle for mesial implant in right and left side was 45 0 and the distal implant angle for right and left side was 45 0 and 46 0 ( P  < 0.05). The mesial zygomatic implant length for right and left side was 55.88 mm and 56.18 mm while, the distal zygomatic implant length for right and left side was 44.56 mm and 45.59 mm ( P  > 0.05). The distance between the two zygomatic implants in right and left side was 5.06 mm and 4.54 mm ( P  > 0.05). Conclusion Virtual planning for placement of implants in quad zygoma approach would be a feasible requirement as it eases out the surgeon’s practice and prevents the possibilities of causing intrusion complications intraoperatively. Hence, quad zygoma implants remains a promising viable option for patients presenting with severe atrophic maxilla. Clinical trial number Not Applicable.

Biodegradable fixation systems could reduce or eliminate problems associated with titanium removal of implants in a second operation. The aim of this study was to compare the long-term (i.e. >5 years postoperatively) clinical performance of a titanium and a biodegradable system in oral and maxillofacial surgery. The present multicenter Randomized Controlled Trial (RCT) was performed in four hospitals in the Netherlands. Patients treated with a bilateral sagittal split osteotomy (BSSO) and/or a Le Fort-I osteotomy, and those treated for fractures of the mandible, maxilla, or zygoma were included from December 2006 to July 2009. The patients were randomly assigned to either a titanium (KLS Martin) or a biodegradable group (Inion CPS). After >5 years postoperatively, plate removal was performed in 22 of the 134 (16.4%) patients treated with titanium and in 23 of the 87 (26.4%) patients treated with the biodegradable system (P = 0.036, hazard ratio (HR) biodegradable (95% CI) = 2.0 (1.05-3.8), HR titanium = 1). Occlusion, VAS pain scores, and MFIQ showed good and (almost) pain free mandibular function in both groups. In conclusion, the performance of the Inion CPS biodegradable system was inferior compared to the KLS Martin titanium system regarding plate/screws removal in the abovementioned surgical procedures. http://controlled-trials.com ISRCTN44212338.

There are various techniques to measure accuracy of dental implant surgery, but limited data validating the techniques used to analyze accuracy. Scan-body-assisted surface-based registration (SB-SBR) is deemed theoretically accurate, but with challenges in testing accuracy. The purpose of the study was to analyze the accuracy of SB-SBR for conventional (CVI) and zygomatic implants (ZI) using 2 complementary techniques. An in-vitro study was designed using a 3D-printed model of an edentulous maxilla with CVI and ZI digitally planned and placed. SB-SBR was performed on the physical model and on a model-free virtual setting, and the implant position was compared with those of the planned implants 10 times. Outcome variables were angular and linear errors (AE and LE), with thresholds of 1° and 1 mm. Paired t-test and Wilcoxson signed-ranked test were used. Results showed greater AE for ZI versus CVI (mean difference, MD 0.42°). Apical LE was greater for ZI (MD 0.68 mm), while CVI exhibited greater platform LE (MD 0.69 mm). Overall AE remained under 1°, but the apical LE of ZI exceeded 1 mm, which could potentially lead to violation of critical structures when combined with surgical error, highlighting the need for caution when interpreting data derived from SB-SBR especially for ZI.

Background Zygomatic implants have been proposed in literature for atrophic maxillary fixed oral rehabilitations. The aim of the present research was to evaluate, by a clinical and tomography assessment, a surgical complication of a zygomatic implant penetration to the orbit. Case presentation A 56 year-old female patient was visited for pain and swelling in the left orbit after a zygomatic implant protocol. The orbit invasion of the zygomatic implant screw was confirmed by the CBCT scan. The patient was treated for surgical implant removal and the peri- and post-operative symptoms were assessed. No neurological complications were reported at the follow-up. The ocular motility and the visual acuity were well maintained. No purulent secretion or inflammatory evidence were reported in the post-operative healing phases. Conclusion The penetration of the orbit during a zygomatic implant positioning is a surgical complication that could compromise the sight and movements of the eye. In the present case report, a zygomatic implant removal resulted in an uneventful healing phase with recovery of the eye functions.

Background: Zygomatic implants have been introduced to rehabilitate edentulous patients with severely atrophic maxillae. Their use has been reported by several studies, describing high overall survival rates at medium–long follow-up. The aim of this study was to retrospectively analyze if a few patient-related and implant-related features are correlated with implant success or the onset of complications. Materials and methods: Data of patients treated with zygomatic implants between May 2005 and November 2012 at three private clinics were collected and retrospectively analyzed. For each implant, the following data were collected: implant length, insertion path, ridge atrophy and sinus characteristics (width, pneumatization, thickness of mucosae, patency of sinus ostium). General patient characteristics and health status data were also recorded. The outcomes evaluated were implant failure, infective complications, early neurologic complications and overall complications. Results: A total of 33 patients (14 men, 17 women, mean age 59.1) that received 67 zygomatic implants were included in the study. The mean duration of the follow-up was of 141.6 months (min 109; max 198). In this period, a total of 16 (23.88%) implants in 8 (24.24%) patients were removed and 17 (51.51%) patients with 36 (53.73%) implants reported complications. Immediate loading resulted in a significantly lower risk of complications compared with the two-stage prosthetic rehabilitation (OR: 0.04, p = 0.002). A thickness of the sinus mucosa > 3 mm emerged to be correlated with a greater occurrence of infective complications (OR: 3.39, p = 0.019). Severe and extreme pneumatization of the sinus was significantly correlated with the incidence of overall complications (p = 0.037) and implant failure (p = 0.044). A large sinus width was predisposed to a higher risk of neurologic complications, infective complications and implant failure (p = 0.036, p = 0.032, p = 0.04, respectively). Conclusions: zygomatic implants are an alternative procedure for atrophic ridge rehabilitation when a conventional implant placement is not possible. Several clinical and anatomical factors can have a significant role in complication occurrence.

It is hypothesized that under optimal glycemic control (GC), there is no difference in the survival of implants placed in the zygomatic bone of edentulous patient with and without type 2 diabetes mellitus (T2DM). The aim was to assess the influence of GC on survival of implants placed in the zygomatic bone of an edentulous patient with and without T2DM at the 10-year follow-up. Twenty patients with T2DM (10 with poorly controlled T2DM and 10 with well-controlled T2DM) and 12 patients without T2DM were included. Hemoglobin A1c (HbA1c) levels were recorded, and demographic data were collected from all participants. Peri-implant inflammatory parameters (plaque index [PI], probing depth [PD], crestal bone loss [BL], and gingival index [GI]) were measured in all patients. Group comparisons were done, and P values, which were less than .01, were indicative of statistical significance. Twenty and 12 male patients with and without T2DM, respectively, were included. Among patients with T2DM, 10 and 10 individuals had poorly and well-controlled T2DM, respectively. The mean HbA1c levels were significantly higher in patients with poorly controlled T2DM (9.2 ± 0.7%) compared with well-controlled T2DM (4.8 ± 0.3%; P < .01) and nondiabetic individuals (4.6 ± 0.3%; P < .01). The crestal BL on the mesial ( P < .01) and distal ( P < .01) surfaces, PD ( P < .01), PI ( P < .01), and GI ( P < .01) were significantly higher around all zygoma implants placed in patients with poorly controlled T2DM compared with patients with well-controlled T2DM and patients without T2DM. These clinicoradiographic parameters were comparable around zygoma implants placed in patient with well-controlled T2DM and in subjects without T2DM. Optimal GC is essential for the long-term stability of zygomatic plants in patients with T2DM.