Accuracy of a flapless protocol for computer‐guided zygomatic implant placement in human cadavers: expectations and reality

Schiroli, Guido; Angiero, Francesca; Zangerl, Antoniettel; Benedicenti, Stefano; Ferrante, Franco; Widmann, Gerlig

doi:10.1002/rcs.1646

Cited by 18 publications

(19 citation statements)

References 26 publications

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“…Vrielinck et al inserted 18 ZIs using customized surgical template and found mean entry, exit, and angle deviations were 2.77 mm, 4.46 mm, and 5.1 degrees, respectively (Vrielinck et al, 2003 ). Schiroli et al and Vosselman et al also designed and fabricated surgical template specific for ZI surgery and gained high accuracy in ZI placement (Schiroli et al, 2016 ; Vosselman et al, 2021 ). Seldom study reported the accuracy in freehand ZI surgery, Gao et al applied digital ZI planning but conducted ZI surgery by freehand, the entry, exit, and angle deviations of 14 ZIs were 4.99 ± 2.66 mm, 6.11 ± 4.28 mm and 8.36 ± 5.3 degrees, respectively (Xing Gao et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Reliability and accuracy of dynamic navigation for zygomatic implant placement

Tao

Lan

et al. 2022

Clinical Oral Implants Res

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Objectives To assess the accuracy of a real‐time dynamic navigation system applied in zygomatic implant (ZI) surgery and summarize device‐related negative events and their management. Material and methods Patients who presented with severely maxillary atrophy or maxillary defects and received dynamic navigation‐supported ZI surgery were included. The deviations of entry, exit, and angle were measured after image data fusion. A linear mixed‐effects model was used. Statistical significance was defined as p < .05. Device‐related negative events and their management were also recorded and analyzed. Results Two hundred and thirty‐one zygomatic implants (ZIs) with navigation‐guided placement were planned in 74 consecutive patients between Jan 2015 and Aug 2020. Among them, 71 patients with 221 ZIs received navigation‐guided surgery finally. The deviations in entry, exit, and angle were 1.57 ± 0.71 mm, 2.1 ± 0.94 mm and 2.68 ± 1.25 degrees, respectively. Significant differences were found in entry and exit deviation according to the number of ZIs in the zygomata (p = .03 and .00, respectively). Patients with atrophic maxillary or maxillary defects showed a significant difference in exit deviation (p = .01). A total of 28 device‐related negative events occurred, and one resulted in 2 ZI failures due to implant malposition. The overall survival rate of ZIs was 98.64%, and the mean follow‐up time was 24.11 months (Standard Deviation [SD]: 12.62). Conclusions The navigation‐supported ZI implantation is an accurate and reliable surgical approach. However, relevant technical negative events in the navigation process are worthy of attention.

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Section: Discussionmentioning

confidence: 99%

Reliability and accuracy of dynamic navigation for zygomatic implant placement

Tao

Lan

et al. 2022

Clinical Oral Implants Res

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“…Treatments with conventional implants performed under surgical guides have achieved survival rates similar to conventional procedures [ 22 ], providing greater accuracy and precision than freehand techniques [ 23 ]. On the other hand, due to variations in the position and angulation of implants with respect to the previous computer-assisted planification zygomatic implants, surgical guides have demonstrated to be highly imprecise [ 18 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Accuracy of digital planning in zygomatic implants

et al. 2021

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Background Zygomatic implants have been described as a therapeutic alternative for patients with severe maxillary atrophy in order to avoid bone augmentation procedures. Taking that into account, in these treatments, the key factor is the position of the implant, the virtual surgical planning (VSP) is widespread among most clinicians before surgery on the patient. However, there are no studies which evaluate the clinical relevance of these VSP. The aim of this study is to determine whether digital planning on zygomatic implants has any influence on the implant dimensions and position, even when performing conventional surgery afterwards. Results Fourteen zygomatic implants were placed in four patients. Pre-operative and post-operative helicoidal computed tomography were performed to each patient to allow the comparison between the digital planning and the final position of implants. Tridimensional deviation (TD), mesio-distal deviation (MDD), bucco-palatine deviation (BPD), and apico-coronal deviation (ACD) were evaluated as well as angular deviation (AD). Significative differences in apical TD were observed with a mean of 6.114 ± 4.28 mm (p < 0.05). Regarding implant position, only implants placed in the area of the first right molar reported significant differences (p < 0.05) for ACD. Also, implant length larger than 45 mm showed BPD significative differences (p < 0.05). Conclusions Zygomatic implant surgery is a complex surgical procedure, and although VSP is a useful tool which helps the clinician determine the number and the length of zygomatic implants as well as its proper position, surgical experience is still mandatory.

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“…In this regard, CAD-CAM technology [26] has helped in the development of minimally invasive surgical techniques guided by intraoral splints [27] or computerassisted procedures [28][29][30]. Treatments with conventional implants performed under surgical guides have achieved survival rates similar to conventional procedures [31], providing greater accuracy and precision than previous techniques [32,33].…”

Section: Introductionmentioning

confidence: 99%

Major clinical results of virtual zygomatic implant and assessment of the risk of bias: a systematic review

Furtado¹,

Martin²,

Manzini³

2022

MedNEXT

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Introduction: In the context of implantology and severe resorption, zygomatic implants (ZI) are indicated and the procedures can be completed with the placement of a custom-made provisional prosthesis, reducing surgical time and optimizing results. Digital (virtual) optimizations for the ZI were developed in computerized radiology machines that allowed improvements in diagnostic and therapeutic tools. Objective: It was carried out a systematic review of the main considerations and clinical outcomes of using digital tools for the optimization of the virtual zygomatic implant. Methods: The rules of the Systematic Review-PRISMA Platform were followed. The research was carried out from January 2022 to April 2022 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 94 articles were found. In total, 62 articles were fully evaluated and 41 were included and evaluated in this study, and of the total of 41 articles, only 14 articles were developed as the main clinical results of the virtual zygomatic implant. Reducing errors and complications is essential if zygomatic implants are to remain a viable treatment alternative, and further research on a guided approach to their placement is encouraged. The surgical guide system showed accuracy for all variables studied and allowed acceptable and accurate implant placement, regardless of the complexity of the case. Thus, the surgical and prosthetic plan, the position, the emergence, the shape of the implants, the position of the provisional prosthesis, the inter-arch relationships, and the surgical templates were designed in a virtual environment and previously performed by the surgeon in stereolithographic models, allowing the surgical procedure was significantly simplified.

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Accuracy of a flapless protocol for computer‐guided zygomatic implant placement in human cadavers: expectations and reality

Abstract: Computer-guided minimally-invasive flapless zygomatic implant surgery remains challenging. Careful planning and perfect stability of the surgical guide are essential.

Cited by 18 publications

References 26 publications

Reliability and accuracy of dynamic navigation for zygomatic implant placement

Reliability and accuracy of dynamic navigation for zygomatic implant placement

Accuracy of digital planning in zygomatic implants

Major clinical results of virtual zygomatic implant and assessment of the risk of bias: a systematic review

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