Simplifying Zygomatic Implant Site Preparation Using Ultrasonic Navigation: A Technical Note

Abstract

Zygomatic implant site preparation could be considered a challenging procedure because of the use of a very long twist drill that could sometimes be difficult to control due to the need for drilling the malar bone on an oblique surface. Ultrasound was recently suggested to achieve better control, but the specific long tips required are not readily available, and the elongated tip also tends to reduce the efficacy. This technical note describes a proposal of a novel computer-aided technique to simplify the procedure of zygomatic implant site preparation. This method uses a standard-length ultrasonic tip to prepare the crestal bone and the zygomatic bone in two individual steps. The desired implant trajectory can be achieved during preparation using a real-time tracking navigation system. The combined use of the navigation system and the ultrasonic tips could aid the surgeon, during the first steps, in achieving optimal control of the instruments employed for the implant site preparation and keeping the planned zygomatic implant position. If the efficacy of the procedure is confirmed through clinical trials, this technique could also contribute to reducing the invasiveness of the procedure, promoting a smaller flap, and reducing the soft tissue damage.

Computer-Aided Rehabilitation Supported by Zygomatic Implants: A Cohort Study Comparing Atrophic with Oncologic Patients after Five Years of Follow-Up

“…Zygomatic implant site preparation is a demanding technique due to the need of a very long drill. To overcome this issue, several methods have been proposed for better control using ultrasonic instruments with or without real-time tracking of the tip [ 35 , 36 , 37 ]. Some techniques for static guidance are also reported in the literature, but these require more clinical steps and additional costs for surgical stent preparation and manufacturing.…”

Augmented reality for dental implantology: a pilot clinical report of two cases

“…Nevertheless, the cases reported were simple and these limitations did not affect the results. Despite this, a comfortable work position might become mandatory in advanced clinical cases [28,29] in which this technology would prove to be beneficial. Other disadvantages could be considered the cost of the device, the time spent to set-up and the need to manage additional software for the AR.…”

Dynamic Navigation for Zygomatic Implants: A Case Report about a Protocol with Intraoral Anchored Reference Tool and an Up-To-Date Review of the Available Protocols

“…Several important surgical complications, such as sinusitis (5.86%), peri-implant mucositis (2.96%), nerve injuries (1.26%), oroantral fistula (1.20%), or even orbital perforation or infratemporal fossa invasion (1.33%) have been reported [ 5 , 9 ]. Furthermore, a good connection with the prosthetic structure strongly depends on the correct positions of the fixtures, with the risk of a too palatal implant emergence, a wrong distribution of masticatory forces, and implant mobility and prosthetic fractures [ 5 , 10 , 11 , 12 , 13 ]…”