The Accuracy of Zygomatic Implant Placement Assisted by Dynamic Computer-Aided Surgery: A Systematic Review and Meta-Analysis

Abstract

Purpose: The present systematic review aimed to investigate the accuracy of zygomatic implant (ZI) placement using dynamic computer-aided surgery (d-CAIS), static computer-aided surgery (s-CAIS), and a free-hand approach in patients with severe atrophic edentulous maxilla and/or deficient maxilla. Methods: Electronic and manual literature searches until May 2023 were performed in the PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases. Clinical trials and cadaver studies were selected. The primary outcome was planned/placed deviation. Secondary outcomes were to evaluate the survival of ZI and surgical complications. Random-effects meta-analyses were conducted and meta-regression was utilized to compare fiducial registration amounts for d-CAIS and the different designs of s-CAIS. Results: A total of 14 studies with 511 ZIs were included (Nobel Biocare: 274, Southern Implant: 42, SIN Implant: 16, non-mentioned: 179). The pooled mean ZI deviations from the d-CAIS group were 1.81 mm (95% CI: 1.34–2.29) at the entry point and 2.95 mm (95% CI: 1.66–4.24) at the apex point, and angular deviations were 3.49 degrees (95% CI: 2.04–4.93). The pooled mean ZI deviations from the s-CAIS group were 1.19 mm (95% CI: 0.83–1.54) at the entry point and 1.80 mm (95% CI: 1.10–2.50) at the apex point, and angular deviations were 2.15 degrees (95% CI: 1.43–2.88). The pooled mean ZI deviations from the free-hand group were 2.04 mm (95% CI: 1.69–2.39) at the entry point and 3.23 mm (95% CI: 2.34–4.12) at the apex point, and angular deviations were 4.92 degrees (95% CI: 3.86–5.98). There was strong evidence of differences in the average entry, apex, and angular deviation between the navigation, surgical guide, and free-hand groups (p < 0.01). A significant inverse correlation was observed between the number of fiducial screws and the planned/placed deviation regarding entry, apex, and angular measurements. Conclusion: Using d-CAIS and modified s-CAIS for ZI surgery has shown clinically acceptable outcomes regarding average entry, apex, and angular deviations. The maximal deviation values were predominantly observed in the conventional s-CAIS. Surgeons should be mindful of potential deviations and complications regardless of the decision making in different guide approaches.

Bimaxillary Immediate Prosthetic Rehabilitation Using a Custom Maxillary Subperiosteal Implant and Fibula-Free Flap Mandibular Reconstruction After Tumor Ablation

“…Zygomatic implants are another graftless option; however, their placement is technically challenging and there are no Food and Drug Administration-approved surgical guides for this procedure. 6 There is also some concern expressed with the placement of unilateral zygomatic implants for partial arch defects given the lack of evidence and concern for mechanical instability of the long lever arm. SPIs offer more flexibility compared to other salvage options.…”

“…Furthermore, non-vascularized bone grafting success is often unpredictable and may be limited by the constraints of the soft tissue envelope. Zygomatic implants are another graftless option; however, their placement is technically challenging and there are no Food and Drug Administration-approved surgical guides for this procedure 6 . There is also some concern expressed with the placement of unilateral zygomatic implants for partial arch defects given the lack of evidence and concern for mechanical instability of the long lever arm.…”

Long‐term survival and complications of Quad Zygoma Protocol with Anatomy‐Guided Approach in severely atrophic maxilla: A retrospective follow‐up analysis of up to 17 years

“…Recent studies have focused on using different guiding techniques to assist with ZI placement to increase intraoperative accuracy and safety 29–33 . Placement of ZIs has become more accurate with the use of surgical navigation systems, while also allowing for implementation of the restorative plan into the implant position 34 . A study by Wu and colleagues 32 in a total of 221 ZI placements in atrophic edentulous using the commercial dynamic navigation system, showed a deviation of 2.64°.…”

“…For the static surgical guide, 29,30 a modified customized template with double sleeves has been recently used and achieved acceptable accuracy in placing ZI. More clinical studies need to be investigated of the feasibility of dynamic and static systems for QZP 34 . A recent systematic review and meta‐analysis has shown acceptable clinical accuracy of ZI placement with the assistance of static dynamic systems through real‐time visualization and tracking techniques 34 …”

“…More clinical studies need to be investigated of the feasibility of dynamic and static systems for QZP 34 . A recent systematic review and meta‐analysis has shown acceptable clinical accuracy of ZI placement with the assistance of static dynamic systems through real‐time visualization and tracking techniques 34 …”