Comparative evaluation of extrasinus versus intrasinus approach for zygomatic implant placement

Deepika Kumari Jain, U S Pal, Shadab Mohammad, Divya Mehrotra, Ravi Katrolia, Saatvik Shandilya, Lakshya Yadav, Arunesh Kumar Tiwari, Deepika Kumari Jain, U S Pal, Shadab Mohammad, Divya Mehrotra, Ravi Katrolia, Saatvik Shandilya, Lakshya Yadav, Arunesh Kumar Tiwari

Abstract

Edentulism, a common problem can occur either as a congenital defect or acquired later due to dental caries, periodontitis, as a consequence of aging, maxillofacial trauma or post-ablation in tumor resections. The rehabilitation of the missing teeth can be done using dental implants. To overcome the deficiency of available bone, processes like sinus augmentation with substituted bone graft and Le Fort I osteotomy with interpositional bone graft have been described in the literature. In order to overcome the associated limitations with these procedures, implants were designed that can be placed in specific anatomical areas like zygoma. This study aims to compare two different types of surgical approaches (Intrasinus vs Extrasinus) for the placement of zygomatic implants to treat atrophic maxilla. The placement of zygomatic implant through both extrasinus and intrasinus approaches were evaluated on the basis of different parameters and it was observed that postoperative pain and swelling was significantly found in intra sinus approach as compared to extra sinus approach. However, in the intranasal approach, poor patient compliance or low satisfaction rate was observed as compared to extra sinus approach. On the basis of the results of the study and post operative evaluation based on various criteria, it was concluded that extra sinus approach has got an edge over intra sinus approach.

Keywords: Atrophic maxilla; Extrasinus; Implants; Intrasinus; Zygomatic implants.

© 2022 Published by Elsevier B.V. on behalf of Craniofacial Research Foundation.

Figures

Graphical abstract
Graphical abstract
Fig. 1
Fig. 1
Bar graph showing patient distribution based on Age showing although the mean age of group A is relatively higher than the group B but there was no significant difference.
Fig. 2
Fig. 2
Bar graph showing patient distribution based on Sex showing that proportion of males is relatively higher than the females, however there was no significant difference between the groups.
Fig. 3
Fig. 3
Intergroup Comparison of VAS exhibiting higher mean VAS in Group B at each time of follow up and was absent in Group A at 12th week. Therefore group A is better than group B and statistically significant difference was present in both groups.
Fig. 4
Fig. 4
Bar graphs of proportion of swelling displaying higher proportion of higher grade swelling in Group B at each time of follow up, while at 12th week it was absent. Statistically significant difference was present in both groups and shows Group A was better than group.
Fig. 5
Fig. 5
Intergroup Comparison of Stability displaying higher mean stability score in Group A at each time of follow up.
Fig. 6
Fig. 6
Bar Graph representing absence of any Cutaneous Fistula in any case.
Fig. 7
Fig. 7
Bar Graph representing Partial Sinus Opacification seen only in Group B. Statistically significant difference was present in both groups.
Fig. 8
Fig. 8
Bar Graph of Suppuration representing suppuration present only in Group B.
Fig. 9
Fig. 9
Bar Graph depicting higher Maxillary Sinus Health score in Group B. Statistically significant difference was present in both groups.
Fig. 10
Fig. 10
Intergroup Comparison of Crestal bone loss revealed no evidence of bone loss around the implant.
Fig. 11
Fig. 11
Intergroup Comparison revealed absence of Zygomatic Bone Fracture in all the cases.
Fig. 12
Fig. 12
Intergroup Comparison of position of zygomatic Implant revealed that in all the 100% cases of Group A, apical 1/3rd of zygomatic implant was inside the zygomatic bone but it was relatively less cases of group B. In remaining cases small exteriorization of the zygomatic implant at apex was observed.
Fig. 13
Fig. 13
Bar Graph showing more Patient Satisfaction in Group A. Statistically significant difference was present in both groups.
Photograph 1
Photograph 1
The armamentarium used for surgery.
Photograph 2
Photograph 2
Extraoral landmarks for zygomatic implant placement.
Photograph 3
Photograph 3
Initial common surgical step -Crestal incision & mucoperiosteal flap reflection.
Photograph 4
Photograph 4
Implant placement through extra sinus approach.
Photograph 5
Photograph 5
Tightening of the zygomatic implant with rachet.
Photograph 6
Photograph 6
Zygomatic implant placement through intrasinus approach.
Photograph 7
Photograph 7
Follow up radiographic image at 1st, 4th & 12th week.

References

    1. Xu X., Zhao S., Liu H., Sun Z., Wang J., Zhang W. An anatomical study of maxillary-zygomatic complex using three-dimensional computerized tomography-based zygomatic implantation. BioMed Res Int. 2017 2017.
    1. Aparicio C., López-Piriz R., Albrektsson T. ORIS criteria of success for the zygoma-related rehabilitation: the (revisited) zygoma success code. Int J Oral Maxillofac Implants. 2020;35(2):366–378.
    1. Davó R., Bankauskas S., Laurincikas R., Koçyigit I.D., Mate Sanchez de Val J.E. Clinical performance of zygomatic implants-retrospective multicenter study. J Clin Med. 2020;9(2):480.
    1. Sogo M., Ikebe K., Yang T.C. Assessment of bone density in posterior maxilla based on Hounsfield units to enhance the initial stability of implants. Clin Implant Dent Relat Res. 2012:14–32.
    1. Migliorança R., Ilg J.P., Serrano A.S., Souza R.P., Zamperlini M.S. Sinus exteriorization of the zygoma fixtures: a new surgical protocol. Implant News. 2006;3:30–35.
    1. Fernández H., Gómez-Delgado A., Trujillo-Saldarriaga S., Varón-Cardona D., Castro-Núñez J. Zygomatic implants for the management of the severely atrophied maxilla: a retrospective analysis of 244 implants. J Oral Maxillofac Surg. 2014;72(5):887–891.
    1. Ishak M.I., Abdul Kadir M.R., Sulaiman E., Abu Kasim N.H. Finite element analysis of different surgical approaches in various occlusal loading locations for zygomatic implant placement for the treatment of atrophic maxillae. Int J Oral Maxillofac Surg. 2012;41(9):1077–1089.
    1. Garcia Garcia B., Ruiz Masera J.J., Zafra Camacho F.M. Bilateral cutaneous fistula after the placement of zygomatic implants. Int J Oral Maxillofac Implants. 2016;31(2):e11–e14.
    1. Esposito M., Worthington H.V. Interventions for replacing missing teeth: dental implants in zygomatic bone for the rehabilitation of the severely deficient edentulous maxilla. Cochrane Database Syst Rev. 2013;9:CD004151.
    1. Davó R., Felice P., Pistilli R., et al. Immediately loaded zygomatic implants vs conventional dental implants in augmented atrophic maxillae: 1-year post-loading results from a multicentre randomised controlled trial. Eur J Oral Implant. 2018;11(2):145–161.
    1. Corvello P.C., Montagner A., Batista F.C., Smidt R., Shinkai R.S. Length of the drilling holes of zygomatic implants inserted with the standard technique or a revised method: a comparative study in dry skulls. J Cranio-Maxillo-Fac Surg. 2011;39(2):119–123.

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