BACKGROUND: The fixed rehabilitation of patients with severely atrophic maxillae is challenging because of the insufficient bone volumes. The number of complications and failures with bone augmentation procedures is still quite high and sometimes an invasive bone harvesting is required. One solution may be to use zygomatic implants. Prospective studies have shown that zygomatic implants can be used successfully for the rehabilitation of patients with an extreme maxillary atrophy, also with immediate loading. However, the placement of zygomatic implants requires experienced surgeons and it is not risk-free because delicate anatomical structures, such as the orbita and brain, may be involved especially during implant site preparation with drills. Ultrasonic osteotomy allows precise and effective bone cutting without damaging adjacent soft tissues, increasing visibility. Thus, ultrasonic devices may be useful in zygomatic implant surgery, to reduce surgical risks, complications, and morbidity. AIM/HYPOTHESIS: To compare the outcomes of zygomatic implant sites prepared using conventional rotary drills or ultrasonic inserts, for placing 2 zygomatic implants per zygoma according to a split-mouth randomised controlled trial design. MATERIAL AND METHODS: Twenty patients with atrophic fully edentulous maxillae having not sufficient bone volumes (no more than 4 mm of bone height sub-antrally) for placing dental implants at all, were randomised according to a split-mouth design to have 2 zygomatic implant sites prepare with ultrasonic inserts (test side), and 2 zygomatic implant sites prepared with drills (control side), at 2 centres. All zygomatic implants (Southern Implants, Irene, South Africa) had a diameter of 4.3 mm. Implants were immediately loaded (within 24 hours). Patients were followed up to 4 months after loading and outcome measures were: time for site preparation, insertion torque, presence of haematoma, prosthesis and implant failures and any complication. Descriptive statistics were used to summarize the data. Wilcoxon signed rank test compared preparation time, complications, prosthesis and implant failures between the two sides, while McNemar test was used for insertion torque comparison between the tested groups. A Chi-Square Goodness of Fit Test investigated the distribution of haematoma presence and patient preference. All statistical comparisons were conducted at the 0.05 level of significance. RESULTS: Forty treated sides (20 patients) were randomly allocated to each group and 80 zygomatic implants were finally placed; up to 4 months post-loading one patient dropped out; 3 complications occurred in 3 patients at drill sides, while 1 occurred at a ultrasonic side. One patient lost 2 implants at drill side, while no implant was lost in the ultrasonic group (P = 0.317); no prosthetic failures were recorded. Ultrasonic treated sides required a longer preparation time (23.50 minutes) than drills (14.35 minutes) with a statistically significant difference (P = 0.000). Only 1 implant (ultrasonic group) was inserted with a torque <40 N cm (P = 0.314). Thirteen patients had a larger haematoma at drill treated side, 7 patients had both haematomas similar in extension while no patient had a larger haematoma at ultrasonic sides (P = 0.0017). Two patients preferred the ultrasonic treated side, while for 18 patients both treatments were equally good (P = 0.000). CONCLUSIONS AND CLINICAL IMPLICATIONS: Zygomatic implant tunnel preparation with ultrasonic inserts and with drills produces comparable results, however ultrasonic inserts allow for a smaller haematoma at surgical site even if with a longer preparation time. Within the limitations of this preliminary study, ultrasonic zygomatic implant site preparation could be a good alternative to the drilling technique. Ultrasonic devices lead to an improvement of surgical visual control and precision and to less risk for soft tissue damage.

Conventional drills versus ultrasonic preparation for placement of zygomatic implants: a 4-month post-loading split-mouth randomised controlled trial / Felice, P.; Balercia, A.; Pistilli, R.; Tuci, L.; Barausse, C.; Esposito, M.. - In: CLINICAL ORAL IMPLANTS RESEARCH. - ISSN 0905-7161. - STAMPA. - (2016). (Intervento presentato al convegno 25th Annual EAO Meeting tenutosi a Paris, France nel 29 September - 1 October 2016).

Conventional drills versus ultrasonic preparation for placement of zygomatic implants: a 4-month post-loading split-mouth randomised controlled trial.

FELICE, PIETRO;BARAUSSE, CARLO;
2016

Abstract

BACKGROUND: The fixed rehabilitation of patients with severely atrophic maxillae is challenging because of the insufficient bone volumes. The number of complications and failures with bone augmentation procedures is still quite high and sometimes an invasive bone harvesting is required. One solution may be to use zygomatic implants. Prospective studies have shown that zygomatic implants can be used successfully for the rehabilitation of patients with an extreme maxillary atrophy, also with immediate loading. However, the placement of zygomatic implants requires experienced surgeons and it is not risk-free because delicate anatomical structures, such as the orbita and brain, may be involved especially during implant site preparation with drills. Ultrasonic osteotomy allows precise and effective bone cutting without damaging adjacent soft tissues, increasing visibility. Thus, ultrasonic devices may be useful in zygomatic implant surgery, to reduce surgical risks, complications, and morbidity. AIM/HYPOTHESIS: To compare the outcomes of zygomatic implant sites prepared using conventional rotary drills or ultrasonic inserts, for placing 2 zygomatic implants per zygoma according to a split-mouth randomised controlled trial design. MATERIAL AND METHODS: Twenty patients with atrophic fully edentulous maxillae having not sufficient bone volumes (no more than 4 mm of bone height sub-antrally) for placing dental implants at all, were randomised according to a split-mouth design to have 2 zygomatic implant sites prepare with ultrasonic inserts (test side), and 2 zygomatic implant sites prepared with drills (control side), at 2 centres. All zygomatic implants (Southern Implants, Irene, South Africa) had a diameter of 4.3 mm. Implants were immediately loaded (within 24 hours). Patients were followed up to 4 months after loading and outcome measures were: time for site preparation, insertion torque, presence of haematoma, prosthesis and implant failures and any complication. Descriptive statistics were used to summarize the data. Wilcoxon signed rank test compared preparation time, complications, prosthesis and implant failures between the two sides, while McNemar test was used for insertion torque comparison between the tested groups. A Chi-Square Goodness of Fit Test investigated the distribution of haematoma presence and patient preference. All statistical comparisons were conducted at the 0.05 level of significance. RESULTS: Forty treated sides (20 patients) were randomly allocated to each group and 80 zygomatic implants were finally placed; up to 4 months post-loading one patient dropped out; 3 complications occurred in 3 patients at drill sides, while 1 occurred at a ultrasonic side. One patient lost 2 implants at drill side, while no implant was lost in the ultrasonic group (P = 0.317); no prosthetic failures were recorded. Ultrasonic treated sides required a longer preparation time (23.50 minutes) than drills (14.35 minutes) with a statistically significant difference (P = 0.000). Only 1 implant (ultrasonic group) was inserted with a torque <40 N cm (P = 0.314). Thirteen patients had a larger haematoma at drill treated side, 7 patients had both haematomas similar in extension while no patient had a larger haematoma at ultrasonic sides (P = 0.0017). Two patients preferred the ultrasonic treated side, while for 18 patients both treatments were equally good (P = 0.000). CONCLUSIONS AND CLINICAL IMPLICATIONS: Zygomatic implant tunnel preparation with ultrasonic inserts and with drills produces comparable results, however ultrasonic inserts allow for a smaller haematoma at surgical site even if with a longer preparation time. Within the limitations of this preliminary study, ultrasonic zygomatic implant site preparation could be a good alternative to the drilling technique. Ultrasonic devices lead to an improvement of surgical visual control and precision and to less risk for soft tissue damage.
2016
Special Issue: Abstracts of the EAO Congress, Paris, France, 29 September - 1 October 2016
Conventional drills versus ultrasonic preparation for placement of zygomatic implants: a 4-month post-loading split-mouth randomised controlled trial / Felice, P.; Balercia, A.; Pistilli, R.; Tuci, L.; Barausse, C.; Esposito, M.. - In: CLINICAL ORAL IMPLANTS RESEARCH. - ISSN 0905-7161. - STAMPA. - (2016). (Intervento presentato al convegno 25th Annual EAO Meeting tenutosi a Paris, France nel 29 September - 1 October 2016).
Felice, P.; Balercia, A.; Pistilli, R.; Tuci, L.; Barausse, C.; Esposito, M.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/572309
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