ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Which Technique Provides Better Zygomatic Implant Stability–Exteriorized Or Branemark?
Clinical Question In a patient with severe maxillary bone resorption, will the insertion of zygomatic implants by means of the conventional Branemark technique (through maxillary sinus) as compared to the exteriorized technique (middle third of implant length is lateral to the maxillary sinus) provide better mechanical stability for the implant?
Clinical Bottom Line The exteriorized technique increases the length of drilling holes in the zygomatic bone and may provide higher mechanical stability as compared to the original Branemark technique. However, technique should depend on the position of maxillary sinus, the concavity formed on the ridge crest, and the region of the implant into the zygomatic bone. In a patient with severe maxillary bone resorption the concavity formed is small and the Branemark technique should be employed. However, when maxillary resorption generates a large concavity the exteriorized technique should be employed.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 20430638Corvello/2010 Zygomatic bone of dry skulls Cohort Study
Key resultsThe exteriorized technique showed longer drilling holes for zygomatic implants as compared to the Branemark technique (p < 0.001). Implant size (length) remained the same. There was no association between surgical technique and implant length (p = 0.497), or the site where the implant emerged (p = 0.067).
#2) 22274763Chrcanovic/2012 Patients with zygomatic implantsSystematic Review
Key resultsBoth techniques show a high success rate. Classical (Branemark) technique had a 98.1% success rate with a follow-up range of 6 to 69 months. The exteriorized techniques had a 99.0% success rate with a follow-up range of 12 to 48 months.
Evidence Search Corvello: "Dental Implantation, Endosseous"[Mesh]) AND "Zygoma"[Mesh] Chrcanovic: “Zygomatic implant techniques (limit: systematic reviews)”
Comments on
The Evidence
Corvello: This study was a cohort design, which employed the use of 18 dry skulls. Nine skulls were used for testing the exteriorized technique, while the remaining nine were used for the Branemark technique. Both zygomatic bones were used in the study. No competing interests are evident in the study. Chrcanovic: This article conducted a systematic review of 41 articles, which reported different techniques for zygomatic implants. Articles were searched electronically – a comprehensive and detailed search was completed. It was not apparent if the articles were assessed for validity. Meta-analysis was not performed.
Applicability Corvello: This article employed the use of dry skulls, and in terms of anatomy and measurements the dry skulls are a good representative of the patient. However, the bone quality of a dry skull is different from that of a vital skill. Due to the difference in bone quality, the dry skulls may not be a good representative for measuring mechanical stability. In accordance to the study the exteriorized technique could be utilized to provide better stability of the implant as compared to the Branemark technique. Chrcanovic: Preference of one technique over the other should take into consideration the concavity on the ridge crest. If the concavity on the ridge crest is large it would be best for the patient if the exteriorized technique was used. However, if the concavity on the ridge crest is small, due to severe maxillary resorption, the Branemark technique should be employed.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Periodontics) (Prosthodontics)
Keywords Implantation, Dental Implants, Zygomatic Implants, Implant techniques, Exteriorized technique, Branemark technique
ID# 2288
Date of submission: 04/19/2012spacer
E-mail telloa@livemail.uthscsa.edu
Author Ashley R. Tello
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Yong-Hee Patricia Chun, DDS, MS, PhD
Faculty mentor/Co-author e-mail ChugY@uthscsa.edu
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