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Title Reported Postoperative Complication Rates Are Lower for Zygomatic Implants Than for Maxillary Sinus Floor Augmentation Surgeries
Clinical Question For edentulous and partial edentulous patients with an atrophic maxilla, does rehabilitation with zygomatic implants lead to increased postoperative complications compared to sinus floor elevation?
Clinical Bottom Line Postoperative complications are reduced when using zygomatic implants to restore the edentulous and partially edentulous atrophic maxilla when compared to sinus floor elevation. This evidence is based on systematic reviews and meta analyses reporting decreased complications rates in atrophic maxillae restored with zygomatic implants. Zygomatic implants offer a successful treatment option with the potential to reduce treatment time, cost, and implant morbidity.
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) 30624789Raghoebar/201911 studies: 383 patients; 615 MSFA procedures; 1,517 implants Meta-Analysis
Key resultsPostoperative complications following maxillary sinus floor augmentation (MSFA) are uncommon, with a reported 8.1% complication rate. Complications reported include post-op bleeding, post-op infection, abscess, sinusitis, peri-implant mucositis, pain, peri-implantitis, and failed restoration. Post-operative bleeding was the most frequent reported complication following MSFA, at a rate of 4.6%.
#2) 27422530Chrcanovic/201668 studies: 2,161 patients; 4,556 zygomatic implants Meta-Analysis
Key resultsPostoperative complication following zygomatic implant (ZI) placement was reported to be 5.4%. Complications reported include sinusitis, soft tissue infection, paresthesia, and oroantral fistula formation. The most frequent reported complication was sinusitis at a rate of 2.4%.
Evidence Search Zygomatic implant AND complications; sinus augmentation AND meta analysis
Comments on
The Evidence
Validity: Both studies are systematic reviews with meta-analyses, the highest level of evidence for this topic. It is important to note that these articles were not a direct comparison of one surgical intervention versus the other. The review of the literature did not reveal any direct comparison of zygomatic implants versus MSFA. The studies included by Raghoebar contain various approaches to MSFA, which may have contributed to the heterogeneity (I2 > 90%) in results. Additionally, both the systematic reviews included multiple studies that failed to report on complications related to the procedure, potentially causing complications to be underreported. Further, the Chrcanovic review contained many studies with a follow-up period of <5 years, whereas the Raghoebar review only included studies with a follow-up period of >5 years. Additional long-term evidence may suggest different results. Perspective: MSFA and ZIs are acceptable treatment modalities for the edentulous and partially edentulous atrophic maxilla. Patient selection is imperative to the success of both procedures and clinicians must evaluate each patient individually to determine the best procedure for their situation. The heterogeneity in surgical approaches to both MSFA and ZIs increases the difficulty to produce valid reviews comparing these two treatment options.
Applicability The atrophic maxilla presents a challenge when restoring a partially or fully edentulous maxillary arch. Restoring the arch with implants typically requires maxillary sinus augmentation to facilitate the proper length and number of implants. Zygomatic implants present an alternative treatment option to restore the atrophic maxilla with implants. Zygomatic implants may allow for a shortened treatment time, decreased morbidity, obfuscating the need for grafting, reduction in patient cost and the potential for fewer implants to support a fixed prosthesis. However, zygomatic implant placement may be a more invasive surgical procedure and failure of the implants may result in the need for complex revision procedures when compared to the conventional implant failures.
Specialty/Discipline (Oral Surgery) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Zygomatic implant, sinus augmentation, complications
ID# 3402
Date of submission: 11/22/2019spacer
E-mail janusz@livemail.uthscsa.edu
Author Caitlin Janusz, DDS, MS
Co-author(s) Francis Keeling, B Dent Sci, MSc, MFDS, RCSI
Co-author(s) e-mail keelingf@uthscsa.edu
Faculty mentor/Co-author Ryan Sheridan, DMD, MS
Faculty mentor/Co-author e-mail ryan.r.sheridan.mil@mail.mil
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