Landes Constantin Alexander
Maxillofacial and Plastic Facial Surgery, The J.-W. Goethe University Medical Centre Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany.
Clin Oral Implants Res. 2005 Jun;16(3):313-25. doi: 10.1111/j.1600-0501.2005.01096.x.
Successful prosthetic rehabilitation is crucial for quality of life in cases of large maxillary defects when surgical reconstruction is not advisable because of general health or patient refusal. For this purpose, the extended indications for Zygomaticus fixtures in different defect types were evaluated.
Twelve patients received 28 zygoma implants and 23 dental implants (if a segment of alveolar process was available) and were followed-up 14-53 months. Zygoma implants were positioned classically in the maxillary molar region and to reduce leverage, a premolar and a canine position was developed. The quality of life was assessed by a validated questionnaire after complete rehabilitation.
Cumulative zygoma implant survival was 82%. Three losses occurred because of persistent infection and gradual loosening. Lost implants were immediately replaced in adjacent bone. Insufficient implant length within soft tissue reconstructions was prone to chronic infection by pocketing and recurrent overgrowth of granulating tissue. Longer implants were free of soft tissue inhibition, yet prone to overloading and high leverage in cases when no anterior alveolar process and dental implants were present. Zygoma implant success was therefore 71%, including the new premolar and canine Zygomaticus fixture-position. Periotest values increased from 0 to +7 to the fourth year, peri-implant bleeding and plaque index were decreasing from 56% to 0% and 33% to 0%, respectively, and good general quality of life with the priorities on chewing and activity was noted.
Zygoma implants can reliably anchor the midfacial maxillary prostheses and enable a quality of life comparable with autologous maxillary reconstruction. They can be replaced immediately if local infection or loosening should occur. A premolar and canine position reduce leverage when no anterior alveolar process is present. The patient can alternatively be provided with dental implants.
当因患者全身健康状况或患者拒绝而不宜进行手术重建时，成功的修复康复对于上颌骨大面积缺损患者的生活质量至关重要。为此，对不同缺损类型中颧种植体的扩展适应证进行了评估。
12例患者接受了28枚颧种植体和23枚牙种植体（如果有牙槽突段），并进行了14 - 53个月的随访。颧种植体经典地放置在上颌磨牙区，为了减少杠杆作用，还开发了前磨牙和尖牙位置。在完全康复后，通过经过验证的问卷评估生活质量。
颧种植体的累积生存率为82%。3枚种植体因持续感染和逐渐松动而丢失。丢失的种植体立即在相邻骨中更换。软组织重建中种植体长度不足容易因袋形成和肉芽组织反复过度生长而发生慢性感染。较长的种植体没有软组织抑制，但在没有前牙槽突和牙种植体的情况下容易出现过载和高杠杆作用。因此，包括新的前磨牙和尖牙颧种植体位置在内，颧种植体的成功率为71%。Periotest值在第四年从0增加到 +7，种植体周围出血和菌斑指数分别从56%降至0%和33%降至0%，并注意到总体生活质量良好，优先考虑咀嚼和活动。
颧种植体可以可靠地固定上颌中面部假体，并使生活质量与自体上颌重建相当。如果发生局部感染或松动，可以立即更换。在前牙槽突不存在时，前磨牙和尖牙位置可减少杠杆作用。也可以为患者提供牙种植体。
