Aparicio Carlos, Polido Waldemar D, Chow James, Davó Rubén, Al-Nawas Bilal
Zygomatic Unit at Hepler Bone Clinic, ZAGA Center, Roman Macaya, 22-24, 08022, Barcelona, Spain.
International Teaching Scholar, Indiana University School of Dentistry, Indianapolis, USA.
Int J Implant Dent. 2022 Apr 1;8(1):13. doi: 10.1186/s40729-022-00412-8.
There are few zygomatic implants (ZI) designs available. The objective of this non-interventional study was to report the effectiveness of two new site-specific ZI, selected and placed following the zygoma anatomy-guided approach (ZAGA).
Consecutive patients presenting indications for rehabilitation using ZI were treated according to ZAGA Concept recommendations. Implants were immediately loaded following the manufacturer's instructions. Success criteria regarding prosthetic offset, rhino-sinus status, soft tissue condition, and implant stability were additionally used as outcome parameters.
Twenty patients were followed for a period of 12 to 28 months (average 18.8 months). Ten received 2 ZI plus regular anterior implants; One received 3 ZI plus regular implants and nine received 4 ZI. In total, 59 ZI were placed, 34 (58%) Straumann ZAGA-Flat design, and 25 (42%) ZAGA-Round. Forty-nine percent of the sites were classified as ZAGA-4 type and 27% as ZAGA-2. Four patients (20%) presented discontinuities of the sinus-nose floor before surgery and 15 patients (75%) presented previous sinus opacities. All implants bar one reached more than 45 N.cm of insertion torque. No surgical complications were observed. After 1 year, the modified Lund-Mackay score was negative in 17 patients. Seventeen sites in 11 patients exhibited decreased opacity when pre-surgical imaging was compared to 1-year post-surgical CBCT. All implants and prostheses remained stable and in function.
The study concluded 100% implant/prosthesis survival rates and low complication levels. Within the limitations of the sample and observation period, results suggest that even in cases of extremely resorbed maxillae (as per cases in this study), ZAGA-Flat and ZAGA-Round ZI are viable treatment options when restoring atrophic maxillae following the ZAGA protocol.
现有的颧骨种植体（ZI）设计较少。本非介入性研究的目的是报告两种新型特定部位ZI的有效性，这两种种植体是根据颧骨解剖引导方法（ZAGA）选择并植入的。
连续的有使用ZI进行修复指征的患者按照ZAGA概念建议进行治疗。种植体按照制造商的说明立即进行加载。关于修复偏移、鼻窦状况、软组织状况和种植体稳定性的成功标准也用作结果参数。
20名患者随访了12至28个月（平均18.8个月）。10名患者接受了2枚ZI加常规前部种植体；1名患者接受了3枚ZI加常规种植体，9名患者接受了4枚ZI。总共植入了59枚ZI，其中34枚（58%）是士卓曼ZAGA - 扁平设计，25枚（42%）是ZAGA - 圆形。49%的部位被归类为ZAGA - 4型，27%为ZAGA - 2型。4名患者（20%）在手术前存在鼻窦鼻底连续性中断，15名患者（75%）存在既往鼻窦混浊。除一枚种植体外，所有种植体的插入扭矩均超过45 N.cm。未观察到手术并发症。1年后，17名患者的改良Lund - Mackay评分呈阴性。与术前影像学相比，11名患者的17个部位在术后1年的CBCT检查中显示混浊减轻。所有种植体和修复体均保持稳定且功能良好。
该研究得出种植体/修复体生存率为100%且并发症水平较低的结论。在样本和观察期的限制范围内，结果表明，即使在极重度吸收的上颌骨病例中（如本研究中的病例），按照ZAGA方案修复萎缩性上颌骨时，ZAGA - 扁平型和ZAGA - 圆形ZI是可行的治疗选择。
