Diagnóstico y tratamiento clínico
This book is an eminently clinical guide that has been created from the knowledge and experience of years in the authors' profession and a highly qualified multidisciplinary team.
Atlas of zygomatic implants, offers the reader a protocol necessary to know the anatomy, diagnosis, classification, treatment plans, anesthetic and surgical techniques, such as regenerations for the placement of zygomatic implants.
Current digital techniques in oral surgery and implantology have placed us in a new technological scenario, and this has also reached zygomatic implants. In a large maxillary atrophy we can place zygomatic implants and make immediate loading, something that, in extreme atrophies, without zygomatic implants is practically unthinkable.
It is true that zygomatic implants are only indicated in a small number of patients, those with extreme maxillary atrophies, among all those treated with dental implants. Zygomatics were introduced to the scientific world by Brånemark in 1998, and since then changes have been made, both in the implants and in the procedure, which have led to a considerable decrease in their complications, in the short and long term. Two important figures in implantology collaborated with him in Spain: Carlos Aparicio Magallón, who has contributed greatly to the scientific development of zygomatic implants with numerous bibliographical contributions and a book, and Joan Pi Urgell, who for many years worked and learned directly with Brånemark . They taught us, formed a school in Spain, and got many other professionals in our country to be grateful for their contributions to Spanish implantology.
It is important that readers who approach this topic know that it is a difficult technique, not without serious complications, and that it should always be performed by an experienced surgeon. It is a procedure reserved for professionals with extensive surgical experience and not carrying out the proper training, with a teacher to guide you, can pose serious problems for the dentist and the patient. Therefore, the first requirement to use zygomatic implants is humility: we must recognize our limitations and train properly before launching into complex treatment like this.
To finish we want to say to those who read this book that we have written it with the idea that it helps professionals to better understand this technique and to know when they can apply it to their patients. Zygomatic implant surgery is a delicate procedure and not without complications, which should only be performed when one has learned from the hand of a teacher and as long as one has sufficient training and surgical experience to do so.
Table of Contents:
Chapter 1: History of zygomatic implants
Reginaldo Migliorança • Javier Aizcorbe-Vicente • André Irschlinger • David Peñarrocha-Oltra • Juan Alberto Fernández-Ruíz • Miguel Peñarrocha-Diago
Chapter 2: Anatomy applied to zygomatic implants
Juan Guarinos-Carbó • María Díaz-Sánchez • Pedro Serrano-Carbó • Miguel Puche-Torres • Francisco Martínez- Soriano • Miguel Peñarrocha-Diago.
SummaryMalar boneBone atrophyInfraorbital regionNeurovascular and muscular elementsPreoperative radiological studyconclusionMessage to rememberBibliographyChapter 3: Radiographic examination and guided surgery in zygomatic implants
María Peñarrocha-Diago • Juan Carlos Bernabeu-Mira • Xulio Pouso-Rey • Juan Alberto Fernández-Ruíz • David Peñarrocha-Oltra
SummaryIntroductionRadiological anatomy of the zygomatic boneTypes of radiographic methodsPreoperative radiological studyPostoperative radiological studyPreoperative and postoperative radiological study procedureGuided surgery on zygomatic implantsMessage to rememberBibliographyChapter 4: Diagnosis, Classifications, and Treatment Plan: A Prosthetic and Surgical Perspective
Miguel Peñarrocha-Diago • Javier Aizcorbe-Vicente • Juan Alberto Fernández-Ruíz • David Peñarrocha-Oltra.
SummaryIntroductionAnatomical flying buttresses Frontomaxilar or canine flying buttress Fronto-zygomatic flying buttress Pterygomaxillary flying buttressZygomatic implants vs. Bone grafts and conventional implantsProsthetic diagnosis of the maxillary edentulousTypes of prosthesis in atrophic upper jawExtraoral examinationOcclusion vertical dimension (DVO)Lip supportLip length, smile line and transition linePosition of the incisal edge of the central incisorIntraoral examinationOcclusion and antagonistic dentitionResult of the aesthetic and functional analysis of the patient's prosthesisSurgical diagnosis of the maxillary toothlessPatient's medical conditionDegree of atrophy of the upper jawImplant distributionSurgical determination of the prosthetic spaceObtaining primary stabilityMessage to rememberBibliographyChapter 5: Conscious sedation in complex dental surgery
Maite Bovaira-Forner • Paula Bovaira-Forner
SummaryIntroductionPreoperative evaluationMonitoring: material and equipmentDrugsOral sedationIV sedationInhalation sedationRecovery and dischargeMessage to rememberBibliography
Chapter 6: Surgical technique for the placement of zygomatic implantsJuan Alberto Fernández-Ruíz • Miguel Peñarrocha-Diago • David Soto-Peñaloza • David Peñarrocha-Oltra
SummaryIntroductionAnesthetic technique for the placement of zygomatic implantsLocal anesthesiaEndovenous sedation accompanied by local anesthesiaGeneral anesthesiaWashing, carving and preparing the operative fieldPre-surgical measuresPreparation of the operative fieldMaterial needed for the surgical approach to the zygomatic processGeneral use materialIncision materialInstruments for detachmentRotary materialOsteoctomy suppliesSurgical technique - incisions, detachment, bed preparation, implant selectionIncisionExposure of the operative fieldPreparation of the implant bedClassic approach or intrasinusal techniqueSinus slot techniqueEstablishment of benchmarksImplant placement sequenceSelection of the type of implant to useClassification according to the angulation of the implant headClassification according to the type of surface treatmentZygomatic implant length and insertionMultiunit abutment placementFlap closureRevision regimeImmediate postoperativePostoperative mediateLate postoperativeDrug guidelinesPatient recoveryInformed consentInformed consent document for zygomatic implantsMessage to rememberBibliographyChapter 7: Bone and soft tissue regeneration in zygomatic implants
Miguel Peñarrocha-Diago • Juan Carlos Bernabeu-Mira • Juan Alberto Fernández-Ruíz • David Peñarrocha-Oltra
IntroductionBone regeneration around zygomatic implantsPalatal bone regenerationVestibular bone regenerationPalatal and vestibular bone regenerationSoft tissue regeneration around zygomatic implantsPalatal rotation pedicled connective tissue scarf or graft techniqueScarf technique along with Bichat ball replacementConnective tissue graftBone and soft tissue regeneration around zygomatic implantsMessage to rememberBibliographyChapter 8: Zygomatic implants and jaw reconstruction
Federico Hernández-Alfaro • Adaia Valls Ontañón
SummaryIntroductionIndicationsStep by step procedureSurgical planningSurgical actProsthetic loadConclusionsMessage to rememberBibliography
Chapter 9: Biomechanics of Angled and Zygomatic Implants
David Soto-Peñaloza • Juan Alberto Fernández-Ruíz • Miguel Peñarrocha-Diago • Blanca Serra Pastor • David Peñarrocha-Oltra
SummaryIntroductionBiomechanics of forces in the middle facial skeletonTransmission of forces from the tooth to the boneTransmission of forces from the implant to the boneBiomechanics of implant-supported restorations with zygomatic implantsBiomechanics of angled implantsBiomechanics of zygomatic implantsMessage to rememberBibliographyChapter 10: Immediate loading on zygomatic implants
Miguel Peñarrocha-Diago • Javier Aizcorbe-Vicente • Blanca Serra Pastor • Juan Alberto Fernández-Ruíz • David Peñarrocha-Oltra
SummaryIntroductionImmediate loading conceptObjectives, requirements and considerations of immediate loading on zygomatic implantsSurgical Considerations: Primary StabilityProsthetic considerationsClinical proceduresDirect techniqueDirect-indirect techniqueIndirect techniqueconclusionMessage to rememberBibliographyChapter 11: Complications in zygomatic implants
Miguel Peñarrocha-Diago • María Díaz-Sánchez • Juan Alberto Fernández-Ruíz • Hilario Pellicer-Chover • Miguel Armengot-Carceller • David Peñarrocha Oltra
SummaryEarly complicationsLip lacerationOrbital injury or periorbital hematomaInfraorbital nerve injuryNasal bleedingRupture of the maxillary sinus wallPain and edemaAcute maxillary odontogenic sinusitis (early onset)Immediate failure of the zygomatic implantIntracranial penetration of the zygomatic implantPrevention of early complicationsLate complicationsMucositis and peri-implantitisVestibular dehiscence of the zygomatic implantOrosinusal communicationChronic maxillary sinusitis, late onsetImpaired speech and functionalityFailure of the zygomatic implantSurvival in zygomatic implantsConclusionsMessage to rememberChapter 12: Clinical cases of zygomatic implants
Miguel Peñarrocha-Diago • María Díaz-Sánchez • David Peñarrocha-Oltra • Juan Alberto Fernández-Ruíz
Zygomatic implants with 15 years of evolution (Cawood and Howell grade V atrophy)Zygomatic implants with 14 years of evolution evolution (Cawood and Howell grade VI atrophy)Zygomatic implants with palatal bone regeneration, without immediate loadingZygomatic implants with vestibular and palatal bone regeneration, without immediate loadingFour zygomatic implants without bone regeneration, with soft tissue grafting and without immediate loadingZygomatic implants with bone regeneration, soft tissue grafting and immediate loadingZygomatic implants with bone regeneration and immediate loading