NobelZygoma implants and compromised patients

Restoration and Implantology
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Nobel Biocare’s Jonathan Fleet discusses NobelZygoma dental implants and the medically compromised patient

When dentists decide what treatment to offer, or if they need to refer a patient to a specialist, they must take into account factors that can contraindicate or challenge the treatment. This is particularly important in relation to medically compromised patients who have special medical and/or dental conditions that can affect their oral health and dental treatment.

Compromised patients and the use of dental implants
Patients can be medically compromised for many reasons, such as resorption of the bone due to increasing age, the use of particular medications, the consequences of cancer or treatment for cancer, and systemic diseases (e.g. diabetes). It is particularly important to take these reasons into account when considering the use of dental implants. For example, oral bisphosphonates can lead to osteonecrosis of the jaw and ultimately to a greater risk of the failure of dental implants [1].

For patients who have suffered from cancers of the head and neck, or who have had ablative surgery, there are several issues surrounding the use of dental implants. Following their cancer and surgery, they may have a loss of teeth or loss of the bone that supports the teeth [2]. They may also have lost significant amounts of hard and soft tissues, leading to such defects as ridge deformities and major jaw resections and reconstructions [3]. The cancer treatment can also cause impaired healing and it can permanently destroy the blood supply to the jaws leading to osteonecrosis [4].

Zygomatic implants for medically compromised patients
These patients have typically been offered restorations (e.g. fixed bridge prostheses, obturators). However, zygomatic implants are now more popular when the residual alveolus is limited for the placement of conventional implants [5]. Zygomatic implants can be particularly beneficial as they overcome the problem of lack of bone or poor-quality bone by anchoring in the zygomatic bone [6], circumventing the need for bone-grafts.

The use of zygomatic implants by highly experienced clinicians has increased. A survey of oral and maxillofacial surgeons found that 1% “always” used dental implants following maxillectomy and 92% “sometimes” did, while 29% used zygomatic implants [7]. Zygomatic implants are also effective for treating patients with head and neck cancer. For example, one study demonstrated a 100% zygomatic implant success rate in 20 patients who had undergone maxillary resection following head and neck cancer [8].

The NobelZygoma implant is ideal for specialists to use when treating patients who have undergone maxillectomy or have severe maxillary resorption, because it avoids complex bone-grafting procedures. The NobelZygoma implant system is suitable for an Immediate Function protocol and it provides a broad choice of temporary prosthetic options. This system dramatically shortens time-to-teeth for increased patient satisfaction. It also has excellent survival rates; one study of 22 zygomatic patients demonstrated an average implant cumulative survival rate of 95.12% after 10 years of loading [9].

Treating patients who have moderate to severe bone loss in the jaw can be particularly problematic. Fortunately, the innovation, development and success of zygomatic implants means that highly experienced clinicians have a suitable and reliable solution.

Author


Jonathan Fleet is product manager with Nobel Biocare UK & Ireland. For more information, contact Nobel Biocare on 0208 756 3300, or visit www.nobelbiocare.com 

References
1. Alani A, Djemal S, Bishop K, Renton T. Guidelines for selecting appropriate patients to receive treatment with dental implants: priorities for the NHS. London: Royal College of Surgeons; 2012.
2. Salvatori P, Mincione A, Rizzi L, Costantini F, Bianchi A, Grecchi E, Garagiola U, Grecchi F. Maxillary resection for cancer, zygomatic implants insertion, and palatal repair as single-stage procedure: report of three cases. Maxillofac Plast Reconstr Surg 2017;39:13.
3. Alani A, Djemal S, Bishop K, Renton T. Guidelines for selecting appropriate patients to receive treatment with dental implants: priorities for the NHS. London: Royal College of Surgeons; 2012.
4. Little J, Falace D, Miller C, Rhodus N. Dental management of the medically compromised patient. St Louis, Missouri: Elsevier; 2013.
5. Alani A, Djemal S, Bishop K, Renton T. Guidelines for selecting appropriate patients to receive treatment with dental implants: priorities for the NHS. London: Royal College of Surgeons; 2012.
6. Salvatori P, Mincione A, Rizzi L, Costantini F, Bianchi A, Grecchi E, Garagiola U, Grecchi F. Maxillary resection for cancer, zygomatic implants insertion, and palatal repair as single-stage procedure: report of three cases. Maxillofac Plast Reconstr Surg 2017;39:13.
7. Alani A, Owens J, Dewan K, Summerwill A. A national survey of oral and maxillofacial surgeons’ attitudes towards the treatment and dental rehabilitation of oral cancer patients. BDJ 2009;207:e21.
8. Boyes-Varley J, Howes D, Davidge-Pitts K, McAlpine J. A protocol for maxillary reconstruction following oncology resection using zygomatic implants. Int J Prosthodont 2007;20:521-31.
9. Aparicio C, Manresa C, Francisco K, Ouazzani W, Claros P, Potau JM, Aparicio A. The long-term use of zygomatic implants: a 10-year clinical and radiographic report. Clin Implant Dent Relat Res 2014;16:447-59.