The Accuracy of Zygomatic Implant Placement Assisted by Dynamic Computer-Aided Surgery: A Systematic Review and Meta-Analysis

Author:

Fan Shengchi12ORCID,Sáenz-Ravello Gustavo3ORCID,Diaz Leonardo4,Wu Yiqun2,Davó Rubén5,Wang Feng2,Magic Marko6ORCID,Al-Nawas Bilal1ORCID,Kämmerer Peer W.1ORCID

Affiliation:

1. Department of Oral and Maxillofacial Surgery, Plastic Operations, University Medical Center Mainz, 55131 Mainz, Germany

2. Second Dental Clinic, Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University, School of Medicine, National Clinical Research Center for Oral Disease, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200011, China

3. Center for Epidemiology and Surveillance of Oral Diseases (CESOD), Faculty of Dentistry, Universidad de Chile, Santiago 8380420, Chile

4. Postgraduate School, Faculty of Dentistry, Universidad de Chile, Santiago 8380420, Chile

5. Department of Implantology and Maxillofacial Surgery, Vithas Davó Instituto Dental, 03016 Alicante, Spain

6. School of Dental Medicine, University of Belgrade, 11000 Belgrade, Serbia

Abstract

Purpose: The present systematic review aimed to investigate the accuracy of zygomatic implant (ZI) placement using dynamic computer-aided surgery (d-CAIS), static computer-aided surgery (s-CAIS), and a free-hand approach in patients with severe atrophic edentulous maxilla and/or deficient maxilla. Methods: Electronic and manual literature searches until May 2023 were performed in the PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases. Clinical trials and cadaver studies were selected. The primary outcome was planned/placed deviation. Secondary outcomes were to evaluate the survival of ZI and surgical complications. Random-effects meta-analyses were conducted and meta-regression was utilized to compare fiducial registration amounts for d-CAIS and the different designs of s-CAIS. Results: A total of 14 studies with 511 ZIs were included (Nobel Biocare: 274, Southern Implant: 42, SIN Implant: 16, non-mentioned: 179). The pooled mean ZI deviations from the d-CAIS group were 1.81 mm (95% CI: 1.34–2.29) at the entry point and 2.95 mm (95% CI: 1.66–4.24) at the apex point, and angular deviations were 3.49 degrees (95% CI: 2.04–4.93). The pooled mean ZI deviations from the s-CAIS group were 1.19 mm (95% CI: 0.83–1.54) at the entry point and 1.80 mm (95% CI: 1.10–2.50) at the apex point, and angular deviations were 2.15 degrees (95% CI: 1.43–2.88). The pooled mean ZI deviations from the free-hand group were 2.04 mm (95% CI: 1.69–2.39) at the entry point and 3.23 mm (95% CI: 2.34–4.12) at the apex point, and angular deviations were 4.92 degrees (95% CI: 3.86–5.98). There was strong evidence of differences in the average entry, apex, and angular deviation between the navigation, surgical guide, and free-hand groups (p < 0.01). A significant inverse correlation was observed between the number of fiducial screws and the planned/placed deviation regarding entry, apex, and angular measurements. Conclusion: Using d-CAIS and modified s-CAIS for ZI surgery has shown clinically acceptable outcomes regarding average entry, apex, and angular deviations. The maximal deviation values were predominantly observed in the conventional s-CAIS. Surgeons should be mindful of potential deviations and complications regardless of the decision making in different guide approaches.

Funder

ITI research

FGD

Publisher

MDPI AG

Subject

General Medicine

Reference51 articles.

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4. Quad Zygoma: Technique and Realities;David;Oral. Maxillofac. Surg. Clin. N. Am.,2019

5. Immediate function in the atrophic maxilla using zygoma implants: A pre-liminary study;Davo;J. Prosthet. Dent.,2007

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