ZYGOMATIC IMPLANT COMPLICATED WITH RECURRENT ORO-ANTRAL COMMUNICATION
Figure 9. 6 months postoperative, frontal view
disappeared. Initially a further surgical thinning
of the flap was planned, but due to the favorable
development, this was abandoned. The flap got
thinner with tight fitting skin around the implant.
The patient is satisfied with the result (Fig.8, Fig. 9,
Fig. 10) and is able to keep the region clean. He was
discharged from surgical follow-up and referred to
his dentist for the prosthetic and implant followup.
Discussion
In recent systematic reviews of survival and
complications of zygomatic implants, both
Chrcanovic and Goiato e.a. find a cumulative
survival rate of 96,7% after 36 months.3,8
Postoperative complications include maxillary
sinusitis, soft tissue infections, paresthesia and
oro-nasal fistulas.3 Maxillary sinusitis is the most
common complication, ranging from 1.5% to
18.42%.9 Maxillary sinusitis, both acute and chronic,
are the main reasons of failure of zygomatic
implants.10 Removal of the zygomatic implants from
the infected area is often performed, if antibiotics
cannot resolve the infection, arguing that the
implants act as a foreign body and maintain the
infection. Other reasons why zygomatic implants
can cause maxillary sinusitis are given by Davó11:
the invasiveness of the surgery to the sinus, the
persistence of an oro-nasal communication,
mainly in absence or loss of the thin palatal bony
wall. Resorption of the thin palatal boneplate that
covers the zygomatic implant leads to oro-antral
fistula followed by implant loss.12
Bedrossian reported on three patients with
zygomatic implants and persistent sinus infections
refractory to oral antibiotic treatments, in which
a Functional Endoscopic Sinus Surgery (FESS)
procedure completely resolved the sinus infections
without removal of the zygomatic implants.13 De
Moraes reported on the successful use of the
buccal fat pad technique to resolve an oro-antral
communication;14 this procedure however was
reported concomitant with the placement of
zygomatic implants and did not resolve an oroantral communication secondary to an infectious
process. Peñarrocha-Oltra (2015) reported on the
successful use of the buccal fat pad to close an
oro-antral communication with an accompanying
maxillary sinusitis in one patient. Their procedure
involved the removal of the zygomatic implant.15
Figure 10. 6 months postoperative, facial frontal view
The reported follow-up period was 6 months.
Stella and Warner advocated the sinus slot
technique in 20007 as an alternative to the original
technique introduced by Bränemark in 1998.16
In both techniques the sinus is penetrated.
Bränemark explicitly states : “The sinus mucosa
was then reflected and no special effort was
made to keep it intact” (Bränemark e.a., 2004).16
The third alternative is the exteriorized technique
avoiding passage through the maxillary sinus.17,18
Chrcanovic e.a. (2013) compared the three surgical
techniques and concluded that neither claimed to
cause sinusitis.19
Adverse complications as for example an oroantral communication secondary to surgical
treatments with zygomatic implants however do
occur. Visscher e.a., in a review of the literature
concluded that surgical closure of oro-antral
communications by a buccal or palatal flap
therefore remain the treatment of choice.20 Even in
the absence of dental implants, the recurrence rate
after surgical closure of oro-antral communications
is high at about 10%.21 The risk of recurrence is 15
times higher with maxillary sinusitis at follow-up.
After two failed surgical attempts to