Prosthetic Rehabilitation with Zygomatic Implants after Maxillectomy: A Systematic Review

Research Article

J Dent & Oral Disord. 2020; 6(3): 1132.

Prosthetic Rehabilitation with Zygomatic Implants after Maxillectomy: A Systematic Review

Lacroix T1, Jaby P2, Nokovitch L3 and Chaux-Bodard AG1,3*

¹Faculty of dentistry, University Claude Bernard Lyon I,France

²Maxillofacial Surgery Unit, Hôpital de la Croix Rousse,Hospices Civils de Lyon I, France

³Head and Neck Surgical Oncology Unit, Anticancer Center Léon Bérard, Lyon I, France

*Corresponding author: Chaux Anne-Gaëlle, Head and Neck Surgical Oncology Unit, Anticancer Center Léon Bérard, Lyon I, France

Received: April 24, 2020; Accepted: May 12, 2020; Published: May 19, 2020

Abstract

Purpose: Due to their high osseointegration success rate, zygomatic implants (ZIs) have been proposed after maxillectomy for stabilizing either removable dentures or fixed prostheses in case of associated reconstructive surgery. The aim of this study was to collect the different studies and case reports published and to highlight what type of ZI-supported prosthesis can be proposed for maxillectomy patients.

Methods: An electronic search was performed in PubMed via Medline, Scopus, the Cochrane Central Register of Controlled Trials and in gray literature from January 1999 to June 2019. The number of implants placed, the age and sex of the patients, the type of reconstruction (free flap or other), the type of attachments and prostheses, and a history of previous irradiation, were assessed.

Results: Fifteen studies were included, resulting in a total of 35 patients, in whom 86 ZIs were placed. Reconstruction was performed in 8 patients, and radiotherapy was performed in 17 patients. A maxillary obturator prosthesis was placed in 12 patients, a fixed prosthesis in 10 patients and a removable denture in 4 patients.

Conclusion: In nonreconstructed patients, ZI-supported obturator prostheses remain a valuable therapeutic option. For reconstructed patients, fixed or removable dentures can be proposed, depending on: the number and repartition of implants, the oral hygiene of patients, patients’ sleight, and aesthetic considerations. The use of ZIs in maxillectomy patients should be considered a reliable technique in patients for whom immediate reconstruction with a microvascular free flap cannot be performed.

Keywords: Zygomatic implants; Maxillectomy; Prosthesis

Introduction

The use of Zygomatic Implants (ZIs) for the prosthetic rehabilitation of maxillectomy patients has been recently proposed. Due to their high osseointegration success rate [1,2], ZIs have been proposed for use after maxillectomy to overcome bone unavailability for stabilizing either removable dentures (comprising obturator prostheses) or fixed prostheses in cases of associated reconstructive surgery. Nonetheless, only a few studies have reported on the rehabilitation of maxillectomy patients with ZIs, regardless of whether surgical reconstruction was performed. The aim of this study was thus to collect the different studies and case reports published and to highlight what type of ZI-supported prosthesis can be proposed for maxillectomy patients according to the literature.

Methods

An electronic search was performed in PubMed via Medline, Scopus, and the Cochrane Central Register of Controlled Trials, andin gray literature from January 1999 to June 2019. The keywords used were “maxillectomy” or “hemimaxillectomy” or “partial maxillectomy” or “subtotal maxillectomy” or/and “tumor resection” and “maxilla” and “obturator prosthesis” or “maxillary obturator” and “zygoma implants” or “zygomatic implants”. Manual revision of the references of the selected studies was also performed.

The inclusion criteria were as follows: articles in English; case reports, case series, and literature reviews; and full-text availability. The PICOS criteria were as follows: the “population” was maxillectomy patients, with or without surgical closure of the defect; the “intervention” was prosthetic rehabilitation with ZIs; the “comparison” was the type of prosthesis performed; the “outcomes” were both the number of ZIs used and prosthetic rehabilitation; and the “study design” included case reports and case series. Systematic reviews and meta-analyses were also included.

The selection criteria included maxillectomy reports (due to oncologic resection, trauma or other etiology), the presence or not of surgical reconstruction, the use of ZIs for oral rehabilitation and reports of the type of prosthesis and implant-prosthesis connection used. When possible, Pellegrino’s classification was used for the classification of the maxillectomy defect (available in the articles or conversion from the classification used) [3].

Articles were read by 2 independent reviewers and selected following the use of a standardized form, which is presented in Table 1. For each article, the number of implants placed, the age and sex of the patients, the type of reconstruction (free flap or other), the type of attachments and prostheses, whether there was a history of previous irradiation, and the specific features of the cases reported were studied. Additionally, a quality analysis of the selected articles was performed (bias and level of evidence) using the modified ROBIN’s tool [4] for each included study (Table 2).