Application of Real-Time Surgical Navigation for Zygomatic Implant Insertion in Patients With Severely Atrophic Maxilla

Purpose: Computer-aided treatment technology has extended its applications to oral implantology. This report describes the authors' initial clinical experience on the application of a commercially available navigation system (VectorVision) in zygomatic implant (ZI) insertion in the severely atrophic maxilla. Materials and Methods: This was a retrospective longitudinal study. Eligible patients with maxillary edentulism who were treated with ZI placement were enrolled. Treatment planning was performed on the computer based on previously obtained 3-dimensional imaging data. The surgical procedure was carried out under the guidance of a surgical navigation system. The outcome variable was safety and additional variables were ZI survival rate and radiologic bone-to-implant contact (rBIC) area in the zygoma. Statistical analysis was performed with SPSS 16.0 for Windows (SPSS, Inc, Chicago, IL). Results: Fifteen patients (8 men, 7 women; age range, 30 to 69 yr; average age, 43 +/- 3.5 yr) were eligible for the study and were enrolled from May 2015 through September 2016. Of the included patients, each of 4 patients received 1 ZI on each side of the zygomatic bone and 2 to 4 standard implants in the edentulous anterior maxilla; the other 11 received a ZI "quad approach" without standard implant insertion. All ZIs were anchored in the site of the maxillary alveolar process and zygomatic bone, and no critical anatomic structure injuries occurred during insertion and postoperative radiographic examination. All ZIs achieved osseointegration, for an overall survival rate of 100% after early healing. The overall rBIC area of ZIs in the study was 4.1 to 24.7 mm (average, 14.5 +/- 4.6 mm). Conclusion: For the limited clinical cases treated in this study, the procedure for ZI placement was feasible and reliable with the guidance of the surgical navigation system. In addition, the potential risk of complications was minimized and ZIs were placed to make the best possible use of the available bone volume. (C) 2017 American Association of Oral and Maxillofacial Surgeons