Anatomic landmarks that should be respected in the craniofacial skeleton, navigation, transfer of pre-op insertion of implants to the surgical field.
Dear Raul,
I do believe that research in zigomatic implants is headed to propose a "safety zone". In other words, we have to seek a protocol or decision-making based upon horizontal ridge resorption or in sinus shape patterns for placing zigomatic implants anchored in a zone out of the orbital cavity. Definitely, what will determine that "safety implant placement" will be angulation and consequently, the emergence of the neck of the implant. Therefore, I would suggest to focus on implant angulation assisted by a virtual implant software to figure out the angulation range for each location.
Thank you Aberto,
This is a very interesting answer. I also agree in that implant angulation taking care not to entry in the orbital cavity and assuring a good stability in the malar bone should be the main goal. Pre-op virtual planning would be a good choice if some anatomical landmarks are fixed for translation into the surgical field.
In many places CBCT is performed and Skull is produced and surgeon try inserting the implant on that (Mock) patient .This make the surgeon able to reproduce fairly Same desired angulations when operating on the (Real) patients.
Dear Kamish,
Thank you for your commets. For sure it may be of some help the fabricación of a stereolithographic model of the skull or at least of the upare maxilla. However, the procedure will still be dependant on the ability of the Surgeon to reproduce tridimensionally the angulation of zygomatic implant insertion. Stereolithographic surgical guides seem not to be adequate to accurately reproduce the angulation of such longitud implants (up to 50 mm) because of the addition of errors.
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