Implants in the pterygoid region: a systematic review of the literature

This systematic review aimed to identify clinical studies on the short-term and long-term survival of implants placed in the pterygoid region. A structured literature search was conducted using PubMed, Scopus and Cochrane databases. Relevant studies were selected according to predetermined inclusion and exclusion criteria. Data from the final included studies could only be extracted for calculating interval survival rate (ISR) and cumulative survival rate (CSR) of implants for different time intervals. The initial database search yielded 693 titles. After filtering, 32 abstracts were selected culminating in 17 full text articles. Three additional articles were added through a hand search to obtain a total of 20 articles. Application of exclusion criteria led to elimination of 11 articles. Pooled data from the final 9 articles showed a first year ISR of 92%. The CSR over a 10 year period, largely due to data from one study was 91%. The minimum follow-up period reported in various studies was less than a year. There is insufficient data about failures that occurred beyond the first year interval, making it difficult to draw conclusions about long-term survival of these implants. More studies with longer follow-up periods involving adequate number of pterygoid implants are needed.     

Clinical outcome of 103 consecutive zygomatic implants: a 6-48 months follow-up study

The purpose of this study was to evaluate retrospectively, after a period of 6-48 months follow-up of prosthetic loading, the survival rate of 103 zygomatic implants inserted in 55 totally edentulous severely resorbed upper jaws. Fifty-five consecutive patients, 41 females and 14 males, with severe maxillary bone resorption were rehabilitated by means of a fixed prosthesis supported by either 1 or 2 zygomatic implants, and 2-6 maxillary implants. This retrospective study calculated the success and survival rates at both the prosthetic and implant levels. Out of 55 prostheses, 52 were screwed on top of the implants, while 3 were modified due to loss of standard additional implants and transformed in semimovable prosthesis. Although osseointegration in the zygomatic region is difficult to evaluate, no zygomatic implant was considered fibrously encapsulated and they are still in function. This study confirms that zygoma bone can offer a predictable anchorage and support function for a fixed prosthesis in severely resorbed maxillae.     

Survival and complications of zygomatic implants: a systematic review

Purpose

This systematic review attempted to answer the focused questions: “What is the survival rate of zygomatic implants (ZIs)?” and “What are the most common complications related to surgery of zygomatic implants?”

Methods

An electronic search without date or language restrictions was undertaken in PubMed in March 2012. Titles and abstracts from these results (n?=?123) were read for identifying studies that meet the eligibility criteria. Eligibility criteria included studies reporting clinical series of zygomatic implants (ZIs). Because of the scarcity of articles with high-level grades of evidence, all articles, including studies with few case reports, were considered for inclusion. All reference lists of the selected and review studies were hand-searched for additional papers that might meet the eligibility criteria. Simple case report articles were not included. Review articles without original data were excluded. Quantitative data extracted from the included studies that provided data for the period of failure of ZIs were used for the calculation of interval survival rate during each follow-up period and cumulative survival rate (CSR) over a 12-year period.

Results

Thirty-seven studies were identified without repetition and five more studies were included by hand-searching, giving a total of 42; 12 evaluated the use of ZI applied with immediate function protocols and 3 for rehabilitating patients after maxillary resections for tumor ablations. These latter three studies showed smaller ZI success. Postoperative complications reported were as follows: 70 cases of sinusitis, 48 of soft tissue infection, 15 of paresthesia, and 17 cases of oroantral fistulas. However, this number may be underestimated, since most of the studies did not mention the presence or absence of these complications. Most ZI failures were detected at the abutment connection phase (6 months after the surgery of implant placement) or before. The CSR over a 12-year period was 96.7 %.

Conclusions

Despite the high survival rate observed, there is an impending need for conducting randomized controlled clinical trials to test the efficacy of these implants in comparison with the other techniques to treat the atrophic maxilla. Thus, the findings reported in the review must be interpreted with considerable caution. Moreover, more studies with longer follow-up periods involving adequate number of ZIs are needed. This will help to obtain a better understanding of the survival of ZIs in a long term. It is suggested that multicenter, randomized controlled clinical trials and longer clinical studies should be implemented in this area, before recommending routine use of ZIs for patients could be given. The placement of zygomatic implants requires very experienced surgeons because it is not risk free since delicate anatomic structures such as the orbita and brain may be involved.     

Short implants (≤6 mm) as an alternative treatment option to maxillary sinus lift

The aim of this systematic review was to evaluate survival rate of short dental implants placed in the posterior area of the maxilla. The electronic literature search of studies published between January 1, 2010 and February 29, 2020 was performed using specific word combinations. The outcome was to meta-analyse the implant survival rate (ISR). The search generated 238 potential studies. After screening procedures, only nine randomized controlled trials fulfilled the inclusion criteria and were selected for qualitative and quantitative analysis. ISR of short implants ranged from 91.9% to 100%, while standard-length implants ISR ranged from 82.9% to 100% with a follow-up from 1 to 5 years in function. The risk ratio difference was 1.24 (95% confidence interval: 0.63–2.45, P = 0.52) for short dental implants failure when compared with standard dental implants, and was not statistically significant. Based on the evidence of the included studies, short implants (≤6 mm) reported high survival rates over short to medium follow-up in posterior maxilla, but the long-term success is as yet not demonstrated.     

Systematic review of survival rates for immediately loaded dental implants

The primary goal of this paper was to determine the survival rate of immediately loaded (IL) dental implants based on a systematic review of the literature. Secondary goals were to determine the influence of several factors on the implant survival rate, such as the type of reconstruction, implant location, and implant surface characteristics. An electronic search of databases was performed, in addition to a hand search of the most relevant journals. All relevant articles were independently screened according to specific inclusion criteria. The selected papers were reviewed. The literature search yielded 270 applicable articles up to December 2005. Of these, 71 met the inclusion criteria for qualitative data analysis. Eight articles were randomized controlled trials. The overall implant survival rate for the included studies was 96.39%. The database included 10,491 IL implants placed in 2,977 patients, with a maximum follow-up of 13 years. IL is well documented and predictable for the edentulous mandible (overdentures and full-arch prostheses) and for maxillary single crowns. Fewer data were found for maxillary full-arch reconstructions, fixed partial prostheses, and mandibular single crowns. For the latter two types of reconstructions, implants placed in anterior sites generally displayed a higher survival rate versus those placed in posterior sites. Rough surfaces displayed a higher survival rate than machined surfaces in all types of reconstructions. Most failures (97.1%) occurred within the first 12 months of loading. This review showed that it is possible to apply IL with excellent survival rates. Implant micromorphology and careful patient selection may affect treatment outcomes.     

Systematic review of survival rates for implants placed in the grafted maxillary sinus

Based on a systematic review of the literature from 1986 to 2002, this study sought to determine the survival rate of root-form dental implants placed in the grafted maxillary sinus. Secondary goals were to determine the effects of graft material, implant surface characteristics, and simultaneous versus delayed placement on survival rate. A search of the main electronic databases was performed in addition to a hand search of the most relevant journals. All relevant articles were screened according to specific inclusion criteria. Selected papers were reviewed for data extraction. The search yielded 252 articles applicable to sinus grafts associated with implant treatment. Of these, 39 met the inclusion criteria for qualitative data analysis. Only 3 of the articles were randomized controlled trials. The overall implant survival rate for the 39 included studies was 91.49%. The database included 6,913 implants placed in 2,046 subjects with loaded follow-up time ranging from 12 to 75 months. Implant survival was 87.70% with grafts of 100% autogenous bone, 94.88% when combining autogenous bone with various bone substitutes, and 95.98% with bone grafts consisting of bone substitutes alone. The survival rate for implants having smooth and rough surfaces was 85.64% and 95.98%, respectively. Simultaneous and delayed procedures displayed similar survival rates of 92.17% and 92.93%, respectively. When implants are placed in grafted maxillary sinuses, the performance of rough implants is superior to that of smooth implants. Bone-substitute materials are as effective as autogenous bone when used alone or in combination with autogenous bone. Studies using a split-mouth design with one variable are needed to further validate the findings.     

Tilted Implants for the Rehabilitation of Edentulous Jaws: A Systematic Review

Purpose: The aim of this review was to evaluate the survival rate of upright and tilted implants supporting fixed prosthetic reconstructions for the immediate rehabilitation of partially and fully edentulous jaws, after at least 1 year of function. Materials and Methods: An electronic search of databases plus a hand search on the most relevant journals up to December 2009 was performed. The articles were selected using specific inclusion criteria, independent of the study design. Results: The literature search yielded 347 articles. A first screening based on the title and abstract identified 25 eligible studies. After full‐text review of these studies, 10 articles were selected for analysis. Seven were prospective single‐cohort studies and three had a retrospective design. A total of 462 patients have been rehabilitated with 470 immediately loaded prostheses (257 in the maxilla, 213 in the mandible), supported by a total of 1,992 implants (1,026 upright and 966 tilted). Twenty‐five implants (1.25%) failed in 20 patients within the first year. All failures except one occurred in the maxilla. No significant difference in failure rate was found between tilted and upright implants, nor between maxillary and mandibular implants. No prosthesis failure was reported. Limited peri‐implant bone loss was reported with no difference between upright and tilted implants. Full patients' satisfaction for function, phonetics, and esthetics was reported in three studies, based on questionnaires. Conclusions: The use of tilted implants to support immediately loaded fixed prostheses for the rehabilitation of edentulous jaws can be considered a predictable technique, with an excellent prognosis in the short‐medium term. However, randomized long‐term trials are needed to determine the efficacy of this surgical approach.     

Critical soft tissue parameters of the zygomatic implant

AIM: Zygomatic implants have been introduced for the rehabilitation of patients with severe bone defects of the maxilla. The soft tissue aspects of the palatal emergence situation have not been described yet. The aim of this study was to evaluate the incidence and clinical impact of possible periimplant alterations of zygomatic implants. MATERIALS AND METHODS: From 1998 to 2001 all patients with zygomatic implants were included into this study (24 patients, 37 zygomatic implants). One implant was lost in the loading phase giving a survival rate of 97%. Fourteen patients with 20 zygomatic implants fulfilled the inclusion criteria and were all available for the recall examination. Thirteen zygomatic implants were inserted in cases of severe maxillary atrophy, seven in cases of tumour-resection of the maxilla. Clinical examination and microbial analysis using a DNA probe was performed. The implants had a mean time in situ of 598 days (min: 326, max: 914). RESULTS: Colonisation with periodontal pathogens was found at four of the 20 implants. A positive microbiologic result of the periimplant pocket and the maximum pocket probing depth were not statistically related. Nine of the 20 implants showed bleeding on probing, four of these had positive microbiologic results. At sites without bleeding on probing only negative microbiologic samples were found (p=0.026). The mean palatal and mesial probing depth was 1 mm deeper than at the vestibular and distal aspect. Thus at nine out of the 20 implants both, bleeding on probing and pocket probing depth >/=5 mm indicated soft tissue problems resulting in a success rate of only 55%. The patient's history (tumor versus atrophy) or smoking habits seemed not to have influence the situation. CONCLUSION: These soft tissue problems should be taken into account if zygomatic implants are considered as an alternative therapy option in the maxilla.     

Immediate occlusal loading of extrasinus zygomatic implants: A prospective cohort study with a follow-up period of 8 years

The aim of this study was to evaluate the long-term success rate of immediate occlusal loading of extrasinus zygomatic implants after an 8-year follow-up. From 62 patients who needed implant treatment in 2003, 25 patients who presented with maxillary atrophy met the inclusion criteria and agreed to participate in the study. All patients received fixed dentures under immediate occlusal loading supported by extrasinus zygomatic implants associated with anterior standard implants. No bone grafting procedures were performed. During the 8-year follow-up period, 21 patients underwent clinical evaluation and radiographic examinations every 6 months. This study conforms to the STROBE guidelines regarding prospective cohort studies. 40 extrasinus zygomatic and 74 anterior standard implants were evaluated. All patients were clinically free of signs and symptoms of sinus disturbance at all follow-up appointments. After 8 years, the success rates of extrasinus zygomatic implants, standard anterior implants and definitive prostheses were 97.5%, 95.9% and 95.2%, respectively. Within the limits of this study, immediate occlusal loading of extrasinus zygomatic implants presents a predictable treatment option for the atrophic maxilla.     

A systematic review of the success of sinus floor elevation and survival of implants inserted in combination with sinus floor elevation

Objectives: The objectives of this systematic review were to assess the survival rate of grafts and implants placed with sinus floor elevation.
Material and Methods: An electronic search was conducted to identify studies on sinus floor elevation, with a mean follow-up time of at least 1 year after functional loading.
Results: The search provided 839 titles. Full-text analysis was performed for 175 articles resulting in 48 studies that met the inclusion criteria, reporting on 12,020 implants. Meta-analysis indicated an estimated annual failure rate of 3.48% [95% confidence interval (CI): 2.48%–4.88%] translating into a 3-year implant survival of 90.1% (95% CI: 86.4%–92.8%). However, when failure rates was analyzed on the subject level, the estimated annual failure was 6.04% (95% CI: 3.87%–9.43%) translating into 16.6% (95% CI: 10.9%–24.6%) of the subjects experiencing implant loss over 3 years.
Conclusion: The insertion of dental implants in combination with maxillary sinus floor elevation is a predictable treatment method showing high implant survival rates and low incidences of surgical complications.
The best results (98.3% implant survival after 3 years) were obtained using rough surface implants with membrane coverage of the lateral window.     

Prognosis of implants and fixed restorations after lateral sinus elevation: a literature review

Aim of this review was to investigate the prognosis of implants inserted in augmented sinuses and fixed restorations supported by these implants. Special attention was given to the impact of grafting material, time of implant placement, residual bone height and type of fixed restoration. An electronic search in PubMed, the German database medpilot and the Cochrane Library was executed followed by supplementary manual search in relevant journals. The search was limited to human studies published up to November 2010. Only publications in English and German, in peer-reviewed journals, were considered. After the initial search and application of selection criteria on titles and abstracts, a full-text analysis of 67 articles was performed, out of which six prospective and three retrospective studies were finally included in the review. The heterogeneous properties of the identified articles did not allow systematic analysis of the data. Success rates of implants were between 96·3% and 100%, survival rates were between 75% and 100%, and survival rates of single crowns, splinted crowns and fixed partial dentures ranged between 96·4% and 100% after a follow-up of 12-101 months. Within the limits of this review, the prognosis of implants and fixed restorations seemed not to be influenced by the type of restorations, graft material, residual bone height and time of implant placement. However, conclusions of this review are based on studies with low level of evidence; therefore, careful interpretation is required. Multicentre randomised controlled clinical trials with sufficient statistical power concentrating on few factors are needed to reach sound conclusions.     

A systematic review of implant-supported maxillary overdentures after a mean observation period of at least 1 year

Aim: The aim of the present systematic review of implant-supported maxillary overdentures was to assess the survival of implants, survival of maxillary overdentures and the condition of surrounding hard and soft tissues after a mean observation period of at least 1 year.
Material and methods: MEDLINE (1950–August 2009), EMBASE (1966–August 2009) and CENTRAL (1800–August 2009) were searched to identify eligible studies. Two reviewers independently assessed the articles.
Results: Out of 147 primarily selected articles, 31 studies fulfilled the inclusion criteria. A meta-analysis showed an implant survival rate (SR) of 98.2% per year in case of six implants and a bar anchorage. In case of four implants and a bar anchorage, the implant SR was 96.3% per person. In case of four implants and a ball anchorage, the implant SR was 95.2% per year.
Conclusion: In all three treatment options, the SR of the implants is more than 95%. The studies included reveal that a maxillary overdenture supported by six dental implants, which are connected with a bar, is the most successful treatment regarding survival of both the implants and overdenture. Second in line is the treatment option with four implants and a bar. The treatment option with four or less implants and a ball attachment system is the least successful.     

Success of immediate loading implants compared to conventionally‐loaded implants: a literature review

The purpose of this systematic literature review was to compare the clinical performance between conventionally‐ (delayed) and immediately‐loaded implants. A literature search of studies published between 1995 and 2012 was performed using several electronic databases and the following key words: “immediate loading”, “dental implants”, “immediate function”, “early loading”, “oral implants”, “immediate restoration”, and “systematic review” was performed. The electronic search was supplemented with hand‐searching in dental journals and cross‐referencing within the selected articles. Studies were considered for inclusion if they analyzed the success of the immediate loading protocol for implants, with emphasis given to randomized, controlled clinical trials. Among the clinical studies extracted from the literature, 120 studies met the inclusion criteria and were included in this systematic review. These studies included trials that involved yielded consistent results of success rates of immediately‐loaded implants comparable to those known from conventionally‐loaded implants, which were subjected to the immediate loading protocol or other loading protocols. According to the findings, there is evidence to suggest that immediate loading protocols demonstrate high implant survival rates and could be cautiously recommended for certain clinical situations. However, studies with a high level of evidence, especially randomized, controlled trials, performed over a longer timeframe are required to show a clear benefit over conventional and other loading types.     

All-on-4种植修复中倾斜种植体与轴向种植体失败率及边缘骨丧失的比较：meta分析

目的　比较All-on-4种植修复中倾斜种植体与轴向种植体随访3年以上的种植体失败率及边缘骨丧失情况。方法　在PubMed、Web of Science、Cochrane Library进行系统检索,手工检索纳入文献的参考文献作为电子检索的补充。检索时间自建库至2019年8月。经过文献筛选和数据提取,进行meta分析。本研究的主要结局为种植体失败率,次要结局为种植体周围边缘骨丧失。结果　12项研究符合纳入标准。结果显示,All-on-4种植修复中倾斜种植体与轴向种植体在种植体失败率上无显著差异（RR=1.24, 95% CI:［0.85, 1.83］, P=0.27）。在种植体周围边缘骨丧失方面,meta分析结果显示All-on-4种植修复中倾斜种植体与轴向种植体之间无显著差异（MD=-0.02, 95% CI:［-0.07, 0.03］, P=0.47）。结论　随访3年以上,All-on-4种植修复中倾斜种植体与轴向种植体具有相似的失败率及边缘骨丧失量。未来需要更多长期随访的高质量研究对本研究结果进行进一步佐证。     

Is there a certain number of implants needed to retain an overdenture?

Summary  The aim of this systematic review was to determine if there are reasons to recommend a certain number of implants for retaining or supporting maxillary or mandibular overdentures. Literature search for this review covered clinical trials, randomized controlled-clinical trials, meta-analyses and review articles in English dental journals from 1990 to 2007. The search produced 1779 articles, of which the abstracts of 182 studies were reviewed and those with any exclusion criterion were removed. The remaining 39 full articles were reviewed against the inclusion criteria for finalizing the selection. Eleven research reports meeting the inclusion criteria were selected for this review; three for the maxilla and eight for the mandible. According to this data, in the maxilla and in the mandible, patient satisfaction or function of the prosthesis are not dependent on the number of implants or type of attachment. In the mandible, an overdenture with two implants and with bar attachment has the least number of complications.     

Longevity of dental implants in type IV bone: a systematic review

Bone quality and quantity are important factors with regard to the survival rate of dental implants. The aim of this study was to conduct a systematic review of dental implants inserted in low-density bone and to determine the survival rate of dental implants with surface treatments over time. A systematic review of the literature was undertaken by two independent individuals; the Medline/PubMed database was searched for the period July 1975 to March 2013. Relevant reports on bone quality and osseointegration of dental implants were selected. The search retrieved 1018 references, and after inclusion and exclusion criteria were applied, 19 studies were selected for review. A total of 3937 patients, who had received a total of 12,465 dental implants, were analyzed. The survival rates of dental implants according to the bone density were: type I, 97.6%; type II, 96.2%; type III, 96.5%; and type IV, 88.8%. The survival rate of treated surface implants inserted in low-density bone was higher (97.1%) than that of machined surface implants (91.6%). Surface-treated dental implants inserted in low-density bone have a high survival rate and may be indicated for oral rehabilitation. However, more randomized studies are required to better evaluate this issue.     

Survival of hydroxyapatite-coated implants: A meta-analytic review

PURPOSE: Some reports show a benefit of coating dental implants with hydroxyapatite (HA), and others assert that resorption of the HA coating compromises long-term implant survival. This study examined this controversy by systematically reviewing all the current literature that reports the outcomes of HA-coated implants in human clinical trials. MATERIALS AND METHODS: A systematic Medline computer search of the English literature yielded 45 human clinical trials that reported on the outcome of HA-coated implants. Eleven studies that met specific inclusion criteria were selected for detailed analysis. The studies were divided into 2 groups. One group of 5 studies reported implant survival using overall percentage, and another group of 6 studies reported implant survival using life-table analysis. RESULTS: The overall percentage survival rates ranged from 93.2% to 98.5%, with 4 to 8 years of follow-up. The cumulative survival rates for studies that used life-table analysis ranged from 79.2% to 98.5%, with 5 to 8 years of follow-up. The yearly interval survival rates reported for the studies using life-tables were variable but remained above 90% and did not show a progressive or precipitous decrease with increasing years of follow-up. CONCLUSIONS: The survival rates reported for HA-coated implants were similar to the survival rates reported for uncoated titanium implants. If resorption of the HA coating causes late failure of implants, the yearly interval survival rates should have decreased with increased years of follow-up. This decrease was not observed in the longitudinal human clinical trials that met the selection criteria for this study. Detailed analysis of these clinical trials did not show that HA-coating compromises the long-term survival of dental implants.     

Short implants versus bone augmentation in combination with standard-length implants in posterior atrophic partially edentulous mandibles: systematic review and meta-analysis with the Bayesian approach

The use of short implants as an alternative to bone reconstruction techniques for the placement of standard-length dental implants is a debated topic. The aim of this study was to perform a systematic review and meta-analysis in order to assist in the clinical decision making about the most appropriate approach for the fixed rehabilitation of the posterior atrophic partially edentulous lower jaws. Only randomized trials with at least 1-year follow-up were included. Of the 1024 studies initially retrieved, 14 articles were selected and independently evaluated by two reviewers. Finally, four studies were included, and underwent data extraction and meta-analysis with the Bayesian approach. Both treatment approaches provide high implant survival rate after 1year of function. However, the probability of survival rate of short implants being greater than standard length implants is 84%, and the probability of complications using short implants being greater than standard-length implants is 15.7%. In spite of similar survival rates when the residual bone is sufficient for placement of short implants, the latter should be preferred to augmentation techniques and standard-length implants due to fewer complications, lower morbidity and greater comfort for patients.     

Usefulness of the Aesthetic Result as a Success Criterion for Implant Therapy: A Review

Purpose: The purpose of this study was to review the reported evaluation criteria of the aesthetic result in oral implant rehabilitation. Materials and Methods: A literature search of MEDLINE, the Cochrane Collaboration, and EMBASE was performed to retrieve studies published between January 1990 and December 2008 using the following key words: “dental implants,”“clinical trial,” and “aesthetic index” (and their synonyms). A manual search of the literature published in the same period was also carried out using the following publications: Clinical Oral Implant Research, The International Journal of Oral and Maxillofacial Implants, and The International Journal of Periodontics and Restorative Dentistry. The inclusion criteria of the published studies were the following: human clinical trial, oral implant rehabilitation, at least 10 implants, at least 6 months of follow‐up from insertion of the prosthesis, and evaluation of the aesthetic result by means of an index. Results: The literature search revealed 650 relevant bibliographic references, of which 89 were selected for further analysis. A final total of 29 articles fulfilled the inclusion criteria; these included 10 retrospective case series, 11 prospective case series, 1 retrospective controlled clinical trial, 1 prospective controlled clinical trial, and 6 randomized controlled clinical trials. In general, evaluations of aesthetic results appear only in the more recent studies and refer mostly to implant rehabilitation in the maxillary anterior zone; the index used, in most cases, was the Papilla Index of Jemt. Conclusions: Although there appears to be a growing interest in aesthetics in dental implantology, there are as yet no universally accepted evaluation criteria of the aesthetic result. Therefore, further research is necessary to establish a common, complete, and reproducible index for the evaluation of aesthetic outcome that can add in the success criteria for implant therapy in the maxillary and mandibular anterior areas.     

Treatment of the edentulous atrophic maxilla using zygomatic implants: evaluation of survival rates over 5–10 years

The aim of this retrospective observational cohort study was to analyse and report the 5–10-year survival rates of endosseous zygomatic implants used in the rehabilitation of the atrophic maxilla. Forty-three consecutive zygomatic implant placements in 25 patients were evaluated over a 5–10-year period. All zygomatic implant surgery was carried out under general anaesthesia. Nobel Biocare zygomatic machined-surface implants were used, and placement was undertaken using the modified sinus slot method. The main outcome measures and determinants for success were survival of the restored implants and the proportion of originally planned prostheses delivered to patients. Of the 25 patients treated, 12 were male and 13 were female; 19 were non-smokers, and the mean age at time of surgery was 64 years. Patients were treatment-planned for implant-retained bridgework, a removable prosthesis retained by fixed cast gold or milled titanium beams, or magnet-retained removable prostheses. A combination of zygomatic and conventional implants was used in all but one patient. In this study it was shown that the overall success rate for zygomatic implants was 86%, with six of the implants either failing to integrate or requiring removal due to persistent infection associated with the maxillary sinus. All patients received their planned prosthesis, although in six cases the method of retention required modification. This study illustrates that zygomatic implants are a successful and important treatment option when trying to restore the atrophic maxilla, with the potential to avoid additional augmentation/grafting procedures and resulting in a high long-term success rate.