A Novel Method to Achieve Preferable Bone-to-Implant Contact Area of Zygomatic Implants in Rehabilitation of Severely Atrophied Maxilla.

Purpose: To propose and evaluate a novel method for achieving a favorable bone-to-implant contact (BIC) area for zygomatic implants (ZIs). Materials and Methods: Patients who needed ZIs to restore a severely atrophied maxilla were recruited. In preoperative virtual planning, an algorithm was utilized to find the ZI trajectory that would achieve the largest BIC area with a predefined entry point on the alveolar ridge. The surgery was conducted according to the preoperative plan with the assistance of real-time navigation. Area BIC (A-BIC), linear BIC (L-BIC), distance from implant to infraorbital margin (DIO), distance from implant to infratemporal fossa (DIT), implant exit section, and deviation of the real-time navigated surgery were measured and compared between the preoperative plan and the placed ZIs. The patients were followed up for 6 months. Results: Overall, 11 patients with 21 ZIs were included. The A-BICs and L-BICs were significantly higher in the preoperative plan than in the placed implants (P < .05). Meanwhile, there were no significant differences in DIO or DIT. The planned-placed deviation was 2.31 ± 1.26 mm for the entry, 3.41 ± 1.77 mm for the exit, and 3.06 ± 1.68 degrees for the angle. All ZIs survived to the 6-month follow-up. Conclusion: This novel method can virtually calculate the trajectory of ZIs and transfer the preoperative plan to surgery to acquire a favorable BIC area. The actual positions of placed ZIs were slightly deviated from the ideal due to navigation errors.