Edentulous; Alveolar Process, Atrophy
Conditions
Keywords
all on four, zygomatic implant
Brief summary
Oral rehabilitation by dental implants in the severely atrophic maxilla often represents a challenge. To overcome this difficulty, bone augmentation procedures such as sinus augmentation, guided bone regeneration (GBR), or distraction osteogenesis have been used to obtain adequate bone height and width for proper three-dimensional implant placement. To avoid surgical morbidity and shorten treatment length, alternative methods such as short or tilted implants, as well as zygomatic implants (ZIs),have been proposed and have shown promising outcomes.
Detailed description
Placement of dental implants in the pterygo-maxillary region provides adequate posterior bone support for the prosthesis which permits better distribution of masticatory forces without the need of sinus floor augmentation, onlay and inlay grafts, split crest technique, or osteogenic distraction. This allows rehabilitating patients with satisfactory full arch fixed maxillary prosthesis, which is usually spanned from second molar to contralateral second molar tooth. The purpose of the present study is to compare the Reliability of all on four by 2 zygomatic implants with 2 conventional implant in anterior region versus all on four approach by conventional implant for the rehabilitation of the atrophied maxilla in terms of survival rates and improving the quality of patient's life and involved complication with maxillary sinus.
Interventions
2 zygomatic implants and 2 anterior conventional implant
patients will receive 4 conventional dental implant
Sponsors
Study design
Intervention model description
This will be a randomized controlled trial - parallel group with the patients. It is a superiority trial. study group are 10 patients receiving 2 zygomatic implants with 2 conventional implant in anterior region, while the control group are another 10 patients receiving 4 conventional implant 2 in anterior region and 2 in posterior region with immediate loading.
Eligibility
Inclusion criteria
1. Patients with severely atrophic edentulous upper arch (Cawood class IV, V, VI) that could not be restored with other type of treatment. 2. Patients who had at least 8-12 mm vertical bone height in anterior maxilla to allow installation of at least 2 conventional implants.
Exclusion criteria
1. Patients with any systemic disease that might interfere with dental implants placement and/or osseointegration e.g. uncontrolled diabetes, hypertension and osteoporosis, etc. 2. Heavy smoker (\> 20 cigarettes daily) and patients with history para-functional habits (e.g. clenching or bruxism, etc.) were also excluded. 3. Intraoral pathological lesion, related to maxilla, maxillary sinus and zygoma.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| change of function of the masticatory muscles | baseline & 6 month after the delivery of the prothesis | measuring muscles activtiy of masseter and temporalis muscles by electromyography |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Implant primary stability | baseline Immediate after implantation | The implant initial stability will be directly measured after implant insertion using the resonance frequency analysis technique by osttel device |
Other
| Measure | Time frame | Description |
|---|---|---|
| Biologic complication and implant survival rate | baseline and sixth months | Any biological complication as sinusitis, fenestration, orbital insults, failure of the implant, are going to be assessed radiographically by the CBCT |