IM0210

_Survival rates Theliteraturereviewrevealedameansurvivalrateforzygomaticimplantshigher than 90%, regardless of the technique used. The most common option is the classi- cal technique, with machined surface implants, in a two-stage loading protocol. Twelve of the 19 papers reviewed with follow-up, met this criteria.1-3, 5-7, 12, 23-27 The other alternatives also present very good results with 95.8–100% survival rates.4, 14, 15, 19-22 A surprising outcome is that the survival rate of the standard im- plantsplacedintheanteriorregionisquitelow(73–98%).Thisisprobablyrelatedto thehighdegreeofresorptionthatsurgeonsfindinthisarea,thereforerequiringmore complex grafting procedures. A total of 1,163 zygomatic implants were found in our review of 19 articles with adequatefollow-up.Twenty-threeimplants(2.0%)werelost,14(60.1%)duringthe osseointegration period and nine (39.1%) after loading. These data can be observed in table 1. _Complications Sixteen papers reported complications. Different authors comment as possible complications orbital lesions, maxillary sinus posterior wall and infratemporal fossa perforation, intraoperative bleeding, nerve lesions (infraorbitary nerve), sinus pathology, lip lesion during the drilling, among others. Nevertheless, only some of these were actually registered in the reviewed studies (26 cases of sinus patho- logy1-3, 5, 12, 14, 22, 23, 26, 27 , seven cases of infraorbitary nerve impairment3, 5 , six cases of lip lesion during drilling3, 23 and nine cases of suborbital haematoma3, 23 ). It is important to stress that most of the cases with sinus pathology were favourably solved. Some of them only needed pharmacological therapy, while others were treated with an antrostomy surgery. Only three zygomatic implants, all from the same report27 , were removed due to their association with recurrent si- nusitis. _Discussion First of all, the few number of papers published related with zygomatic implants was surprisingly low, 59 articles in our Medline review (December, 2009). Among them, only 19 presented follow-up results.1-7, 12, 14, 15, 19-27 Moreover, most of the au- thors are broadly experienced oral surgeons, which may difficult the reproducibility of their results. Amongallpublishedtechniquesandmodifications,themostcommontreatment optionpublishedistheclassicaltechnique,withmachinedsurfaceimplants,inatwo- stage loading protocol (12 studies).1-3, 5-7, 12, 23-27 Another important factor is that the majority of the studies have reduced samples (only five articles had more than 100 implants)2, 4-6 and short follow-up times (only Brånemark et al.1 presented a follow- up of five to ten years). These are important limitations that need to be corrected in future research. Nevertheless, the placement of these implants seems to be a good treatment option since the published results so far are excellent, regardless of the usedtechnique(95.8–100%).Ontheotherhand,thestandardimplantsplacedinthe anteriorregionhavelowsurvivalrates(73–98%).Thesedifferencescouldberelated with the grafting techniques used in combination with the cited conventional im- plants. Accordingly, Brånemark et al.1 presented a 73% survival rate of the standard implants,butinthisstudy,70%ofthepatientsreceivedbonegraftsinthesamesur- gical procedure in which the anterior implants were placed. Thefailurepatternofzygomaticimplantisverysimilartothatofthestandardim- plants.Ifonetakesthestudiescitedinthisreviewintoaccount,atotalof23implants *PricesincludeshippingandVAT I hereby agree to receive a free trail subscription of (4 issues per year).I would like to subscribe to cos- metic dentistry for € 44* for German customers,€ 46* for customers outside Germany, unless a written can- cellation is sent within 14 days of the receipt of the trial subscription. The subscription will be renewed auto- matically every year until a written cancellation is sent to OEMUS MEDIA AG, Holbeinstr. 29, 04229 Leipzig, Germany, six weeks prior to the renewal date. Reply per Fax +49 341 48474-290 to OEMUS MEDIA AG or per E-mail to grasse@oemus-media.de First Name Last Name Company Street ZIP/City/County E-Mail Signature Signature Notice of revocation: I am able to revoke the subscription within 14 days after my order by sending a written cancellation to OEMUS MEDIA AG, Holbeinstr. 29, 04229 Leipzig, Germany. OEMUS MEDIA AG Holbeinstraße 29, 04229 Leipzig Tel.: +49 341 48474-0 Fax: +49 341 48474-290 E-Mail: grasse@oemus-media.de AD