Immediate implant-retained prosthetic obturation after maxillectomy based on zygomatic implant placement by 3D-guided surgery: a cadaver study

• DOI: 10.1186/s40729-021-00335-w
• Publication Date: 2021-06-13T23:03:41Z
• Authors: N. Vosselman; H. H. Glas; S. A. H. J. de Vi...; J. Kraeima; B. J. Merema; H. Reintsema; G. M. Raghoebar; M. J. H. Witjes
• Keywords: MAXILLA; Technical Advances Article; Computer-aided design; 03 medical and health sciences; 0302 clinical medicine; Zygomatic implants; Cadaver; Maxilla; Humans; Maxillary obturator; 3D VSP; Zygoma; Prosthetic rehabilitation; R; Guided surgery; RK1-715; Prostheses and Implants; FREE-FLAP RECONSTRUCTION; TIME; Surgery, Computer-Assisted; Dentistry; ORAL-CANCER; Medicine; Maxillectomy; Three-dimensional; SURGICAL NAVIGATION

Abstract Background The aim of this study was to introduce a complete 3D workflow for immediate implant retained prosthetic rehabilitation following maxillectomy in cancer surgery. The workflow consists of a 3D virtual surgical planning for tumor resection, zygomatic implant placement, and for an implant-retained prosthetic-obturator to fit the planned outcome situation for immediate loading.

Materials and methods In this study, 3D virtual surgical planning and resection of the maxilla, followed by guided placement of 10 zygomatic implants, using custom cutting and drill/placement-guides, was performed on 5 fresh frozen human cadavers. A preoperatively digitally designed and printed obturator prosthesis was placed and connected to the zygomatic implants. The accuracy of the implant positioning was obtained using 3D deviation analysis by merging the pre- and post-operative CT scan datasets.

Results The preoperatively designed and manufactured obturator prostheses matched accurately the per-operative implant positions. All five obturators could be placed and fixated for immediate loading. The mean prosthetic point deviation on the cadavers was 1.03 ± 0.85 mm; the mean entry point deviation was 1.20 ± 0.62 mm; and the 3D angle deviation was 2.97 ± 1.44°.

Conclusions It is possible to 3D plan and accurately execute the ablative surgery, placement of zygomatic implants, and immediate placement of an implant-retained obturator prosthesis with 3D virtual surgical planning.The next step is to apply the workflow in the operating room in patients planned for maxillectomy.