CE Questions The answer sheet and further instructions are located on the tear-out card that appears on page 37, or take the test online at dimensionsofdentalhygiene.com. 1. At 10 years, what is the success rates for dental endosteal implants in addressing edentulism? A. 95% B. 96% C. 97% D. 98% 2. In what year did Per-Ingvar Brånemark, MD, PhD, and his team explore the potential of zygomatic implants as an alternative for patients ineligible for conventional dental implants? A. 1997 B. 1998 C. 1999 D. 2000 3. Zygomatic implants are designed to provide a stable anchor for prosthesis retention using the zygomatic bone. True False 4. What is the bone density of the quadrangular zygomatic bone? A. 98% B. 97% C. 96% D. 95% 5. Which of the following is the overall survival rate of zygomatic implants at 12 years? A. 94.7% B. 95.7% C. 96.7% D. 97.7% 6. Inadequate alveolar bone is never caused by tooth loss. True False 7. Severe dental atrophy is defined as an alveolar ridge less than which of the following? A. 4 mm B. 5 mm C. 6 mm D. 7 mm 8. Evaluation criteria used to select patients indicated for zygomatic implants consist of which of the following? A. Medical history B. Radiographic series C. Clinical examination D. All of the above 9. The most common culprits behind zygomatic peri- implantitis are Gram-negative bacteria. True False 10. What is the range of length for zygomatic implants? A. 30 to 52.5 mm B. 40 to 52.5 mm C. 50 to 52.5 mm D. 52 to 54.5 mm SECTION 1 SECTION 2 SECTION 3 dimensionsofdentalhygiene.com January/February 2024 • Dimensions OF DENTAL HYGIENE 35 Zygomatic implants are immediately loaded at the time of surgical implant placement. Patients are placed on a post-surgical regime of antibiotics, applying ice for 20 minutes on and 10 minutes off for 24 hours, and sleeping with their heads elevated to control swelling. Nutritional recommendations include a soft diet and frequent hydration. Implementing sinus precaution procedures including refraining from blowing the nose for 3 weeks, and decreasing antra pressure by opening the mouth in the event of a sneeze. Rinsing with salt water twice a day for 2 weeks is also recommended. Zygomatic implants are longer than dental alveolar implants, ranging in length from 30 to 52.5 mm.21 The head of the zygomatic implant is designed to allow the dental prosthesis to be attached at a 45° or 55° angle to the long axis of the implant (Figures 1 to 3).21 The length and trajectory of the zygomatic implants create a problematic situation for biofilm control. Due to the length of zygomatic implants and the penetration through the antrum and oral mucosal tissues, the threads of the implant are often exposed. This can be reduced with improved surgical technique and the use of immediate load buccal fat pad.21 A zygomatic implant with clinical visualization with seven threads is considered normal.5 The threads provide a protected area for biofilm accumulation. The immediate load provisional fixed prosthesis which is not removed unless there is implant or tissue complication during the first 6 months and prior to final restoration fabri- cation may complicate biofilm removal.21 Therefore, patients must be taught strategies for self-care to clean around the prosthesis. Unlike dental alveolar implants, zygomatic implants’ length, design, angulation, exposure of the threads, and the fact the prosthesis cannot be removed require a stringent protocol to manage the biofilm.22 The standard evaluation of a zygomatic implant includes absence of pain and mobility, lack of any sinus pathologies, mild recession of the peri-implant soft tissue exposing up to seven implant threads, and the correct balance of forces on the dental prosthesis to the implant fixture.5 The removal of supragingival and subgingival biofilm from zygomatic implants should be done with an air abrasive device and glycine or erythritol powder with careful angula- tion of the tip.23 Patients should be on a 3-month recare schedule to prevent calculus for- mation.22 Typically, biofilm and food debris accumulation are removed during a hygiene appointment. Both glycine and erythritol powders are biocompatible with oral tissues, prosthesis, and implant. They will not cause corrosive or mechanical wear and they may reduce the presence of P. gingivalis in patients with periodontitis.23 If necessary, the dental hygienist should use hand scalers (eg, titanium scalers) biocompatible around implants. Other adjunctive measures may include end-tuft brushes, in-office oral irrigation, and at-home irrigation or water flosser on low-medium power.22 Patients should also use an over the counter antimicrobial mouthrinse twice a day. Magnunson et al24 revealed that using a water flosser compared to floss reduced bleeding around implants. The long-term use of chlorhexidine mouthrinse may contribute to the corro- siveness around dental implants, therefore, it should only be used in the short term.25 In the operatory, polishing with a low abrasive paste and a rubber cup should be done on the dental prosthesis. Conclusion Motivating and educating patients on their self-care are critical for those with zygomatic implants. Dental hygienists are knowledgeable in preventing peri-mucositis and peri- implantitis and in recognizing sinus complications, thus, they should be prepared to help patients with zygomatic implants achieve and maintain oral health. The references that accompany this article appear with the web version at: dimensionsofdentalhygiene.com. D
