Papers by Carlos Aparicio
Atlas of the Oral and Maxillofacial Surgery Clinics, 2021
Clinical Dentistry Reviewed
A protocol to perform a prosthetically driven minimally invasive zygomatic osteotomy, named zygom... more A protocol to perform a prosthetically driven minimally invasive zygomatic osteotomy, named zygoma anatomy-guided approach (ZAGA) is introduced. The ZAGA method aims at promoting a patient-specific therapy by adapting the osteotomy type to the patient's anatomy. In most cases, this method avoids the opening of a window or slot into the lateral wall of the maxillary sinus before implant placement. Instead, a mucoperiosteal flap, including the posterior maxillary wall and the superior zygomatic rim, is raised to allow visual control of the complete surgical field. The surgical management of the implant site is guided by the anatomy of the patient according to specific prosthetic, bio-mechanic, and anatomic criteria. The ZAGA Concept represents the logical evolution of the extra-sinus technique and ZAGA classification previously described by Aparicio. The results of using the combination of the ZAGA Concept together with the new ZAGA implant designs consistently show less traumatic...
Atlas of the Oral and Maxillofacial Surgery Clinics
Dentistry Journal
Zygomatic implants are a treatment solution for patients with severe maxillary atrophy. This trea... more Zygomatic implants are a treatment solution for patients with severe maxillary atrophy. This treatment option allows delivering immediate fixed teeth within 24 h. Numerous peer-reviewed publications have reported different success rates, resulting in a disagreement on the topic. Therefore, the overall efficacy and predictability of this rehabilitation is still a matter of discussion. With this study, we aimed to identify the published literature on the use of zygomatic implants for the reconstruction of the severely atrophic maxilla and report the cumulative success rate (CSR) as a function of follow-up time. A systematic review of the literature on zygomatic implant for the treatment of severe maxillary atrophy was performed and 196 publications were included in the study. The cumulative success rate of zygomatic implants for the treatment of severe maxillary atrophy was 98.5% at less than 1 year, 97.5% between 1 and 3 years, 96.8% between 3 and 5 years and 96.1% after more than 5 ...
The International Journal of Oral & Maxillofacial Implants
Different surgical approaches including the slot and the extrasinus techniques have been describe... more Different surgical approaches including the slot and the extrasinus techniques have been described to overcome disadvantages of the original Brånemark technique for the placement of zygomatic implants. A new concern associated with zygomatic implants placed externally to the maxillary wall is the possibility of disturbing buccal soft tissues, ending up with a dehiscence and a potential infective problem. Recently, a new methodology known as the Zygoma Anatomy-Guided Approach (ZAGA) has been described based on the concept of delivering specific therapy for each patient. ZAGA involves a variety of possibilities of implant trajectory from the intrasinus to an eventual extrasinus passage according to variations in patient anatomy. ZAGA methodology includes a rationale of how to prevent most of the reported complications of zygomatic implants. The objective of this technical note is to introduce the "Scarf Graft" as a part of the ZAGA protocol intended to prevent soft tissue dehiscence around extramaxillary zygomatic implants. A pediculated connective tissue graft is placed around the neck of the extramaxillary zygomatic implants. The increased connective tissue thickness consistently gives stable gingival tissue for prevention of recession. Currently, the treatment of soft tissue dehiscence around zygomatic implants does not have predictable results. Protocols for its prevention, such as the proposed ZAGA Scarf Graft, should be incorporated if an eventual dehiscence is foreseen.
International Journal of Implant Dentistry, 2022
Introduction There are few zygomatic implants (ZI) designs available. The objective of this non-i... more Introduction There are few zygomatic implants (ZI) designs available. The objective of this non-interventional study was to report the effectiveness of two new site-specific ZI, selected and placed following the zygoma anatomy-guided approach (ZAGA). Materials and methods Consecutive patients presenting indications for rehabilitation using ZI were treated according to ZAGA Concept recommendations. Implants were immediately loaded following the manufacturer’s instructions. Success criteria regarding prosthetic offset, rhino-sinus status, soft tissue condition, and implant stability were additionally used as outcome parameters. Results Twenty patients were followed for a period of 12 to 28 months (average 18.8 months). Ten received 2 ZI plus regular anterior implants; One received 3 ZI plus regular implants and nine received 4 ZI. In total, 59 ZI were placed, 34 (58%) Straumann ZAGA-Flat design, and 25 (42%) ZAGA-Round. Forty-nine percent of the sites were classified as ZAGA-4 type an...
The International Journal of Oral & Maxillofacial Implants, 2021
This cross-sectional study aimed to identify and characterize the pathway for appropriate placeme... more This cross-sectional study aimed to identify and characterize the pathway for appropriate placement of four zygomatic implants in the severely atrophic maxilla and to group the anatomical variations of the osteotomy trajectory for anterior zygomatic implants. Materials and Methods: CBCT images of patients presenting indications for the use of four zygomatic implants to withstand a maxillary rehabilitation were reviewed. Cross-sectional planes corresponding to the implant trajectories, designed according to a zygoma anatomy-guided approach for implants placed in the anterior and posterior maxilla, were assessed separately. The relationship of the implant osteotomy trajectory with the correlated residual alveolar bone, nasal and sinus cavities, maxillary wall, and zygomatic bone anatomies was established. Results: The study population included 122 globally recruited patients, with 488 zygomatic implants, 244 of which had their starting point on the anterior incisor-canine area and 244 on the posterior premolar-molar area. The anatomy of the osteotomy path designed for the anterior implants ("A") was named and grouped into five assemblies from zygomatic anatomy-guided ZAGA A-0 to A-4, representing 2.9%, 4.5%, 19.7%, 55.7%, and 17.2% of the studied sites. Percentages for posterior implant ("P") trajectories of the osteotomy were grouped and named as ZAGA P-0 to P-4, representing 5.7%, 10.2%, 8.2%, 18.4%, and 57.4% of the sites, respectively. Approximately 70% of the population presented anatomical intra-individual differences. Conclusion: The trajectory of the zygomatic implant followed different anatomical pathways depending on its coronal point being anteriorly or posteriorly located, which justifies a new zygoma anatomy-guided approach classification for anteriorly placed zygomatic implants. Topographic characteristics of the anatomical structures that are cut by an anterior oblique plane joining the lateral incisor-canine area to the zygomatic bone, representing the planned anterior osteotomy path in a quadruple-zygoma indication, have not been previously reported. Adaptation of surgical procedures and implant sections/designs to individual patients' anatomical characteristics is essential to reduce early and long-term complications.
Zygomatic implants are used for prosthetic rehabilitation of the severely atrophic maxilla. The o... more Zygomatic implants are used for prosthetic rehabilitation of the severely atrophic maxilla. The original surgical technique (OST) at modum Branemark prescribed an intra-sinus pathway of the implant from a palatal site entrance and preparation of an antrostomy for visualization during implant insertion. However, different morphologies of the edentulous maxilla exist. The more concave the maxillary anterior wall, the more palatal position the implant head position will be. If the maxilla is severely atrophic, the palatal entrance will occur through thin cortical bone. These situations frequently result in bulky prosthetic constructions, impaired hygiene and, eventually, sinus complications.
El NIOM examina los materiales dentales disponibles en el mercado escandinavo comprobando que reu... more El NIOM examina los materiales dentales disponibles en el mercado escandinavo comprobando que reunan los requisitos apropiados para su uso. Otro de sus cometidos es la investigacion y desarrollo de nuevos materiales y tecnicas. El instituto proporciona informacion acerca de materiales dentales a todos los grupos de usuarios interesados.
The International Journal of Oral & Maxillofacial Implants, 2020
Zygomatic-related implant rehabilitation differs from traditional implant treatment in biomechani... more Zygomatic-related implant rehabilitation differs from traditional implant treatment in biomechanics, clinical procedures, outcomes, and eventual complications such as soft tissue incompetence or recession that may lead to recurrent sinus/soft tissue complications. The extreme maxillary atrophy that indicates the use of zygomatic implants prevents use of conventional criteria to describe implant success/failure. Currently, results and complications of zygomatic implants reported in the literature are inconsistent and lack a standardized systematic review. Moreover, protocols for the rehabilitation of the atrophic maxilla using zygomatic implants have been in continuous evolution. The current zygomatic approach is relatively new, especially if the head of the zygomatic implant is located in an extramaxillary area with interrupted alveolar bone around its perimeter. Specific criteria to describe success/survival of zygomatic implants are necessary, both to write and to read scientific literature related to zygomatic implant-based oral rehabilitations. The aim of this article was to review the criteria of success used for traditional and zygomatic implants and to propose a revisited Zygomatic Success Code describing specific criteria to score the outcome of a rehabilitation anchored on zygomatic implants. The ORIS acronym is used to name four specific criteria to systematically describe the outcome of zygomatic implant rehabilitation: offset measurement as evaluation of prosthetic positioning; rhino-sinus status report based on a comparison of presurgical and postsurgical cone beam computed tomography in addition to a clinical questionnaire; infection permanence as evaluation of soft tissue status; and stability report, accepting as success some mobility until dis-osseointegration signs appear. Based on these criteria, the assessment of five possible conditions when evaluating zygomatic implants is possible. Int
Gaceta Dental Industria Y Profesiones, 2007
Carlos Aparicio ha sido uno de los pioneros en la aplicacion de la osteointegracion en nuestro pa... more Carlos Aparicio ha sido uno de los pioneros en la aplicacion de la osteointegracion en nuestro pais y ha dedicado los ultimos veinte anos al desarrollo de destacadas practicas clinicas que han contribuido a la evolucion de esta ciencia. Carlos Aparicio es internacionalmente reconocido tanto por su practica implantologica como por su labor docente, en la actualidad se prepara para asumir la presidencia del 16.o Congreso Cientifico de la Asociacion Europea de Osteintegracion (EAO) que se celebra en Barcelona los proximos 25, 26 y 27 de octubre.
Gaceta Dental Industria Y Profesiones, 2011
European journal of oral implantology, 2011
The aim of the present cross-sectional study was to propose a classification system based on a cr... more The aim of the present cross-sectional study was to propose a classification system based on a cross-sectional survey of zygomatic implant cases. Cone beam computerised tomography (CBCT) postoperative images and clinical intra-surgery photographs of 200 sites corresponding to 100 patients, treated with a total of 198 zygomatic implants in the maxilla according to an anatomy-driven prosthetic approach, were reviewed with regard to anatomy and pathway of the zygomatic implant body. The patients were consecutively selected independently of the type of surgery performed, with the unique requirement of a post-surgical CBCT performed at the moment of selection. Of special interest was the morphology of the lateral sinus wall, residual alveolar crest and the zygomatic buttress. An attempt was made to divide the patients into groups, describing typical anatomies and implant pathways. Five basic skeletal forms of the zygomatic buttress-alveolar crest complex and subsequent implant pathways c...
Practical procedures & aesthetic dentistry : PPAD, 2008
I n most developed countries of the world, the dental IQ of the average patient has changed consi... more I n most developed countries of the world, the dental IQ of the average patient has changed considerably in the last decades, as society has become more health conscious. People are living longer in a youth-oriented society, and patients expect dental solutions where not only function is restored, but health, aesthetics, and selfesteem as well. Dentistry itself has evolved from the aggressive and resective procedures of the past which, by contemporary standards, could often be classified as imprecise and invasive. There is ample evidence today that periodontal disease can be arrested in the majority of instances, and that teeth-with proper maintenance-can be maintained for many years in health, function, and comfort, even when severely affected. 1,2 The etiology of periodontitis and the role of the known risk factors are much better understood. Innovative surgical approaches that maintain a biological basis allow periodontists to regain support and restore tissue in affected areas. Additionally,
Periodontology 2000, 2014
Periodontology 2000, 2008
Clinical Oral Implants Research, 2003
Clinical Oral Implants Research, 1998
Clinical Oral Implants Research, 2006
The aim of this paper was to review the clinical literature on the Resonance frequency analysis (... more The aim of this paper was to review the clinical literature on the Resonance frequency analysis (RFA) and Periotest techniques in order to assess the validity and prognostic value of each technique to detect implants at risk for failure. Material and methods: A search was made using the PubMed database to find clinical studies using the RFA and/or Periotest techniques. Results: A limited number of clinical reports were found. No randomized-controlled clinical trials or prospective cohort studies could be found for validity testing of the techniques. Consequently, only a narrative review was prepared to cover general aspects of the techniques, factors influencing measurements and the clinical relevance of the techniques. Conclusions: Factors such as bone density, upper or lower jaw, abutment length and supracrestal implant length seem to influence both RFA and Periotest measurements. Data suggest that high RFA and low Periotest values indicate successfully integrated implants and that low/decreasing RFA and high/increasing Periotest values may be signs of ongoing disintegration and/or marginal bone loss. However, single readings using any of the techniques are of limited clinical value. The prognostic value of the RFA and Periotest techniques in predicting loss of implant stability has yet to be established in prospective clinical studies.
Clinical Implant Dentistry and Related Research, 2003
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Papers by Carlos Aparicio