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Zygomatic implants: indications,techniques and outcomes, andthe Zygomatic Success Code
CARLOS APARICIO , CAROLINA MANRESA , KAREN FRANCISCO , PEDRO CLAROS ,JAVIER AL �ANDEZ , OSCAR GONZ �ALEZ-MART�IN & TOMAS ALBREKTSSON
In some patients, conventional implant treatment
cannot be performed in the edentulous maxilla
because of advanced bone resorption and/or the
presence of extensive maxillary sinuses, leading to
inadequate amounts of bone tissue for anchorage of
the implants. For over three decades, bone grafting
prior to, or simultaneously with, implant placement
has become routine in oral rehabilitation. Various
bone-augmentation techniques, such as sinus floor
augmentation and onlay bone grafting, have been
described with the common goal of increasing the
volume of load-bearing bone (28, 48, 50, 56, 57, 59, 76,
79–81, 83, 86, 91, 92).
The aims of this paper are: (i) to present an over-
view of the conventional grafting technique, the cur-
rent gold standard in the treatment of extremely
resorbed maxillae; (ii) to review an alternative treat-
ment – the zygomatic implant; and (iii) to establish
specific criteria to evaluate and report the success of
a rehabilitation anchored on zygomatic implants3 .
Conventional grafting for severelyresorbed maxilla4
For most indications, autogenous bone continues to
be the gold standard for graft material. In addition to
the risks and complications of the graft procedure
itself, it also involves a donor site with associated sur-
gical morbidity, additional operating time and extra
costs. Systemic review articles5 (1, 39) have emphasized
that because of the heterogeneity among clinical trials,
guidelines for clinical practice are difficult to define.
However, one should be aware of the fact that the use
of iliac crest bone grafts, for example, in combination
with immediate or delayed implant placement, has a
failure rate of 10–30% (28, 57, 59, 83, 92).
Despite numerous publications, the effectiveness
of sinus-grafting procedures remains controversial.
Most of the literature describing these techniques
lacks defined implant success and failure criteria or
has not described the initial bone height and
standardized radiographic follow up (48, 50, 79, 80,
86, 91).
In a systematic review of the lateral window tech-
nique, an estimated annual failure rate of 3.5%, trans-
lating into a 3-year implant survival of 90.1%, was
found (76). The best results (98.3% implant survival
after 3 years) were obtained with moderately rough
surface implants. According to the authors, that sys-
tematic review had several shortcomings, as follows.
First, the absence of appropriate randomized con-
trolled trials, making it necessary to include papers
with lower levels of evidence (e.g. prospective and ret-
rospective cohort studies). Second, out of 48 reviewed
studies, 65% did not report on dropouts. Third, it is
known that the residual bone height 6significantly
influences implant survival; however, many of the
included studies failed to report the original residual
bone height at the site of implant placement or graft
failures. Finally, the studies included were conducted
mainly in an institutional environment, such as uni-
versities or specialists’ clinics.
Therefore, the long-term outcomes observed may
not necessarily be generalized to the routine private
practice. Different reviews of the transalveolar tech-
nique (56, 86) reported very similar results, with an
estimated survival rate of 92.8% after 3 years of func-
tion. However, again, only 16% of the studies reported
*Established new criteria to report on rhinosinusitis diagnosis.
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(31)
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(34)
recommended by the Task Force on Rhinosinusitis
for research outcome (61). The radiological test
includes six regions: anterior ethmoid; posterior eth-
moid; maxillary; frontal; sphenoid; and osteomeatal
complex. Each region is given a score of 0, 1 or 2
(Table 6). Any scan with a score of >0 would be con-
sidered an abnormal or ‘positive’ scan.
Questionnaire for sinusal reactions
A patient questionnaire developed, in 1997, by Lanza
and Kennedy (58) to identify the presence of rhino-
sinusal clinical symptoms, as specified by the Task
Force on Rhinosinusitis diagnostic clinical criteria
(Table 7), must be presented to each patient. Each
symptom question is answered ‘yes’ or ‘no’. Diagnosis
of sinusitis requires a ‘yes’ answer in two or more
major criteria, in one major and two or more minor
criteria, or purulence on nasal examination.
Peri-implant soft-tissue condition
One concern may be the long-term effect of having
exposed threads towards the soft tissues at the lateral
aspect of the zygomatic implants. Soft tissue dehi-
scences and their evolution must be reported in
prospective studies. Photographs must be used to
quantify the number of exposed threads (Table 5).
To understand why we are not using standard peri-
odontal parameters, such as bleeding on probing or
probing depth, the clinician should bear in mind that
for different anatomic reasons, the zygomatic implant
would be placed in different locations with respect to
the residual crest, varying from a completely bone-
surrounded implant head to just a buccal soft-tissue
relationship. Moreover, when placing zygomatic
implants following the original technique, the palatal
bone thickness surrounding the implant head is fre-
quently extremely poor or even nonexistent. In those
cases, probing may cause disruption of the soft tissue
sealing and cause oro-antral communication.
Besides, an eventual probing would give different val-
ues depending on the intensity of the palatal curva-
ture and whether it is located on the buccal side or
the palatal abutment side.
Specific criteria for zygomatic prosthesissuccess
A bulky dental bridge at the palatal aspect sometimes
leads to discomfort, speech problems and problems
with oral hygiene. For precise reporting on prosthesis
success, anatomic measurements to assess the
position of the head of the zygomatic implant with
regard to the middle of the crest of the alveolar ridge
Table 5. Zygomatic Success Code
Criteria Condition I
Success grade I
Condition II
Success grade II
Condition III
Success grade III
Condition IV
Failure
Criterion A:
zygomatic
implant
stability
(individually
tested)
No mobility
No pain
Light clinical
mobility
No pain
Clear clinical mobility
(no evidence of
disintegration of the
apical part of the
implant or rotation)
No pain
Clear clinical mobility
(evidence of disintegration
of the apical part of the
implant)
Rotation and/or pain
Criterion B:
associated
sinus pathology
(Aparicio et al. (11))
Lanza and Kennedy
test (�)
Lund-Mackay
score = 0
Lanza and Kennedy
test (+)
Lund-Mackay
score = 0
Lanza and Kennedy
test (�)
Lund-Mackay score >0
Lanza and Kennedy test (+)
Lund-Mackay score >0
Criterion C:
peri-implant soft
tissue condition
No recession Light recession.
Implant head
is visible
(yuxta-gingival).
No exposed
threads
Recession. Up to seven
exposed threads
Recession. More than seven
exposed
threads
Criterion D:
prosthetic offset*
0 mm ≤ D ≤ 6 mm
�3 mm ≤ D ≤ 0 mm
6 mm < D ≤ 10 mm
�4 mm ≤ D < �3 mm
10 mm < D ≤ 15 mm
�5 mm ≤ D < �4 mm
D > 15 mm
D < �5 mm
Description of the specific criteria (A, B, C and D) classifying zygomatic implants as successful (Grades I, II or III) or failed (Grade IV). The green color indicates suc-cess. The red color is considered as unacceptable (implant failure). Zygomatic implants are scored using a code consisting of four digits, each representing one spe-cific criterion of success. A number is given depending on the condition of each criterion (for example, 1/3/2/1). The success grade of the implant is determined bythe worst condition of the four criteria (i.e. 1/3/2/1 would be classified as success Grade III).*Prosthetic offset (D): distance from the center of the implant head to the center of the residual alveolar ridge. Positive values correspond to zygomatic implantsplaced palatally and negative values correspond to zygomatic implants placed buccally to the alveolar crest.
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this table must have 4 colors. .- Red color for the column of condition IV Failure.- Orange color for condition III column .- Green color for columns condition I and II.- Grey ( or a different color ) for the criteria column
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In a previous study ( 11 ) Aparicio et al. compared the classical technique versus the ZAGA. The L-M score was statistically significantly lower for the ZAGA group (2.36 1 3.86 vs 0.56 1 1.26, p = .042).
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Similarly, a statistically significant difference was reported by Aparicio and coworkers ( 11 )(p = .047) regarding the percentage of patients with no radiological signs or clinical symptoms of rhinosinusitis (L-M score zero and Lanza and Kennedy test negative) was observed between groups (54.55% for the classical technique vs 76.25% with the ZAGA, p = .047).
in the horizontal axial dimension should be included.
A positive value on this implant head position to the
alveolar ridge relationship indicates a palatal position
of the implant, whereas a negative value indicates a
buccal emergency. An implant placed with no contact
with the buccal bone at the head level will probably
induce soft tissue dehiscence (Table 5).
Summarizing remarks
The zygomatic implant was originally used in the
rehabilitation of discontinuous maxillae to anchor an
obturator prosthesis to the zygomatic bone. Despite
unfavorable functional load direction and limited
anatomy, clinical follow up indicated that zygomatic
implants provided excellent anchorage for various
prostheses. Based on these encouraging results, the
zygomatic implant was later used as a treatment
option when onlay bone grafting procedures had
failed. However, placement of zygomatic implants
should be considered as a major surgical procedure
and proper training is needed. As mentioned for the
sinus floor elevation, the included zygoma studies
were mainly conducted in an institutional environ-
ment, such as universities or specialists’ clinics.
Therefore, the long-term outcomes observed may not
be generalized to dental services provided in routine
private practice. Surgery is usually performed under
general anesthesia, although recent research shows
the possibility of performing zygomatic implant
placement also under local anesthesia. Compared
with major bone grafting, it is still a less invasive tech-
nique and can be used in cases where bone grafts
cannot be harvested for some reason. In situations
where bone grafting of the anterior maxilla is needed,
intra-orally harvested grafts can be used before zygo-
matic and regular implants are installed.
An extra-sinusal approach to the placement of
zygomatic implants is a modification of the standard
technique reported in 2008 by Aparicio et al. (5) and
subsequently in 2008 (7). 52A classification for the
Table 6. Lund-Mackay computed tomography staging system
No abnormality Partial opacification Total opacification
Ant. ethmoid R 0 1 2
L 0 1 2
Post. ethmoid R 0 1 2
L 0 1 2
Maxillary R 0 1 2
L 0 1 2
Frontal R 0 1 2
L 0 1 2
Sphenoid R 0 1 2
L 0 1 2
Not obstructed obstructed
Osteomeatal complex R 0 2
L 0 2
Total score –
Ant., anterior; L, left; Post., posterior; R, right.Lund-Mackay staging worksheet 50(61). Each region is scored as 0, 1 or 2. (0 represents no abnormality; 1 represents partial opacification; and 2 represents total opaci-fication). The osteomeatal complex can only be scored as 0 or 2. The minimum possible score is 0 (negative computed tomography) and the maximum score is 24.
Table 7. Task 51orce on Rhinosinusitis Criteria for thediagnosis of rhinosinusitis*
Major criteria Minor criteria
Facial pain or pressure Headache
Facial congestion or fullness Fever (all nonacute)
Nasal obstruction Halitosis
Purulent discharge Fatigue
Hyposmia or anosmia Dental pain
Purulence on examination Cough
Fever (acute only) Otalgia or aural fullness
*Diagnosis of rhinosisnusitis requires: two or more major criteria; one majorand two or more minor criteria; or purulence on nasal examination.From Lanza and Kennedy (58).
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A normal or “negative” scan is defined as any scan with a L-M score of 0. Any scan with a score >0 was considered an abnormal or “positive” scan.
zygomatic patient has been proposed, establishing
the relationship of the zygomatic buttress–alveolar
crest complex to the various anatomy-guided zygo-
matic implant pathways (Figs 4–8) (4). This classifica-
tion could help the clinician to refine the original
technique for the placement of zygomatic implants
by understanding the possibility of finding not only
interindividual anatomic differences but also intra-
individual ones. The possibility of placing zygomatic
implants with part or all of their body out of the max-
illary sinus should be linked to fewer sinus complica-
tions as less of the implant is inside the sinus and
implants are placed more crestally, with reduced pos-
sibility of oro-antral communication (4). Moreover,
when compared with the original technique, there is
a clear improvement in the implant position for the
prosthetic rehabilitation (11).
One concern of the technique may be the long-
term effect of exposed threads toward the soft tissue
at the lateral aspect of the zygomatic implants. Fri-
berg and Jemt53 (46) were unable to observe any
increased marginal bone loss or failure rate for
machined implants with exposed threads at implant
surgery compared with fully submerged implants fol-
lowed up for 5 years. This is also the experience of
the authors. Petruson (77) used sinuscopy of the
maxillary sinuses of 14 patients with zygomatic
implants, placed with no particular care regarding
whether or not membrane disruption occurred, and
found no signs of adverse reactions. As discussed by
Becktor et al. (17), it is likely that problems with
sinusitis are related more to oro-antral communica-
tions than to exposed implant threads per se.54 The in-
vitro study reported by Corvello et al. (29) showed
that when the exteriorized technique was used,
longer holes were required for zygomatic implant
placement in the zygomatic bone than when using
the original Br�anemark technique55 , but no difference
in implant length was found. Preference for one
technique over the other should take into consider-
ation the concavity formed by the ridge crest, maxil-
lary sinus and region of implant insertion in the
zygomatic bone.
Given the current knowledge (35) it seems that a
low percentage of patients with zygomatic implants
will develop rhinosinusitis. Interestingly, the rate is
not very different from the sinusitis rate in the general
population or the sinusitis rate associated with sinus
grafts. As proposed by the authors (11), systematic
parameters have to be used to report on sinus status.
The diagnosis and treatment (by Ear, Nose and
Throat56 specialists) must follow the current recom-
mendations for the treatment of rhinosinusitis in
conventional patients 57. In most cases, it seems that it
will not be necessary to remove any osseointegrated
zygomatic implants (18). The best way to avoid this
potential complication might be to perform exhaus-
tive radiological (computed tomography scan) and
clinical examinations of all patients before the place-
ment of a zygomatic implant; patients with potential
risk factors for the development of chronic rhinosi-
nusitis should be identified, studied and if necessary
treated by staff of the Ear, Nose and Throat depart-
ment 58before implant placement (35).
Finally, a Zygomatic Success Code, describing the
specific criteria to score the success of a rehabilitation
anchored on zygomatic implants 59, is proposed
(Table 5).
Conclusions
� Grafting to treat severely resorbed maxillae is cur-
rently the gold standard procedure, but failure
rates of 10–30% have been reported in the litera-
ture.
� Zygomatic implants have, in many cases, shown
improved clinical results compared with bone
grafting and represent a possible new gold-stan-
dard procedure in compromised maxillary bone.
� Zygoma success criteria differ from those of ordin-
ary implants because the proper evaluation of
crestal bone loss presents measurement prob-
lems. Instead, the current authors suggest the fol-
lowing: a cone beam computed tomography
approach to evaluate whether sinuses are healthy;
a clinical questionnaire where ‘yes’ and ‘no’
answers can be given; evaluation of soft tissue
dehiscence on a four-point grading scale based on
photographs obtained; and evaluation of pros-
thetic success based on final positioning of the
zygomatic implant with respect to the center of
the alveolar crest in the horizontal dimension.
References
1. Aghaloo TL, Moy PK. Which hard tissue augmentation
techniques are the most successful in furnishing bony sup-
port for implant placement? Int J Oral Maxillofac Implants
2007: 22(Suppl.): 49–70.
2. Ahlgren F, Storksen K, Tornes K. A study of 25 zygomatic
dental implants with 11 to 49 months follow-up after load-
ing. Int J Oral Maxillofac Implants 2006: 21: 421–425.
rate of zygomatic implants in atrophic or partially resected
maxillae prior to functional loading: a retrospective clinical
report. Int J Oral Maxillofac Implants 2006: 21: 413–420.
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Abstract
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Abstract
The zygoma implant has been an effective option in the management of the atrophic edentulous maxilla as well
as for maxillectomy defects. Br�anemark introduced the zygoma implant not only as a solution to obtain poster-
ior maxillary anchorage but also to expedite the rehabilitation process. The zygoma implant is a therapeutic
option deserving consideration when a patient-centered ethics-based approach is used in the treatment-plan-
ning process. This concept includes much more than a single surgical technique and embraces a philosophy that
places the patient’s welfare foremost. This paper reviews the indications for zygoma implants and the surgical
and prosthetic techniques (including new developments) and also reports on the clinical outcome of the zygo-
matic anatomy-guided approach. An overview of conventional grafting procedures is also included. Finally, a
Zygoma Success Code, describing specific criteria to score the success of rehabilitation anchored on zygomatic
implants2 , is proposed.
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Author Query Form
Journal: PRDArticle: 12038
Dear Author,During the copy-editing of your paper, the following queries arose. Please respond to these by marking upyour proofs with the necessary changes/additions. Please write your answers on the query sheet if there isinsufficient space on the page proofs. Please write clearly and follow the conventions shown on theattached corrections sheet. If returning the proof by fax do not write too close to the paper's edge. Pleaseremember that illegible mark-ups may delay publication.Many thanks for your assistance.
Query reference Query Remarks
1 AUTHOR: The short title ‘Zygomatic implants’ has been supplied. Please
approve, or provide an alternative short title if this one is unacceptable.
2 AUTHOR: Please check the wording of the phrase ‘describing specific cri-
teria to score the success of rehabilitation anchored on zygomatic
implants’. Would ‘describing specific criteria to score the success of reha-
bilitation dependent on zygomatic implants’ be clearer? Please indicate
any changes required to the original text.
3 AUTHOR: Please check the wording of the phrase ‘to establish specific
criteria to evaluate and report the success of a rehabilitation anchored
on zygomatic implants’. Would something like ‘to establish specific crite-
ria to evaluate and report the success of a rehabilitation dependent on
zygomatic implants’ be clearer? Please indicate any changes required to
the original text.
4 AUTHOR: Please check heading levels.
5 AUTHOR: Please check the phrase ‘Systemic review articles’. Would ‘Sys-
tematic review articles’ be clearer? Please indicate any changes required
to the original text.
6 AUTHOR: For clarity, the text ‘the amount of residual bone height’ has
been reworded as ‘the residual bone height’. Please check/approve the
change.
7 AUTHOR: Please check the spelling of ‘resorved’ in the heading ‘The
zygoma implant as an alternative treatment for the severely resorved
maxilla’. Do you mean ‘resorbed’?
8 AUTHOR: ‘prevent’ has been changed to ‘avoid the need for’ in the phrase
‘to avoid the need for sinus lift procedures’. Please check/approve the
changes.
9 AUTHOR: as ‘between’ is used for comparison of two factors, the phrase
‘is dependent on the spatial relationship between the zygomatic bone,
the maxillary sinus and the alveolar crest.’ has been changed to ‘is depen-
dent on the spatial relationship of the zygomatic bone, the maxillary
sinus and the alveolar crest.’ Please check/approve the change.
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for a dentist the term anchored is clear; means the rehabilitation is fixed to Z implants
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for a dentist the term anchored is clear; means the rehabilitation is fixed to Z implants
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yes ‘Systematicreview articles " are clearer
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approved
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resorbed
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10 AUTHOR: Please check the wording of the Table 1 legend. Would some-
thing like ‘Table 1. Treatment recommendations based on the presence
of bone in the different zones of the maxilla (Bedrossian (18))’ be clearer?
Please indicate any changes required to the original legend.
11 AUTHOR: if possible, reference numbers should be avoided in headings.
Accordingly, reference 60 has been deleted from the heading ‘General
guidelines for zygomatic implants (60)’ and inserted in the introductory
sentence ‘The general guidelines for zygomatic implants (60) are as fol-
lows.’ added to the main text. Please check/approve the changes.
12 AUTHOR: Please check the wording of the text ‘The palate has been
respected’. Is ‘resected’ correct here?
13 AUTHOR: For clarity, the text ‘It was a self-tapping titanium implant with
a machined surface in lengths from 30 to 52.5 mm’ has been reworded as
‘It was a self-tapping titanium implant with a machined surface and
available in lengths of 30–52.5 mm’. Please check/approve the changes.
14 AUTHOR: For clarity, the text ‘ Later on, the implant head received an
angulation of 45°(24). Today the surface has evolved…’ has been
reworded as ‘Later on, the implant head was angulated to 45° (24). In
today’s fixture the surface has evolved…’. Please check/approve the
changes.
15 AUTHOR: ‘epinephrine 1:50.000’ has been reworded as ‘epinephrine
(diluted 1:50,000)’. Please check/approve the changes. Please also note/
approve similar changes made subsequently in the text.
16 AUTHOR: Is the phrase ‘(1:50,000 dilution of epinephrine)’ necessary?
You have already mentioned the use of epinephrine at this dilution ear-
lier in the paragraph.
17 AUTHOR: For clarity, the text ‘The local anesthetic procedure includes
the use of four different local anesthetic approaches at the same time’
has been reworded as ‘The local anesthetic procedure includes the simul-
taneous use of four different local anesthetic approaches, as follows:’
18 AUTHOR: For clarity, the phrase ‘in cases of thin alveolar/basal bone’ has
been reworded as ‘in patients with thin alveolar/basal bone’. Please
check/approve the changes.
19 AUTHOR: ‘went out’ has been changed to ‘extended’ in the phrase
‘extended buccally’. Please check/approve the change.
20 AUTHOR: Please cross-check the values presented in Table 2 with the cor-
responding values given in the text as there seem to be some discrepan-
cies (e.g. 1026 patients, 2130 zygomatic implants and 3297 conventional
implants are cited in the table).
21 AUTHOR: In the references listed in Tables 2–5, the year of publication
has been replaced with the reference number. Please double check that
the correct reference number has been added in each case.
22 AUTHOR: Please check/approve the changes made to the column head-
ings of table 2.
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yes modify to: Table 1. Treatment recommendations based on the presenceof bone in the different zones of the maxilla (Bedrossian (18))’
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approved
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No , please do not change
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approved
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please do not change, epinephrine 1:50.000’ , is correct
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no necessary
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please leave ‘went out’
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thanks for the observation. The correct figures are: 1031 patients, 2131 zygomatic implants, 3297 conventional implants . For both, the text and table 2
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23 AUTHOR: As refs 10 and 11 have been e-published ahead of print, the
Table 2 footnote ‘*** Accepted’ has been deleted in accordance with the
changes made to the references in the list. OK?
24 AUTHOR: ‘Dale 2000’ is not in the reference list. Please add the relevant
details to the reference list, and replace the year of publication with the
reference number here (i.e. in the Table 2 footnote).
25 AUTHOR: For clarity, the text ‘In a first study’ has been reworded as ‘In
an initial study’. Please check/approve the changes.
26 AUTHOR: Please could you clarify what you mean by ‘regular’ in the
phrase ‘28 regular patients’?
27 AUTHOR: Please could you clarify what you mean by ‘regular’ in the
phrase ‘106 regular implants’? Would ‘106 conventional implants’ be
more appropriate here?
28 AUTHOR: For clarity, the text ‘Of the 106 originally installed conventional
implants placed during insertion of the zygomatic implant’ has been
reworded as ‘Of the 106 conventional implants originally placed during
insertion of the zygomatic implant’. Please check/approve the changes.
29 AUTHOR: Please could you clarify what you mean by ‘regular’ in the
phrase ‘regular implants’? Would ‘conventional implants’ be more appro-
priate here?
30 AUTHOR: For clarity, the phrase ‘to allow for the installation of support-
ing conventional implants’ has been reworded as ‘to allow supporting
conventional implants to be placed’. Please check/approve the changes.
31 AUTHOR: Please check/approve the text added (underlined) to the fol-
lowing phrase ‘…; those that have, all have a prospective or retrospective
cohort design and were conducted mainly in institutions…’.
32 AUTHOR: Please replace ‘CSR’ with the full term, here and where ‘CSR’ is
used subsequently in the text.
33 AUTHOR: ‘related’ has been changed to ‘relative’ in the phrase ‘relative to
the center of the alveolar crest’. Is this correct?
34 AUTHOR: For clarity, the text ‘The deviation of the head of ZI related to
the centre of the alveolar crest in the horizontal plane was as a mean
5.12mm (SD = 2.38).’ has been reworded as ‘The mean � standard devia-
tion of the head of the zygomatic implant relative to the center of the
alveolar crest in the horizontal plane was 5.12 � 2.38 mm’. Please check/
approve the changes.
35 AUTHOR: To avoid starting the sentence with a number, the text ‘54.55%
of the patients evaluated according to L-M score did not present opacifi-
cation (L-M = 0) in any sinus.’ has been reworded as ‘ Of the patients
evaluated according to the Lund-Mackay score, 54.55% did not present
opacification (Lund-Mackay = 0) in any sinus’. Please check/approve the
changes, including replacement of ‘L-M’ with ‘Lund-Mackay’.
36 AUTHOR: Please replace ‘TRF’ with the full term.
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From Darle (30)
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change regular patients to : patients suffering just from maxillary atrophy
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106 conventional implants’ may be more appropriate
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approved
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conventional implants may be more appropriate
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all have a prospective or retrospective cohort design and were conducted mainly in institutions…’.
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37 AUTHOR: To avoid starting sentences with a number, the full stops (x2)
were deleted and replaced with a semicolon (one instance) and with ‘and’
(one instance) in the following text (changes underlined): ‘Two (9.09%)
were diagnosed with sinusitis (TRF criteria); 77% reported satisfaction
levels above 81% and 32% reported the maximum satisfaction score of
100%.’. Please check/approve the changes.
38 AUTHOR: Please check the entry ‘2 (6.9) 1’. Is this correct or should the
entry be changed to ‘2 (6.9)’?
39 AUTHOR: ‘Pe~narrocha et al. 2007’ – do you mean ‘Pe~narrocha et al.
2005’, as given in the reference list? If so, please change the the entry in
Table 3 to ‘Pe~narrocha et al. (75)’. If not, please provide the details for
‘Pe~narrocha et al. 2007’ in the reference list and replace the year of publi-
cation in Table 3 with the appropriate reference number.
40 AUTHOR: please check the entry ‘Dav�o et al. 2009’ in Table 3. The only
entry that matches this is ‘Davo 2009’. Is this the corresponding refer-
ence? If so, please change the the entry in Table 3 to ‘Davo (32)’. If not,
please either provide the details for ‘Dav�o et al. 2009’ in the reference list
and replace the year of publication in Table 3 with the reference number
or, if the year of publication is incorrect, replace the year in the existing
entry with the appropriate reference number.
41 AUTHOR: please check the entry ‘Dav�o et al. (2007)’ in Table 4. Are you
referring to ‘Davo et al. 2007’, as given in the reference list? If so, please
change the the entry in Table 4 to ‘Davo et al. (34)’. If not, please provide
the details for ‘Dav�o et al. (2007)’ in the reference list and replace the year
of publication in Table 4 with the corresponding reference number.
42 AUTHOR: Please check the entry ‘Dav�o et al. (2010)’ in Table 4. do you
mean ‘Davo et al. 2010’, as given in the reference list? If so, please change
the the entry in Table 4 to ‘Davo et al. (31)’. If not, please provide the
details for ‘Dav�o et al. (2010)’ in the reference list and replace the year of
publication in Table 4 with the corresponding reference number.
43 AUTHOR: For clarity, the text ‘The position of emergence of the head of
ZI in relation to the center of the alveolar crest in the horizontal plane,
had a mean value of 2.92 mm (SD = 2.30)’ has been reworded as ‘The
mean � standard deviation position of emergence of the head of the
zygomatic implant in relation to the center of the alveolar crest in the
horizontal plane was 2.92 � 2.30 mm’. Please check/approve the
changes.
44 AUTHOR: Please replace ‘OHIP-EDENT’ with the full term.
45 AUTHOR: Please check the wording of the text ‘A Zygomatic Success Code
describing specific criteria to score the success of a rehabilitation
anchored on zygomatic implants is proposed’. Would ‘A Zygomatic Suc-
cess Code describing specific criteria to score the success of a rehabilita-
tion dependent on zygomatic implants is proposed’ be clearer? Please
indicate any changes required to the original text.
46 AUTHOR: Please check the wording of the text ‘prostheses bucco lingual
offset’. Would ‘prostheses offset buccolingually’ be clearer? Please reword
the original text for clarity.
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change to ‘2 (6.9)’
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75
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32
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34
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31
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oral health impact profile for assessing health-related quality of life in edentulous adults
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no, preferable keep the original text
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stay
47 AUTHOR: For clarity, ‘a light mobility’ has been changed to ‘slight mobil-
ity’. Please check/approve the changes.
48 AUTHOR: ‘CBCT’ has been changed to ‘cone beam computed tomography
scan’ in the heading ‘Scoring a cone beam computed tomography scan’.
OK?
49 AUTHOR: For clarity, the text ‘If chronic rhinosinusitis is suspected, a
new Cone Beam CT including all sinuses must be implemented’ has been
reworded as ‘If chronic rhinosinusitis is suspected, a cone beam com-
puted tomography scan of all sinuses must be performed’. Please check/
approve the changes.
50 AUTHOR: Please check/approve the changes made to the Table 6 foot-
note.
51 AUTHOR: Please check/approve the changes made to the layout of Table
7.
52 AUTHOR: The text ‘An extra-sinusal approach to the placement of zygo-
matic implants is a modification of the standard technique reported in
2008 by Aparicio et al. (5) and subsequently in 2008 (7).’ does not make
sense as ref. 5 was published in 2010. Would ‘An extra-sinusal approach
to the placement of zygomatic implants is a modification (5) of the stan-
dard technique first reported in 2008 by Aparicio et al. (7).’ be clearer?
Please rephrase the original text to clarify the intended meaning.
53 AUTHOR: ‘Friberg’ has been changed to ‘Friberg and Jemt’ to correspond
with the authors listed in the reference. OK?
54 AUTHOR: For clarity, the text ‘it is more likely that problems with sinusi-
tis are more related to oro-antral communications than to exposed
implant threads per se.’ has been reworded as ‘ it is likely that problems
with sinusitis are related more to oro-antral communications than to
exposed implant threads per se’. Please check/approve the changes.
55 AUTHOR: For clarity, the text ‘longer holes for zygomatic implant place-
ment in the zygomatic bone than the original Br�anemark technique were
provided’ has been reworded as ‘longer holes were required for zygo-
matic implant placement in the zygomatic bone than when using the ori-
ginal Br�anemark technique’. Please check/approve the changes.
56 AUTHOR: ‘ENT’ has been replaced with ‘Ear, Nose and Throat specialists’.
Is this correct?
57 AUTHOR: Please clarify what you mean by ‘ conventional patients’.
Would ‘the general population’ provide a clearer explanation? Please
indicate any changes required to the original text.
58 AUTHOR: For clarity, the phrase ‘the ENT department’ has been
reworded as ‘staff of the Ear, Nose and Throat department’. Is this cor-
rect?
59 AUTHOR: Please check the wording of the text ‘a rehabilitation anchored
on zygomatic implants’. Would ‘a rehabilitation dependent on zygomatic
implants’ be clearer? Please indicate any changes required to the original
text.
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thanks for the comment , it was published first as . Epub 2008 Dec 3.
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yes, thanks
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with no implants
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please maintain ‘a rehabilitation anchoredon zygomatic implants’
60 AUTHOR: Please provide page range for references [10, 11, 25, 26].
61 AUTHOR: Reference [16] has not been cited in the text. Please indicate
where it should be cited; or delete from the Reference List and renumber
the References in the text and Reference List.
62 AUTHOR: Please provide page range for ref. [49].
63 AUTHOR: Please provide page range for ref. [53].
64 AUTHOR: Reference [71] has not been cited in the text. Please indicate
where it should be cited; or delete from the Reference List and renumber
the References in the text and Reference List.
65 AUTHOR: Reference [88] has not been cited in the text. Please indicate
where it should be cited; or delete from the Reference List and renumber
the References in the text and Reference List.
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there is not more information on the paper
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47-56
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1-6
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was able to establish a treatment concept for immediate / early loading of dental implants ( 71) and in a zygoma study (72)
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