Real-Time Surgical Navigation System for the Placement of Zygomatic Implants with Severe Bone Deficiency

This case report describes the clinical application of a real-time surgical navigation system to guide zygomatic implants on their placement. With the assistance of this novel navigation system, constant visualization of the drilling trajectory and exact control of the drilling direction can be achieved, which could minimize the risk of penetration into critical anatomical structures. Moreover, implants might be accurately placed in accordance to the preoperative planned position. In this patient, who had previously undergone a hemimaxillectomy, three zygomatic implants were placed on the unilateral zygoma, and two conventional implants were placed on the unresected maxilla. Measurement of distributive deviation of implants between preoperative planning and the postoperative result showed the mean linear deviations at the entrance and apical point of the implant were 1.07 ± 0.15 mm (range: 0.9 to 1.1 mm) and 1.20 ± 0.46 mm (range: 0.7 to 1.6 mm), respectively. The mean angle deviation between the axes of the planned and the actual implant was 1.37 ± 0.21 degrees (range: 1.2 to 1.3 degrees). Therefore, this surgical navigation system represents a reliable approach to guide the placement of zygomatic implants. Keywords: computer-assisted surgery, minimal invasion, real-time three-dimensional navigation system, zygomatic implant