Zygomatic Implant

What Is a Zygomatic Implant?

A zygomatic implant takes its anchorage from the cheekbone (os zygomaticum) rather than from the upper jaw itself. Conventional implants are generally 8-16 mm long; a zygomatic implant is considerably longer, because it has to reach past the resorbed jawbone into a different bone altogether.

It is considered when the upper jaw no longer offers enough support for conventional implants. In some patients it can reduce the need for extensive bone augmentation. It is not the first answer to every case of bone loss, and it is more demanding surgery than conventional implant placement: the surgical plan and the prosthetic plan have to be prepared together.

Who Is Assessed as a Candidate?

It may be considered in patients with advanced upper-jaw bone loss, in those for whom a previous implant or graft has not worked, or where tissue loss calls for a specific rehabilitation. Having worn a denture for a long time, or wanting teeth sooner, is not on its own a reason for this treatment.

The final decision follows examination and three-dimensional imaging. It is not settled from photographs or from a description of your case at a distance.

• Anatomical assessment. The upper jaw, the cheekbones and the sinuses are examined clinically and on imaging.
• General health and medication. Drugs affecting bone metabolism, uncontrolled illness and previous treatment are considered separately. A patient who is a poor candidate for grafting is not automatically a good candidate for a zygomatic implant.
• Sinus health and maintenance. Existing sinus problems, and whether long-term oral care and review appointments are realistic for you, are part of the plan.

How the Alternatives Compare

The options weighed against a zygomatic implant include a conventional implant plan using whatever bone remains, implants placed after bone augmentation, and a removable prosthesis. All-on-Four also requires enough bone in the right positions; it is not an answer to every degree of bone loss either.

What the discussion has to cover is the extent of the surgery, the chance of additional procedures, how cleanable the prosthesis will be, the total length of treatment and your individual risks. It cannot be said that a zygomatic implant is safer, faster or more economical for every patient.

Neither column below is the better choice in the abstract. Which one applies to you is decided from your own anatomy, your general health and the prosthesis planned.

Risks and Long-Term Follow-Up

Sinusitis, soft tissue infection, a communication between the mouth and the sinus, altered sensation and implant loss can occur. Because of what lies next to the surgical field, rare but serious complications are also possible. Problems requiring maintenance or repair of the prosthesis can develop.

The systematic review by Chrcanovic and colleagues reports sinusitis among the significant complications, and notes that it can appear years after surgery. An implant still being in place does not mean nothing has gone wrong. Regular review and cleaning around the prosthesis are part of long-term care, not an optional extra.

What the Published Evidence Reports

These are figures from studied groups, with the limits the authors themselves state. They do not predict an individual result and are not a promise of one.

Taken together, the studies below say this: the technique is well documented, the failures that do occur cluster early, sinus complications are the ones to watch for, and the prosthesis needs its own maintenance. That is a different statement from a success rate offered as a personal forecast.

• Chrcanovic and colleagues (2016) pooled 68 studies covering 4,556 zygomatic implants in 2,161 patients and reported a 12-year cumulative survival rate of 95.21%, with most failures identified within the first six months after surgery. The same review reports postoperative sinusitis in 2.4%, soft tissue infection in 2.0%, paresthesia in 1.0% and oroantral fistula in 0.4% of cases — while cautioning that these figures may be underestimates, because a number of the included studies did not report complication rates at all.
• Aparicio and colleagues (2006) followed 69 patients treated with 131 zygomatic and 304 conventional implants for between six months and five years. No zygomatic implant was removed during that period, but three patients developed sinusitis 14-27 months after surgery, gold screw loosening was recorded in nine patients, and fractures of prosthetic teeth occurred in four. The prosthetic side needed attention even where the implants did not.
• Bedrossian (2010) reported a seven-year prospective study of 36 patients treated with 74 zygomatic and 98 anterior implants. Two zygomatic implants were mobile at second-stage surgery and were replaced; three patients had maxillary sinus infections that did not respond to oral antibiotics and required endoscopic sinus surgery.

Recovery

Swelling, bruising and pain can occur. You are given individual instructions on diet, oral hygiene, medication and returning to daily activity. Having temporary teeth fitted does not mean you can return to hard food straight away.

Contact the team treating you if pain or swelling increases, or if you develop fever, bleeding that does not stop, or new altered sensation. Any unexpected symptom involving your vision needs urgent assessment.

Frequently Asked Questions

Does a zygomatic implant remove the need for bone grafting?

In some patients it can avoid grafting, but it cannot be said that no grafting will be needed anywhere in the mouth. Additional procedures may still be required elsewhere. The plan is settled after examination and imaging.

Are the definitive teeth fitted on the day of surgery?

Where early loading is appropriate, the prosthesis used is usually a temporary one. The timing of the definitive prosthesis depends on tissue healing, the state of the implants and the prosthetic plan. Treatment is more than the day of the operation.

Can a zygomatic implant be used for life?

No lifetime guarantee can be given. Implants and prostheses need regular maintenance, and biological or mechanical problems may call for further treatment. Survival rates in research do not settle an individual outcome in advance.

Is the surgery painful?

Pain during the procedure is controlled by the anaesthetic. Discomfort, swelling and bruising afterwards are expected, and their extent varies with the surgery and the individual; no fixed number of days is promised. Tell the team if pain increases rather than settles.

How is the cost determined?

The number of implants, the surgical and anaesthetic requirement, the temporary and definitive prostheses and any additional procedures all affect the total. A personal plan with its scope set out is prepared after examination. Ask for follow-up and for the handling of any complication to be written into that plan rather than left open. What drives the figure is set out in our guide to zygomatic implant prices.

Which zygomatic implant system and guide are used?

For zygomatic implants at Dentopol Ümraniye, JD zygomatic implants and the Z-GO Guide system are used. Whether and how the guide is used is planned case by case; a guide does not replace the surgeon's assessment during the procedure or the safety margin required around anatomical structures. You can ask your surgeon which system and model will be used.

Scientific References

• Chrcanovic BR, Albrektsson T, Wennerberg A. Survival and Complications of Zygomatic Implants: An Updated Systematic Review. *Journal of Oral and Maxillofacial Surgery*. 2016;74(10):1949-1964. PMID 27422530. DOI
• Aparicio C, Ouazzani W, Garcia R, Arevalo X, Muela R, Fortes V. A prospective clinical study on titanium implants in the zygomatic arch for prosthetic rehabilitation of the atrophic edentulous maxilla with a follow-up of 6 months to 5 years. *Clinical Implant Dentistry and Related Research*. 2006;8(3):114-122. PMID 16919019. DOI
• Aparicio C, Manresa C, Francisco K, et al. Zygomatic implants: indications, techniques and outcomes, and the zygomatic success code. *Periodontology 2000*. 2014;66(1):41-58. PMID 25123760. DOI
• Bedrossian E. Rehabilitation of the edentulous maxilla with the zygoma concept: a 7-year prospective study. *International Journal of Oral & Maxillofacial Implants*. 2010;25(6):1213-1221. PMID 21197500.