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Zygomatic Implants

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Read the article to learn about the indications, purpose, history, the technique, the clinical challenges, and recent advances in zygomatic implantation.

Written byDr. Achanta Krishna Swaroop

Medically reviewed byDr. Lekshmipriya. B

Published At April 16, 2022
Reviewed AtJuly 25, 2024

What Are Zygomatic Implants?

Zygomatic implants are anchored into the zygoma or the cheekbone rather than in the maxilla or upper jaw. In the current scenario of dental implantation, zygomatic implants are usually considered for placement using an immediate loading protocol.

What Are the Indications for Zygomatic Implants?

The main indications for the dentist to opt for zygomatic implants are as follows:

  • Severely resorbed edentulous maxilla (loss of teeth in the upper jaw).

  • In partially edentulous patients, as an alternative to sinus augmentation procedures.

  • When will it be used due to failed sinus augmentation for other implant procedures?

  • For jaw and dental rehabilitation after resection of jaw cancers, tumors, or trauma.

  • When there is a failure of conventional implants.

  • Failure of bone grafts placed due to multifactorial or systemic factors in the patient.

The dental surgeon always uses zygomatic implants when there is no viable alternative for rehabilitating jaw, speech, and masticatory functions in edentulous patients. The biggest clinical challenge is accommodating bone regeneration modalities to compensate for the continuous resorption of the maxillary alveolar process that continues after a tooth loss or tooth extraction.

Zygomatic implants can be planned in conjecture with several strategies proposed in recent decades in implantology. For example, clinically challenging surgical methodologies can be adopted to rehabilitate the edentulous patient or in patients indicated for zygomatic implants, such as bone regeneration before the placement of conventional implants, Lefort 1 osteotomy procedures with repositioning of the maxillary segment (either downward or forward positions), distraction osteogenesis, inlay grafting procedures either to the maxillary antrum or to the nasal floor, onlay grafting procedures or interposition bone grafting, etc.

What Are the Recent Developments in Zygomatic Implants?

The introduction of zygomatic implants was originally made by the revered father of modern implantology, Professor Branemark. Since then, several authors and researchers have been in defense of this methodology to compensate for the continuous atrophy or bond resorption that takes place in the maxilla or upper region with zygomatic implantation.

Zygomatic implants also offer an additional advantage to the dental surgeon or implantologist by possibly loading the implant immediately (immediate implant loading). When techniques like Lefort 1 maxillary advancement are used, virtual surgical planning greatly benefits the operator.

Specific imaging communications in dentistry have emerged, like DICOM (digital imaging and communications in medicine) management software used for 3D (three-dimensional) planning and reconstruction before the zygomatic implantation procedure. The software that supports this purpose is Simplant O and O version, Dentsply, Leuven, etc. Through this 3D planning, the operator can plan the proper emergence profile of the implant, and adequate alveolar bone support can be ensured around the implant to prevent implant failure. Additionally, these software offer the advantage of selecting surgical or provisional prosthesis post-implantation based on the extent of maxillary advancement planned by the surgeon, like occlusal splints, fixation of mini plates, etc.

What Is the Procedure for the Placement of Zygomatic Implants?

The implant surgery can be performed under general anesthesia preferably. A crystal incision can be given bilaterally on the maxilla. Post the elevation of the mucoperiosteal flap to the level of the zygomatic buttress and palatal segments; a Lefort 1 osteotomy procedure can be performed. The maxilla is then osteotomized (using an osteotome instrument in rotational motion) and can be consequently repositioned or fixed with screws to the bone to increase stability.

As suggested by revered Branemark, the original procedure includes inserting these zygomatic implants through an intrasinusal trajectory with the help of a long anchored implant ranging from 35 to 55 mm. However, because of the palatal emergence profile of these zygomatic implants, it becomes difficult to rehabilitate the patient for the clinician prosthetically, and the patient may have compromised cleaning in that area, leading to poor oral hygiene and peri-implantitis or peri-implant mucositis conditions (that may lead to long-term implant failure).

In the present scenario in dental implantology, the advocated methods vary from practitioner to practitioner; however, most authors or clinicians support the placement of zygomatic implants with certain modifications technically, as mentioned earlier, with multiple methods like the use of only bone grafting, bone regeneration, and Lefort 1 maxillary advancement procedures.

What Are the Challenges in the Placement of Zygomatic Implants?

In the case of zygomatic implants, the clinically challenging surgical method is to achieve a proper emergence profile of the implant platform. Hence, computer-assisted planning on a virtual platform or through the above-mentioned 3D software, along with prefabricated surgical splints, can ensure that the emergence profile is as per operator and patient expectations and simultaneously corresponds to correct maxillary advancement repositioning for the long-term stability of the implant.

Another major challenge is the severely atrophied maxillary region or alveolar process that requires a 3D approach. A well-designed prosthesis by the surgeon can overcome the complications associated with anterior maxillary defects, saggital atrophy, and less labial support. Vertical defects must be managed by hybrid prosthesis, metal-ceramic or zirconia bridging, or prosthetics to restore the conventional pink and white esthetics associated with normal gingival and tooth structure and form. As zygomatic implants already have the advantage of being immediately loaded, achieving bone anchorage and primary implant stability by precise planning virtually and immediate provisional prosthesis fabrication can considerably shorten the period of having the jaw function and form restored in the edentulous patient.

What Could Be the Complications of Zygomatic Implant?

Sinusitis is the most frequent side effect linked to zygomatic implants. Appropriate pre-operative diagnostics and evaluation of the sinus, the extra-sinus surgical approach, and the fast loading of the implants reduce or even eliminate this problem. Orosinusal fistula, orbital perforation, and infraorbital nerve paresthesia are some side effects documented both during and after the implantation of zygoma implants.

How Zygomatic Implant Differs From Conventional Dental Implants?

Zygomatic implants, which last more than 12 years, are thought to be a long-term remedy for tooth and jawbone loss. They are fixed in the zygoma bone, usually in the upper jaw, although conventional implants are placed in the lower or upper jaw.

Conclusion

To conclude, zygomatic implants are of great use in patients with atrophic edentulous maxilla. They are a viable alternative for those patients seeking sinus augmentation procedures, and due to recent advances in virtual planning and advanced surgical methods that accompany implantation, the dental implantologist can ensure long-term success.

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Frequently Asked Questions

Zygomatic implants have a 96 percent success rate and survival of more than five years. They are made using high-quality materials. They can last for a lifetime if maintained properly. Overall, health and oral hygiene can play an important role in deciding the life of zygomatic implants.
For the replacement of an edentulous upper jaw, sinus augmentation surgeries, and facial and oral rehabilitation owing to facial fractures, cysts, and tumors of the jaw, zygomatic implants are recommended. They differ from the regular implants in that they attach to the zygoma of the upper jaw. Regular implants attach to the maxilla or the upper jaw. Zygomatic implants are used when there is insufficient bone density in the upper arch.
With a low incidence of complications, zygomatic implants have reportedly been found to provide satisfactory results. The zygoma is stronger than the jaw bone. Hence, it can hold three to four implants. These implants can be used to hold the complete upper teeth with a few incisions. 
The risks of zygomatic implants include the development of oroantral fistulas, orbital penetration and injury, transient sensory nerve impairments, and vestibular cortical fenestration. Peri-orbital hematoma or edema can be seen in some patients after the surgery. Some might have mild to moderate nasal bleeding. Some may have minor gingival issues post-operatively.
By bypassing a possibly painful surgery entirely, people can acquire zygomatic implants. Following the implant operation, people experience substantially less pain than they would with conventional implants. They can usually be managed with over-the-counter drugs.
Although dental implants are considered a permanent tooth replacement solution, it is still possible to have them removed. However, the removal of a zygomatic implant can cause a large amount of bone loss. However, it rarely occurs and has low maintenance as well if proper oral hygiene is maintained.
Fracture of the zygoma is the second most common fracture of the face after nasal fractures. The multiple sites of juncture with adjacent facial bones are vulnerable to external forces. The zygoma serves as the buttress to the maxilla and the skull. Hence, it is sturdy. However, its prominence makes it more vulnerable to injuries.
No, zygomatic implants will be placed in the upper jaw and the cheekbone. However, it can be used in addition to the regular implant to replace a fully edentulous mouth. Regular implants can replace the lower arch, while zygomatic implants can be used in the upper arch.
A zygomatic Implant is a gold standard for the treatment of severe bone loss and other related conditions since the complications are rare. They are used in cases with severe bone loss or bone density. They are also done in patients where a bone graft or sinus manipulations are not feasible.
One of the most frequently fractured bones in the body is the clavicle, also known as the "collarbone." It is usually common among children. It can happen during childbirth, as the child passes through the birth canal. Nonetheless, the zygomatic fracture is the second most frequent facial fracture in the face, right after nasal fractures. 
Since there is no need for a bone graft during the procedure itself, recovery time can be substantially shorter—between four and six months. However, care must be taken to avoid any injury to the area, as it can interfere with the healing. Further, it can push the cheekbone out of position. 
Particularly after eating, gentle swishing with warm salt water or a prescription mouthwash is advised to dislodge the big particles. Brushing the teeth regularly would be effective. The area must be kept clean after every meal. Smoking must be avoided for at least three months post-surgery.
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Dr. Achanta Krishna Swaroop from iCliniq
Dr. Achanta Krishna Swaroop

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