Patients with extreme maxilla atrophy often find themselves unsuitable for conventional dental implants, their lack of quality bone disqualifying them from the procedure. However, these days, patients who don’t have enough bone structure in their upper jaws can be successfully rehabilitated using specialised implants, such as customised 3D-printed implants, and remote anchorage implants, such as pterygoids and zygomatic dental implants. These implants are longer—ranging between 30mm and 52.5mm—and are firmly into the zygomatic bone.
There are both two-stage and immediate loading protocols with most placed today using an immediate loading protocol- so called ‘same day teeth’ approach.
Zygomatic implants offer a huge breakthrough for patients and significantly reduce the time and the number of surgeries compared to regular dental implants as they don’t require bone grafts. Additionally, long-term studies and systematic reviews on zygomatic implants document high success rates with only minimal complications. The cumulative survival rate of zygomatic implants is 96 per cent after 12 years.
Yet, while zygomatic dental implants offer many advantages, they also present some unique challenges and necessitate higher surgical skills.
Intricate anatomy
One of the primary factors contributing to the success of the procedure is the possession of higher surgical skills and the knowledge of intricate anatomy of the maxillofacial structures and the zygomatic bone itself. The zygomatic bone is a complex and curved structure that forms the framework of the middle of the face. This bone extends from the temporal bone of the skull to the maxilla and serves as an anchor for various important structures, such as the infratemporal fossa, the orbit and the maxillary sinuses.
Proper placement of zygomatic dental implants requires a thorough understanding of this anatomy to avoid damage to adjacent structures and ensure successful outcomes. The dental clinician needs to carefully navigate around vital structures such as nerves and blood vessels, which increases the level of expertise required for successful implantation.
Not all zygomatic procedures are the same. Unlike traditional implant placement, which often requires a bone graft or sinus lift to create sufficient bone volume, the anatomically guided ZAGA technique allows for immediate implant placement without the need for additional procedures. The procedure, especially when planned and delivered using 3D digital workflow, is considered minimally invasive because it requires less surgical trauma and a shorter recovery time compared to conventional techniques.
Minimally invasive
The implants are anchored into the zygomatic bone, which provides increased stability and support for the dental prosthesis. It is typically performed under local anaesthesia with or without sedation.
Research shows that immediately loaded quad zygomatic implants may offer more successful outcome compared with delayed loading protocols. Initially a temporary bridge is fitted which is replaced with a permanent prosthesis after a few months to allow for modifications to achieve the best phonetic, aesthetic, functional results.
Potential complications
Zygomatic dental implants can carry a slightly higher risk of complications compared to traditional dental implants due to the proximity to vital structures, such as the sinuses and nerves. Inexperienced or unskilled surgeons may encounter difficulties during the placement process, which could result in complications like sinus perforation, nerve damage, or a suboptimal implant position.
In the majority of studies, sinusitis is the most frequently observed complication. However early results show that sinusitis is indeed a very rare complication associated with the modern ZAGA implant system. Non-osseointegration of zygomatic implants can occur too, often caused by overheating, malpositioning, contamination or trauma during the surgery. Insufficient bone quantity or quality, a lack of primary stability and incorrectly indicated immediate loading can be factors too.
Local infections or mucositis are directly related to the appearance of sinusitis, favoured by the lack of osseointegration, lack of contact between the implant and the bone crest, superficial infection and lack of cicatrisation of the soft tissues. Poor osseointegration at the marginal area of the implant at its palatal aspect, along with functional forces, may increase the risk of oroantral communication and the posterior development of sinusitis. Paresthesia has also been recorded, along with bruising and labial laceration due to poor surgical technique.
Limited availability
Zygomatic dental implants are not readily available at all dental practices. Due to the advanced nature of the procedure, not all dentists are trained to perform zygomatic implant surgeries.
A two-day course taking place in 2024 at the ZAGA Centre in Manchester – a clinic that is part of the international network of oral surgeons highly trained and experienced in zygomatic implant rehabilitation – provides intensive hands-on surgical training, in the use of zygomatic, nazalus, trans-sinus and pterygoid implants for the treatment of severely atrophic maxilla. The course has been structured specifically for those wishing to introduce zygomatic implants into their practice.
With the exciting advances offered by Straumann-ZAGA implant system as developed by Carlos Aparicio, Zygomatic implants offer a viable and arguably less invasive solution for patients who lack sufficient bone in the upper jaw for conventional solutions. By addressing these challenges with proper surgical planning and expertise, the success rate of zygomatic dental implants can be maximised, and patients with extreme maxilla atrophy can smile with confidence once again.
For more information call 01612 371842, email ucer@icedental.institute or visit www.ucer-clinic.dental
References available on request.