It is estimated that, in the UK, one in two women and one in five men aged over 50 will have an osteoporotic fracture in their lifetime. Bone atrophy is becoming increasingly observed, with lifestyle choices often the biggest cause. Weakened or diminished alveolar bone complicates implant treatment, impacting patients’ quality of life.
Excessive bone resorption, combined with poor bone quality and increased maxillary sinus pneumatisation, makes it impossible for conventional implants to be placed in the posterior maxilla. As successful osseointegration requires adequate bone density, advanced treatment techniques like zygomatic implants are required.
Losing bone
Since the 1990s, zygomatic implants have been used clinically with high survival rates. As an alternative to bone grafting and sinus lift procedures, zygomatic implants are supported in the basal facial structure, reaching the zygomatic bone on both sides. As bone atrophy is common, identifying patients who may be at risk, and therefore may require zygomatic implants, is important.
Bone atrophy is multifactorial, and patients may display many aetiological signs. Age is usually a unifying cause, with declining levels of testosterone in men and low oestrogen levels in women (especially after menopause or the premenopausal absence of menstrual periods) being linked to bone loss.
Patients whose diets are low in calcium and vitamin D are at a higher risk too; bones are weaker without these substances. Other lifestyle habits that are linked to bone atrophy include chronic heavy consumption of alcohol, regularly smoking, and low levels of physical activity, with the latter limiting hormone release.
Indications for zygomatic implant
It may be unclear when zygomatic implants are better suited to a patient instead of conventional implant treatment or other graftless alternatives. There is minimal agreement on the degree of bone resorption or available bone required for zygomatic implants to succeed. But the shortened treatment time, ability to immediately load, the stable engagement of the cortical bone in the zygoma and the lack of grafting have made zygomatic implantation an agreeable option for both practitioners and patients in the right clinical situations.
Besides inadequate alveolar bone density, there are other for zygomatic implant treatment. Patients who have had an unsuccessful conventional implant therapy may seek an alternative, whilst unsuccessful bone grafting – or a patient’s refusal to undergo bone grafting – may also lead them to zygomatic implant treatment. Another indication is maxillary deficiency secondary to cleft palate. If these situations present themselves, treating such patients with zygomatic implants, or referring them to a more experienced professional to do the same, may be the best option to restore a good quality of life.
Complications
Whilst enormously beneficial for treating patients with an atrophic edentulous maxilla or maxillectomy defects, there are possible post-surgical complications with zygomatic implant treatment. Soft tissue dehiscence, sinusitis and prosthodontic fractures are the most common side-effects that hinder rehabilitation. During the maintenance process, severe gingival hyperplasia/hypertrophy, pressure ulcers, fistulas and horizontal gingival fissures may be observed. Practitioners can reduce these complications with solutions like intraoral, extraoral and temporomandibular joint examination, using peri-implant health indices, and the digital stimulation of tissues. To prevent peri-implantitis from the increased risk of bacterial mucositis, observing the soft tissue and transmucosal path with magnifiers can monitor the development of gingival disease. By using and understanding the appropriate measures for limiting complications with zygomatic implants, practitioners can enhance their patient’s rehabilitation prospects.
Be part of the change
The advantages of zygomatic implants are many. The reduced risk of infections, quicker healing time and the predictability of the treatment in trained hands make it ideal for providing the strong foundation for the jaw and teeth to function properly again. With a much higher survival rate of after 10 years versus conventional implants, offering zygomatic implants can help your patients and your practice.
To learn from experts in the field, consider the Zygomatic and Pterygoid Implant Masterclass. Taught by Professor Cemal Ucer and Professor Andrea Tedesco at Manchester ICE Postgraduate Dental Institute and Hospital, the course provides hand-on surgical training and the chance to converse with some of the most accomplished experts in the fi eld. You will be able to anatomically dissect a cadaver with zygomatic, nasal and pterygoid implants, learning minimally invasive concepts and techniques. With excellent teaching and support guiding you through the process, completing the course will give you an alternative implant treatment to offer your patients.
Zygomatic implants are an effective option for treating atrophic edentulous maxilla. The advantages of providing multiple implant options means that patients will receive the most appropriate treatment to ensure their long-term health and a restored good quality of life.
References available on request.