Zygomatic Implant

THE PROBLEM IT SOLVES

The upper jaw loses bone faster than the lower, and for longer. Once the upper back teeth have been gone for some years, the ridge narrows and shortens from below while the sinus expands into the space from above.

In severe cases what remains is a thin shell of bone, too little to hold a conventional implant anywhere in the back of the upper jaw and sometimes at the front as well.

Historically these patients had two options: extensive bone grafting over a long period, with no guarantee it would produce enough bone; or a removable upper denture, which many find difficult to tolerate and which continues to press on the ridge.

Zygomatic implants provide a third route. Rather than rebuilding the jaw, they bypass it, taking their anchorage from the cheekbone, which is dense, substantial and does not resorb when teeth are lost.

 

HOW THEY WORK

A zygomatic implant is considerably longer than a conventional one — typically between three and five centimetres — because it has to pass from the jaw up into the cheekbone.

It is placed through or alongside the maxillary sinus, following a path planned in advance from a three-dimensional scan, and engages the dense bone of the zygoma at its upper end. The part that emerges into the mouth receives the prosthesis in the usual way.

Depending on how much bone remains at the front of the jaw, a case may use two zygomatic implants combined with conventional implants at the front, or four zygomatic implants where there is nothing usable at the front at all.

The fixed bridge is then attached to them.

 

WHO THEY ARE FOR

Zygomatic implants are not a routine alternative to standard implants. They are intended for specific situations:

Severe bone loss in the upper jaw where conventional implants cannot be placed.

Patients who do not want extensive grafting, or for whom grafting is not realistic.

Failed previous grafting.

Loss of bone after a cyst, tumour or injury, or after surgery to the upper jaw.

Patients who cannot tolerate a removable upper denture.

Where there is enough bone for conventional implants, with or without routine grafting, conventional implants remain the first choice.

 

WHAT THE TREATMENT INVOLVES

Zygomatic implant placement is an advanced surgical procedure. It requires a surgeon trained and experienced specifically in the technique, and detailed three-dimensional planning beforehand.

It is generally carried out under general anaesthesia or deep sedation, in an operating theatre, because of the length of the procedure and the anatomy involved.

A particular feature of the technique is that zygomatic implants are often stable immediately, because they engage dense cheekbone rather than relying on the soft, resorbed jawbone. That means a fixed temporary bridge can frequently be attached within a short period of surgery rather than after months of healing — which is the main reason the technique is used where it is.

The permanent bridge follows after a period of healing and settling.

 

RECOVERY

Swelling is significant in the first days and extends into the cheek and around the eye, and bruising is common. It reduces over the following one to two weeks.

Because the implant passes through or beside the sinus, the aftercare resembles that for sinus surgery: avoiding nose-blowing, sneezing with the mouth open, no straws, and avoiding pressure changes including flying for a defined period. Antibiotics are usually prescribed.

A soft diet is required initially, and follow-up is closer than for routine implant treatment.

 

RISKS AND CONSIDERATIONS

This is a more complex procedure than conventional implant treatment and the risks reflect that. They include sinus inflammation or infection, which is the most frequently reported complication; soft tissue problems where the implant emerges into the mouth; altered sensation in the cheek; and, uncommonly, injury to structures near the implant path. Implant failure is possible, as with any implant.

Long-term maintenance matters a great deal. The point where the implant emerges through the gum needs to be kept meticulously clean, and professional review at regular intervals is part of the treatment rather than an optional extra.

Because the technique is demanding, the experience of the surgeon and the quality of the planning are more consequential here than in routine implant work. It is reasonable to ask how often the surgeon performs the procedure.

 

HOW IT COMPARES WITH THE ALTERNATIVES

Extensive bone grafting followed by conventional implants rebuilds the jaw itself. It is a longer path, often requiring several procedures and many months, and it depends on the graft taking. For some patients it is the right answer; for others the time and the uncertainty are not acceptable.

A removable denture involves no surgery and no implants. Some patients manage well with one; others find an upper denture difficult to tolerate, particularly where the ridge is flat.

Zygomatic implants avoid the grafting and typically give fixed teeth far sooner, at the cost of a more demanding surgical procedure.

Which is appropriate is decided from the scan, the patient's general health and what the patient wants from the result. All three are legitimate options in the right circumstances.

 

QUESTIONS PATIENTS ASK

Is it painful? The procedure is carried out under general anaesthesia or deep sedation. Afterwards, swelling and bruising are usually more troublesome than pain, which is generally controlled with medication.

 

How long do zygomatic implants last? They are intended as a permanent solution, and published follow-up studies report high survival over many years. As with all implants, the outcome depends on the surgery, the prosthesis and long-term maintenance.

 

Will I have teeth straight away? In many cases a fixed temporary bridge can be attached within a short period of surgery, because the implants are stable immediately. Whether that applies to a particular case is decided by the surgeon.

 

Can they be removed later if needed? Removal is possible but is a significant procedure. This is not a treatment to approach as reversible.

 

Will it affect my sinuses? The implant passes through or beside the sinus, so sinus-related complications are the most commonly reported. Aftercare instructions are designed around protecting the sinus and should be followed closely.

 

Do I need a bone graft as well? Avoiding extensive grafting is the main purpose of the technique. Small localised grafting is sometimes carried out alongside.

 

Can they be used in the lower jaw? No. There is no equivalent bone to anchor into below. Severe bone loss in the lower jaw is managed differently.

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