Zygoma Implants

When the upper jaw no longer has enough bone for a standard implant, zygomatic implants find their support in the cheekbone. We explain what the technique is, what the research shows and who it suits.

About this article: general information,

For years, a badly resorbed upper jaw was one of the harder problems in implantology. If there is no bone, a standard implant has nothing to hold onto, and the usual answer was extensive grafting, sinus lifting and long waiting. Zygoma implants changed that picture: instead of building bone where there is none, they anchor in the cheekbone, which stays solid in most people even when the upper jaw has worn away.

The result is that many patients who were told fixed teeth in the upper jaw were not possible do, after all, reach a firm, fixed bridge. This is not a miracle and not a guarantee for everyone, but a well-founded technique with good long-term data behind it. Below we explain honestly how it works, what the studies show and where its limits lie.

The problem

Why the upper jaw runs out of bone

A standard dental implant is a titanium root placed into the jawbone. For it to stay stable it needs enough bone in both height and width. In the upper jaw that bone is often the first to go, for several common reasons:

• long-term tooth loss, because bone that no longer carries a tooth gradually disappears,
• years of wearing a removable denture, which presses on and wears down the ridge,
• advanced periodontitis, an inflammatory disease that breaks down the supporting bone,
• tooth loss after injury or an earlier procedure that did not hold.

The upper jaw has an extra obstacle. Above the back teeth sits the maxillary sinus, an air cavity that expands as bone is lost by drifting down towards the ridge, cutting the available height even further. That is why the back of the upper jaw is the most common place where patients are told there is “no bone for an implant”. implants without bone

The key distinction: “you do not have enough bone” and “there is no solution for you” are two different sentences. The first is about one method. Zygoma implants exist precisely so that the second does not have to follow from the first.

The technique

What Zygoma implants are

Zygoma implants, or zygomatic implants, are longer implants, up to roughly 60 mm, that do not seek their main support in the upper jaw. Instead they anchor into the cheekbone (Latin os zygomaticum), the dense bone of the cheek that in most people stays preserved even when the upper jaw has lost much of its volume. In practical terms, the implant bridges the bone that is missing and reaches a part of the skull that is still strong.

Because support comes from the cheekbone, a zygomatic approach can in many cases avoid the extensive bone grafting and sinus lifting that a standard implant in a resorbed jaw would require. That usually means fewer stages and a shorter overall path to fixed teeth. It is, though, more demanding surgery than a standard implant, so it belongs in experienced hands and depends on careful 3D planning. guided implantology and CBCT

“For a patient who has heard for years that nothing can be done in the upper jaw, a zygomatic implant is often the difference between a removable denture and firm, fixed teeth. It is demanding surgery, but a predictable one when it is planned and performed well.”

dr. Zdenko Trampuš, DDS · Ortoimplant DENTAL SPA

The combination

The Zygoma All-on-4 combination

Zygoma implants are rarely used alone. In the common Zygoma All-on-4 combination, two zygomatic implants, one on each side, carry the back of the arch, while standard implants are placed at the front of the jaw, where bone is more often preserved. Together they hold a fixed bridge across the whole upper arch.

When there is not enough bone for standard implants at the front of the upper jaw either, Quad Zygoma is used, that is, four zygomatic implants, two on each side. In variations of All-on-X treatment, zygomatic implants can provide the distal support while transnasal implants are used at the front, when the patient’s anatomy and the biomechanical plan for the future fixed restoration point to such a combination.

The goal is the same as with a standard All-on-4: firm, fixed teeth on a small number of well-placed implants. The path to it simply runs through the cheekbone rather than through grafted bone. Which combination of implants suits your jaw is decided from the 3D scan, taking into account the position of the sinus, the nerves and the remaining bone.

Anchorage

Cheekbone, not jaw

Support comes from dense zygomatic bone that stays solid when the upper jaw has resorbed.

Augmentation (bone grafting)

Often avoided

Extensive grafting and sinus lifting can frequently be bypassed, so treatment is usually shorter.

Planning

3D and guided

A CBCT scan and careful planning are essential, given the length and angle of the implants.

Timing

Fixed teeth in a short time

In Zygoma All-on-4 / All-on-X treatment we use an immediate loading protocol. The temporary fixed bridge is as a rule fitted a short time after surgery, most often on the same day or within 24 hours, so you leave with teeth rather than an empty jaw. The permanent bridge is made later, once healing has settled, usually after a few months.

Immediate loading is made possible by adequate primary stability of the implants, which is one of the key preconditions for such a protocol. Situations in which the temporary fixed bridge cannot be fitted within the planned short time frame are exceptionally rare and depend on the specific clinical, anatomical or biological circumstances of the individual patient. In the literature, immediate loading performs at least as well as delayed loading.

On expectations: “fixed teeth in a short time” means a temporary fixed bridge, not that treatment ends on day one. Healing, the permanent bridge and follow-up all still matter. An honest timeline is part of what we give you.

The evidence

What the research shows

Zygoma implants are not new or experimental. They have been studied for more than two decades, and the picture from systematic reviews is consistent: high survival over long periods, with a small set of complications to watch for.

• A 2023 systematic review and meta-analysis reports a mean survival of zygomatic implants of 96.2 percent at six years, with immediate loading (98.1 percent) performing slightly better than delayed loading (95 percent).¹
• An earlier updated systematic review, of 4,556 implants in 2,161 patients, found a twelve-year cumulative survival of 95.2 percent, with most failures occurring in the first six months.²
• For the full-arch context, a systematic review of the All-on-4 concept reports implant survival above 99 percent beyond 24 months, and that is the framework within which zygomatic implants are usually placed.³

Two honest caveats belong with these numbers. First, they are averages across many clinics and different types of patient, not a prediction for any single person. Second, zygomatic surgery carries risks: the most frequently described biological complication is sinusitis, present in a minority of patients over several years, which is why planning, experience and follow-up matter.¹ Good data is a reason for confidence, not for promises.

Background

A short history

The zygomatic bone was first put to use for implants by Per-Ingvar Brånemark, the Swedish researcher regarded as the father of modern dental implantology. Recognising that the cheekbone offered dense, reliable anchorage, he placed the first zygomatic implants at the end of the 1980s, originally for patients who had lost bone after tumour surgery or injury. From those beginnings the technique was refined and, over the following decades, extended to the atrophic edentulous upper jaw.

What began as a solution for rare, severe cases is today an established option, supported by long-term research, for people whose upper jaw simply no longer has enough bone for standard implants.

Recovery

Recovery: the DENTAL SPA concept

Because placing a zygomatic implant is far more demanding than placing a conventional implant, recovery with us begins before the surgery itself. We prepare the patient and the body before surgery, continue that support during the procedure, and afterwards give targeted support to healing and postoperative recovery. The procedure is carried out under potentiated intravenous analgosedation, the depth of which is adjusted to the patient and to the procedure, so the patient stays relaxed, feels no pain and, with procedures of this scale, most often sleeps through the surgery. Afterwards, mild swelling and tenderness in the first few days are usual and are managed with pain medication and clear instructions.

Our DENTAL SPA concept is an integral part of the perioperative protocol: before, during and after the procedure we apply individually tailored DENTAL SPA treatments as medical support for healing, postoperative recovery and the processes that matter for osseointegration. In this way we create more favourable conditions for healing and for the body’s recovery after major surgery. DENTAL SPA recovery

Our principle: if we judge that a technique is not right for you, or that preparation is needed first, we say so and suggest a better path. An honest assessment is worth more than any single procedure.

A transparent approach

Who Zygoma implants are not the right choice for

Zygoma implants extend what is possible, but they are not for absolutely everyone and they do not guarantee an outcome. In some situations they may not be the first choice, or may need preparation first:

• Active infection or untreated sinus inflammation: this needs to be resolved first, because it affects both the safety of the surgery and healing.
• Certain general health conditions: some chronic diseases, particular medications (for example some bone medications) or recent cancer treatment call for coordination with a physician and sometimes a delay.
• Active smoking and poor oral hygiene: both significantly affect healing and long-term success, so those habits are worth sorting out first.
• Unrealistic expectations: anyone hoping for a result with no healing, no care and no check-ups is likely to be disappointed, whatever the technique.

What is possible for you specifically can only be assessed reliably after an examination and a 3D analysis. That is exactly the point of the first visit.

Frequently asked questions