Zygomatic implants vs. conventional implants: when are they recommended?

Conventional dental implants are used to replace missing teeth when there is sufficient bone to support them. In cases of severe atrophy of the upper jaw, however, treatment may require bone reconstruction or a different surgical approach.

Zygomatic implants are one of the alternatives that may be considered in certain complex situations. They utilise the zygomatic bone for anchorage and have different indications, surgical characteristics and risks compared to conventional implants.

The choice depends not only on the amount of bone available, but also on the patient’s anatomy, the type of restoration required and the desired outcome. 

Zygomatic implants are dental implants that are longer than conventional ones and utilise the zygomatic bone, located in the cheekbone region, for anchorage. They are mainly used in the rehabilitation of the upper jaw where there is significant bone atrophy or bone loss, when conventional implants cannot be placed under suitable conditions without additional procedures.

They can support prosthetic restorations in carefully selected cases, but are not a routine solution for every missing tooth or every bone deficiency.

Zygomatic implants are reserved for carefully selected cases. They do not replace conventional implants when there is sufficient bone for conventional treatment, but may offer an alternative in cases where the anatomy of the jaw or a history of previous treatment limits other options.

Severe bone atrophy in the upper jaw

Following tooth loss, the bone may gradually resorb. In certain cases, bone loss is so advanced that the remaining bone volume is no longer sufficient for the placement of conventional implants without additional procedures.

In such situations, zygomatic implants may be considered as part of the treatment plan.

Failure of previous treatments

Some patients have already undergone bone grafting procedures that did not produce the desired result, or have lost previously placed implants.

In these cases, a different strategy may be required, and zygomatic implants may be one of the options considered.

Situations where extensive bone reconstruction is to be avoided

Extensive bone reconstruction may involve multiple surgical stages and a longer treatment time.

In certain situations, zygomatic implants can reduce the need for extensive bone augmentation procedures and the number of surgical stages.

However, the decision is made only after a thorough assessment of the patient’s anatomy, general health and prosthetic goal.

The main differences relate to the area in which the implants are anchored, their length and placement, the amount of bone required, and the complexity of the surgical planning.

The length and position of the implants

Zygomatic implants are longer, and their trajectory differs from that of conventional implants.

These characteristics make positioning and surgical planning more complex and require a careful three-dimensional analysis of the patient’s anatomy.

Complexity of the procedure

Conventional implants are used in most standard cases where there is adequate bone support.

Zygomatic implants are reserved for complex cases and require specific surgical expertise, as well as careful planning of their relationship with the anatomical structures in the region. 

In certain cases, yes.

Zygomatic implants can reduce the need for extensive bone reconstruction in selected patients with severe atrophy of the upper jaw.

However, this does not mean that bone augmentation is unnecessary in all cases, nor that zygomatic implants are automatically the most suitable solution.

The patient’s anatomy, the prosthetic goal and the available alternatives must all be considered.

If you have been told that you do not have enough bone for implants, you can find out more in our article on the possibility of having fixed teeth when there is a bone deficit.

Planning is one of the most important stages of treatment, as the procedure must be tailored to both the patient’s anatomy and the desired prosthetic outcome.

The assessment may include:

• a clinical consultation;
• review of medical history;
• examination of the maxillary and zygomatic bones;
• CBCT and three-dimensional analysis;
• assessment of the maxillary sinuses;
• planning of implant placement;
• determination of the future prosthetic restoration.

Why is prosthetic planning important?

The position of the implants must also be determined with regard to the future fixed restoration.

Function, force distribution and the possibility of proper oral hygiene must be taken into account right from the planning stage.

For this reason, collaboration between the surgical and prosthetic teams is essential for developing a coherent treatment plan. 

Where clinically indicated, zygomatic implants can broaden the range of treatment options for patients with severe bone atrophy in the upper jaw.

Possible advantages include:

• the possibility of restoring jaws with severe bone loss;
• a reduced need for extensive bone grafts in certain cases;
• the possibility of achieving a fixed restoration;
• a reduction in the number of surgical stages in certain situations;
• the availability of an alternative following the failure of previous treatments.

Can fixed teeth be placed immediately on zygomatic implants?

In certain cases, immediate loading with a fixed temporary restoration may be possible.

However, this option is not suitable for every patient. Sufficient implant stability must be achieved, and the clinical situation must allow for the immediate loading protocol.

The decision is made following an assessment, and the final restoration is carried out at a later stage.

Zygomatic implants are used in complex cases, and this involves a number of specific considerations and risks that must be discussed prior to treatment.

These include:

• the greater complexity of the surgical procedure;
• the close proximity to the maxillary sinus and other anatomical structures;
• possible sinus complications;
• soft tissue complications;
• possible prosthetic problems;
• the need for advanced surgical experience.

Sinusitis is one of the complications described in the literature on zygomatic implants, which is why assessment of the maxillary sinuses and careful planning are important. 

The choice is not based solely on the amount of bone available. The doctor must analyse the full clinical picture and compare the possible treatment options.

The following factors are taken into account:

• the amount and distribution of available bone;
• the anatomy of the jaw;
• history of previous procedures;
• the need for augmentation procedures;
• general state of health;
• the prosthetic objective;
• available alternatives.

For more information on the options available when bone resorption is significant, you may also wish to read the article on dental implants in cases of severe bone loss.

Zygomatic implants are not the first choice for every patient

Zygomatic implants are intended for carefully selected cases.

Where the anatomy permits the use of conventional implants, these remain a standard treatment option. The choice of a zygomatic solution must be justified by the clinical situation and determined following an individual assessment. 

Zygomatic implants may be an option in certain cases involving severe bone deficiency in the upper jaw, but the indication must be determined on a case-by-case basis.

The treatment must be weighed up against existing alternatives, and careful patient selection is essential. Surgical and prosthetic planning must be carried out jointly from the outset.

If you have been told that you do not have enough bone for implants, book an implantology assessment and find out which treatment options may be suitable for your situation.