Zygomatic implants: the solution when there is no bone left in the upper jaw

When the upper jaw has lost almost all of its bone, a standard implant has nowhere to anchor. A zygomatic implant looks for another point of support: the cheekbone, which resorbs very little.

  • No years of bone grafting
  • CBCT planning
  • Oral and maxillofacial surgery
  • Fast fixed provisional restoration, when stability allows
Zygomatic implant — anchorage in the zygomatic bone, at Smile by Ada

A standard implant is anchored in the alveolar bone, where the root of the tooth used to be. That bone gradually disappears after tooth loss, and in patients who have had no teeth for many years, or who have worn a removable denture for a long time, it can become insufficient even for bone grafting. A zygomatic implant bypasses the resorbed area and is anchored in the zygomatic bone, which has never supported teeth and therefore resorbs very little.

Hence the size: a standard implant is between 8 and 15 millimetres long, a zygomatic one between 30 and 55. The classic approach places two zygomatic implants at the sides and two standard implants at the front. When the front area has also been lost, four zygomatic implants are used.

It is not a simpler version of a standard implant but an oral and maxillofacial surgical procedure. It is planned on CBCT, carried out under sedation or general anaesthesia and requires specific training in this technique. We propose it only where it is indicated, after evaluating the alternatives.

When it is recommended

A zygomatic implant addresses a single situation: a severely atrophic upper jaw in a patient with no teeth, where a conventional implant has nowhere to anchor.

  • You have worn a full removable denture for years and the bone has resorbed
  • You have been turned down for implants because of a lack of bone
  • Bone grafting or a sinus lift would not provide a sufficient base, or you have already tried them and they did not succeed
  • You want a fixed solution and cannot commit to the months-long timeline that bone reconstruction requires

How it differs from a standard implant and a sinus lift

The three approaches solve the same problem in different ways, and the choice is not a preference but a consequence of the CBCT measurements.

  • A standard implant needs sufficient alveolar bone. It is the first option whenever that bone is there.
  • A sinus lift rebuilds the bone, and a standard implant is placed afterwards. The timeline usually requires between 4 and 9 months of healing.
  • A zygomatic implant forgoes rebuilding the bone and seeks support in the zygomatic bone. The procedure is more extensive, but the fixed restoration comes within a few days, not a few months.

What the treatment involves

  • Consultation and CBCT. The available bone is measured, the sinuses are checked, and the number and path of the implants are decided
  • Prosthetic planning before surgery: the restoration that will sit on the implants is known from the start
  • The procedure, under deep sedation or general anaesthesia
  • The provisional fixed restoration, fitted in the first few days when initial stability allows
  • The definitive restoration, after the healing period set by your surgeon

Recovery

Swelling and bruising in the cheek area are expected and subside within a few days. The first two weeks call for a soft diet and careful hygiene.

Long-term hygiene matters more than with standard implants. The path of the implant makes cleaning more demanding, and regular check-ups are not optional.

  • Do not blow your nose for the period indicated by your surgeon
  • No smoking and no strenuous physical activity in the first few days
  • Take the prescribed antibiotic exactly as directed
  • Regular check-ups, with professional cleaning of the restoration

Risks and limitations

The survival rates reported in the literature are high, but complications occur more often than with standard implants. We tell you about them beforehand, not afterwards.

  • Sinusitis is the most frequently reported long-term complication
  • There are rare but serious risks related to the path of the implant close to the eye socket. This is precisely why planning is done on CBCT, not on a panoramic X-ray
  • Soft-tissue problems around the implant and difficult hygiene are real limitations of the technique
  • It is not performed during acute sinusitis or with untreated sinus disease
  • Heavy smoking and uncontrolled medical conditions reduce the chances of success

What it includes

  • ✓Two zygomatic implants plus conventional implants at the front
  • ✓Quad zygoma: four zygomatic implants, for total atrophy
  • ✓CBCT planning
  • ✓Provisional fixed restoration in the first few days, when stability allows
  • ✓Deep sedation or general anaesthesia
Your specialists

Dr. George Stuparu

Specialist in oral and maxillofacial surgery

Dr. Alexandra Gheorghe Prunache

Specialist in oral and maxillofacial surgery

Cases of severe atrophy are planned on CBCT together with the prosthetic stage, in a single plan discussed with the patient before the procedure.

Frequently asked questions

How soon will I have fixed teeth?

When initial stability allows, the provisional fixed restoration is fitted in the first few days after the procedure. The definitive restoration follows after the healing period set by your surgeon.

Does it hurt?

The procedure is carried out under deep sedation or general anaesthesia, so you feel nothing during it. The discomfort afterwards is controlled with the prescribed medication and is most noticeable in the first few days.

I was turned down elsewhere because of a lack of bone. Is it the same thing?

Most often the refusal refers to a standard implant, which needs alveolar bone. Zygomatic implants exist precisely for situations where that bone is no longer there. The real assessment is made on CBCT.

Is it better than a bone graft?

It is not better, it is different. A graft rebuilds the bone and allows a standard implant, but it requires months of healing. A zygomatic implant shortens the path, at the cost of a more extensive procedure. The choice is made case by case, not on principle.

How much does it cost?

The plan is given in writing after the consultation with CBCT, because the number of implants and the type of restoration vary greatly from one case to another. We do not give estimates over the phone for this procedure.

Sources and references

The information above is for education only and does not replace a medical consultation.