Zygomatic implants

In the 1990s, P.I. Bränemark (Sweden) started using the bone that forms the cheek as an anchoring point for (zygomatic) dental implants. In the year 2003-2004, documentation and data were published showing success rates with zygomatic implants were as good as with conventional implants.

The technique of zygomatic implants has been developed over the last twenty years, and, as such, those implants are not really a point of debate. They do not rely on the alveolar jaw bone anchorage, as conventional implants do, but rely solely on the zygoma anchorage. Those implants are much longer (3.5 to 5 cm) than the regular dental implants (0.7 to 1.5 cm).

The zygomatic bone is an excellent quality bone with sufficient bony volume in virtually all patients. In each zygoma there is enough space and volume to place one or two implants. When those implants are connected to a fixed dental bridge work, they are conceived to withstand normal chewing forces.

The zygomatic bone, as part of the facial bones, is particularly well known by maxillofacial surgeons since zygoma fractures occur frequently in people (fights, car accidents, work & sport accidents) and are almost exclusively treated by this specialty.

The advice to patients therefore is that such zygomatic implants should be placed by somebody who is really well-trained (i.e. a maxillofacial surgeon, with a vast knowledge of the immediate environmental structures of the zygoma bones).

In conclusion: zygomatic implants are an extremely welcoming adjunct in the dental implant universe, and Dr Defrancq is using them on a regular basis.

The indication

Zygomatic implants are reserved for patients with an explicit lack of bone in the back area of the upper jaw. Older patients are good indications, since no bone grafts are necessary and the fitting supra-structure (i.e. teeth) can be made immediately (i.e. from a practical point of view, three days after implantation, with an aesthetic fitting included).

With zygomatic implants, patients have teeth in a couple of days, whereas if implants have to be placed into the graft it takes about eight months at least to finalise the extended bridge.

Most often, one zygomatic implant on each side can be combined with regular implants in the front region.
Sometimes two of those implants are placed both sides in more extreme cases.

The procedure

Before the operation, an extended i-cat is taken, enabling us to study the bone structures, especially the zygoma bones in a three-dimensional way. Zygomatic implants are placed in a surgical procedure under general anaesthesia.

There are two basic options:

  • Option 1: Four zygomatic implants are placed in the totally & extremely atrophic upper jaw (no bone for regular implants), followed by a fixed supra-structure (teeth) within a few days. An extra regular implant at the front is always welcome for reasons of stability and can prevent a lot of regret afterwards.
  • Option 2: Two zygomatic implants are placed in the second premolar area, and three to four regular implants in the anterior upper jaw. This option is also followed by a fixed supra-structure (teeth) within a few days.

Indeed, usually some bone is still available in the anterior part of the upper jaw straight under the nose area. If a few (two to four) regular implants can be placed in the front area, then Dr Defrancq always does so. The sinuses are located in the more posterior part of the jaw, and due to the expansion of the sinuses there is often not enough bone available. Dr Defrancq places two zygomatic implants there. An immediate loading always follows the procedure, and patients have fixed porcelain or chrome cobalt teeth within a week.

Taking care of your oral hygiene after the implants

Having a fixed bridge on zygomatic implants still means that you need to maintain regular daily oral hygiene. Along with brushing, most patients use a water-pick for routine cleaning around the implants and the bridge. Visits to a mouth hygienist on a regular basis are also mandatory for control and/or cleaning.

The mucosal area around the zygomatic implants must be checked for dehiscence. Dr Defrancq is convinced this is certainly ‘surgical technique’ sensitive.

A soft plastic mouth guard during the night may be advisable, certainly during the first year, and certainly if you know you will be clenching your teeth.

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