Zygomatic Implants: making sense of the sea of implant options

20 July 2021
3 min read

Today there are a plethora of different treatment strategies and implant systems available, each with different indications and their own strengths. While this takes us further away from standardisation and creates complexity, it is ultimately advantageous to patients. Systems are now available that allow more patients to safely receive implants than previously possible, which is an achievement worth celebrating. When the only tool you have is a hammer, every problem looks like a nail – more options allow us to better tailor treatment to the needs of a patient according to their individual anatomical, aesthetic, and functional requirements.

There are dozens of suppliers of dental implants, offering variations on almost every aspect of the design; from the basic shape to the precise material selected. Some patients are well-served with a straightforward single tooth replacement, while others require implant-supported bridges or full-arch reconstruction. Some patients demand the best aesthetic results possible, while others are more concerned with durability and comfort, and many have a mix of expectations.

Where there is insufficient bone tissue to support implants, bone grafting is typically required, such as a sinus lift. Whilst maxillary sinus grafting has been shown to be a highly successful long-term treatment modality, it has significant drawbacks, including extended period of graft maturation followed by longer implant rehabilitation. Failing full arch implants often result in total loss of alveolar bone, especially in the pre-maxillary region, as is the case in severely atrophic maxilla, necessitating major extraoral grafting surgery.

Zygomatic Implants offer a graftless alternative for the rehabilitation of the severely atrophic maxilla. Zygomatic procedures enable patients with severely atrophic maxilla to be fitted with implant-support prostheses without the need for costly, time-consuming, and difficult bone grafts. Dentures can be difficult to impossible for patients with extensive bone defects, such as those caused by some congenital conditions, or that occur during head and neck cancer treatment. Because these implants are anchored into the zygoma bone, rehabilitation could routinely be completed in a single day where anatomical deficiencies would have rendered other methods non-viable.

While zygomatic implants are, for obvious reasons, only viable in the maxilla, edentulism in the maxilla is considerably more common than in the mandible, occurring around 35 times as often. Consequently, there are many patients who can potentially benefit from the procedure.

Since initial development by Brånemark et al., (2004), modern zygomatic implants have undergone further scientific development by Carlos Aparicio’s ZAGA group (Aparicio et al, 2008). The anatomically-guided ZAGA concept uses the newly launched Straumann/ZAGA implant system that involves five main surgical approaches (ZAGA type 0-IV) for zygomatic implant placement: full intrasinus, combined intra/extrasinus path, or extramaxillary trajectory.

The ZAGA technique recognises the existence of the inter – and intra-individual anatomical differences and aims to preserve the integrity of the maxillary sinus whilst maximising implant primary stability and bone implant contact (BIC). This is achieved by engaging the three key pillars of the facial anatomical architecture: the zygoma, alveolar bone and the lateral wall of the maxillary sinus. For this purpose, “Tunnel” or “Channel” osteotomy techniques are employed according to each anatomical situation. Furthermore, a prosthodontically-driven implant trajectory allows the head of the implant to be positioned at an optimal restorative site, whilst the alveolar bone and lateral wall of the sinus are preserved for optimum bone seal and stability, to prevent future hard and soft tissue complications. 

Material and engineering differences between implant systems can also impact treatment outcomes. The ZAGA implants have been developed as a result of close collaboration between ZAGA and Straumann implants, and offer the benefit of Straumann Groups leading position in the field of implant dentistry.

The drawback with a diversity of systems is that it increases the breadth of knowledge expected from clinicians, and places more complicated and costly inventory demands on practices. Additionally, as implantology continues to mature, we will likely see older designs and methods being deprecated; which could add to the challenge of restoring failing implants in some instances.

If you are dealing with a complex or urgent case, such as a patient with failing implants, consider referring your patient to the Centre for Oral-Maxillofacial and Dental Implant Reconstruction, a ZAGA centre based in Manchester. Led by Professor Cemal Ucer – Specialist Oral Surgeon – the practice offers the latest patient-centric treatments and technologies. The team are well-versed in complex procedures, including nerve lateralisation and repositioning, allografts, and of course zygomatic dental implants – allowing us to find the right solution for your patient’s specific needs.

The diversity of implant systems and approaches currently in use can be intimidating, but it is a truism that diversity is a strength. In the natural world evolution pushes towards diversity, inevitably filling ecological niches as they occur and creating a more robust system overall. While not quite as endlessly adaptive, the current market for implant systems is working hard to fulfil various niches. With adequate knowledge, the current variation between implant systems provides scope for quite specific patient needs to be targeted with great results.