Zygomatic implants allow teeth replacement despite poor bone quantity

Zygomatic implants, also known as zygoma implants, are extra-long type of dental implants dentists and oral surgeons place in the upper jawbone (maxilla) of patients affected by very poor bone quantity. The scope is to support a fixed fake teeth arch (all dental elements replacement) or 2 to 5 unit bridge (partially edentulous people).

Zygomatic implants anchor to the zygoma bone (cheek bone) independently of the jawbone quantity you lost that’s why they are a good alternative to pre-implant oral surgery such as bone graft or sinus lift.

Conventional dental implants need at least 10 mm of bone and they have to guaranty 35 Ncm torque to allow immediate load. With zygomatic implants you can have your new teeth in one day without the need to wait for the bone to regrow or to integrate in case of grafting surgery.

Why is my jawbone not enough for implants ?

There are many different reasons why a person may not have enough bone to support standard implants to replace missing teeth. Here is a list of the most common:

Because you lost your natural teeth long ago so you are a long-time dentures wearer

As soon as you lose your natural dental due to different reasons, the soft tissue (gums) and the bone start to reabsorb. This is a natural and irreversible process.

The point is that our body doesn’t keep what is useless. The jawbone becomes useless because it doesn’t have to keep teeth in place any more. After a while, when you decide to replace your teeth with dental implants, the dentist has to check whether the remained bone in the upper jaw is enough to support titanium / zirconia screws or not. In the negative case bone graft is required before the conventional implant placement procedure.

After that you also have to wait for the healing (about  6 to 8 month). The last step involves the implants insertion and an additional healing time to allow the screws to integrate with the new bone (osseointegration).

As you can see it is a very long procedure and painful for many patients but not for all. So after at least 12 month and three surgical operation, you can have your new teeth in place.

Zygomatic implants dramatically reduce the time you have to wait because they can be placed and loaded within the same appointment (same day teeth) so you can leave the dental office with your new fake teeth.

Because of failed bone graft

In the description above I mentioned the hard tissue grafting is required to support the implants but I didn’t say that procedure may fail. In that case you can still have your implant-supported dentures thanks to zygomatic dental implants.

Because of trauma or accident

Accidents or trauma may happen at any age so what if you lose an important portion of the upper jaw ? Do you want to stay without teeth ? The solution is to find a reputable oral surgeon who is able to insert implants in your cheekbone and anchor to it the dental prosthesis.

The same procedure works in case of rehabilitation after oral cancer resection or failed sinus augmentation.

How do zygomatic implants work ?

Statistics reveal that the upper back jawbone (ware molars or bicuspid teeth used to be – quad zygoma – ) is more soft and thin than that we can find in the front part of the mouth (canines and incisors zone). In case of severe atrophy it is impossible to rely on that poor volume to support conventional implants.

Using the zygoma protocol, surgeons insert each zygomatic implant from the inside of the mouth starting from the alveolar crest. The primary stability is assured by the anchorage to the more hard cheek bone.

Depending on the anatomical structure of the patient, zygomatic implants can go  through or right next to maxillary sinuses (extrasinus placement) as shown by the images below.

The second surgical approach decreases the sinusitis risk.

To get more stability, 1 to 4 standard implants can be added in the front part of the upper jaw.

Pre-surgery Exams and 3D Insertion Planning

In order to plan the surgical procedure, you have to undergo a few painless exams:

Panoramic (2D) radiography

This X-rays exam is necessary to get the big picture but it is not enough because it doesn’t allow the dentist to exactly evaluate the volume of the involved bone;

Static and dynamic bite recording

The bite recording allows the technician to evaluate your bite high and recreate the perfect occlusion once zygomatic implants and dental prosthesis will be in place.

Blood exam and anesthesia allergy test

Since the surgery requires local anesthesia combined with intra-venous sedation (sleep dentistry), blood exam is mandatory as well as the test that confirms you are not allergic to anesthesia.

Gums impression

A study model is created starting from your gum impression so the dental technician can build up the temporary dentures you will wear immediately after the implants surgery placement and for the next 2 to 4 months.

Cone beam computed tomography (CBCT)

CBCT is the most important X-rays exam you have to undergo.
With a single rotation around your head, Cone beam Computed Tomography can acquire a volumetric data set of your bones, gums, sinuses and other anatomical structures.

The scanning software collects all the images together creating a three-dimensional (3D) virtual model where the dentist can virtually place the zygomatic implants. A plastic drill guide is then fabricated based on the virtual implant placement.

How many zygoma implants do I need ?

Case 1:

The most frequent case is when the surgeon plans to insert 2 zygomatic implants on each side of the maxilla. Those implants may go through the sinus alveolar and are screwed to the cheekbone.

Case 2:

To give the dentures more stability and strength, the dentist can add 1 to 4 standard titanium implants to the front of the jaw in the area where the upper front teeth used to be. The conventional implants can also be angulated (45°).

Case 3:

In situations where the bone availability is extremely poor, up to 4 zygomatic Implants may be placed to achieve a stable support for the dental prostheses.

The prosthetic stage

Once the implants are in place a temporary denture or bridge is attached to them using special screws. The temporary denture has two main goals: the first and easy to guess is giving the patient the possibility eat, speak well and get his/her aesthetics back. The second scope is to keep the zygomatic implants firmly in place to ensure the correct osseointegration.

The denture is made of acrylic and includes 10 to 12 prosthetic resin/composite teeth. The ruff of the mouth (palate) won’t be covered by the fixed bridge.

Usually the denture has its false pink gingiva to fill the gap in between the soft tissue and the base of fake teeth.

Post-surgery, recovery and healing time

Immediately after surgery you may experience bleeding, swelling and different grade of pain in the treated zone. The Ice bag helps you to keep swelling under control. The dentist will prescribe you antibiotics you should take for 5 to 7 days to avoid infection. In addition, to deal with the pain, over-the-counter painkillers work very well.

The post-operative rinses with chlorhexidine mouthwash provide good control over oral bacteria and you should use it unless there is a specific contraindication. Chlorhexidine mouthwash reduces the amount bacteria in the oral cavity and favors the healing process.

Approximately 2 month after surgery, the dentist call you back at the dental office to:

• unscrew the prosthesis;
• inspect the healing;
• remove the stiches (sutures).

A few visits to the dentist are required to adjust the dental prosthesis, correct the bite and check the healing process.

4 to 6 months later, the prosthodontist will replace the temporary denture with the definitive and, finally,  the whole restoration of your mouth is over !!!

Advantages of zygomatic over conventional

• bone grafting or sinus lift are not necessary.
  It dramatically reduces the overall timeframe to reach the complete mouth restoration.
• The risk of osseointegration failure decrease.
  In fact, the cheek bone is much harder than upper jawbone and zygomatic implants are much longer and stronger;
• The patient will never experience embarrassment because he/she will always have teeth in the mouth;
• The surgery can be done under IV sedation (while you are sleeping);
• People with severe upper jawbone atrophy can replace their teeth with implants instead of to continue with uncomfortable removable dentures.
• The patient aesthetics is equal to or better than the natural teeth because it is possible to adjust the color and the shape of the fake teeth.

How much do Zygomatic implants cost ?

The surgical zygoma procedure requires both skilled oral surgeon trained in zygomatic implants  and very good products.

As for the cost of zygomatic implants, here is a price table that can give you an overall idea about the single and total price the complete restoration will cost.

The price for 4 zygoma implants + temporary denture (the upper one) starts from $12,000

The cost for 6 zygoma implants + temporary denture (the upper one) starts from $16,000.

The prices listed above are average zygomatic implants costs and do not include complementary services.

Are there additional costs I have to calculate ?

• Initial consultation and pre-surgery exams (X-rays and CBCT) = $350;
• Residual damaged teeth extractions;
• Intra-venous sedation = $125/hour
• IV sedation = $150/hour
• Definitive dentures = from $2,000 (composite teeth) up to $8,000 (zirconia fake teeth)

The price you will pay also dipend on the implants brand. Here is an article about the best dental implants available on the market.

Does my insurance cover the zygomatic implants cost ?

Unfortunately there are a few expensive dental insurance plans that cover the partial cost of the restoration using this type of implants. The good news is that insurance companies are changing their policy due to the fact that replacing missing teeth with implants is more convenient than using alternatives such as bridges (in the long term).

Prognosis and success rate

It is one of the few times that the “All on 4” procedure can be done predictably in the upper jaw because the implants are much longer and stronger.

The zygomatic implants success rate is very high: 98% (the same as conventionals).

Risks and Complications

The most common complication associated with zygomatic implants is sinusitis. That’s because of the maxilla sinuses perforation (bacteria can have easy access to the sinus area).

Planning an extra-sinus surgical approach and immediate loading of the implants seems to reduce or even eliminate the sinusitis risk.

Additional complications reported during and after the zygoma implants placement include:

• infraorbital nerve paresthesia,
• orosinusal fistula;
• perforation of the orbit.

Conclusion

Zygomatic implants combined with fixed dentures are the definitive solution for patients who do not have enough bone in the upper jaw. A well skilled and experienced oral surgeon is required as well as an adequate surgical planing.

CBCT is the only X-rays exam that can guaranty the procedure success guiding the surgeon in each step.

Do not forget that even if you don’t have natural teeth, you still have to keep your mouth as clean as possible. In fact the first cause of implants failure called peri-implantitis, are bacteria that form the dental plaque. Visit the dental office twice a year to get your denture professionally cleaned and relined.