What are zygomatic implants?
Conventional dental implants use the bone available in the upper jaw, or in the lower jaw, to obtain stability. When there is adequate bone volume in those regions, that is the usual approach.
Zygomatic implants are longer implants, planned to obtain anchorage in the zygomatic bone, popularly known as the cheekbone. That region tends to preserve bone volume even when the upper jaw shows pronounced loss. For this reason, in selected cases of severe atrophy of the upper jaw, this alternative may be studied.
An important point from the outset: zygomatic implants are not a universal solution and do not replace individual assessment. The indication depends on clinical examination, on computed tomography and on the analysis of the health conditions of each patient.
Why do some people not have enough bone for implants?
The amount of available bone varies considerably from person to person and may change over time. Among the situations that may be associated with reduced bone volume are:
- Prolonged tooth absence, since the bone that supported the tooth tends to remodel as time passes.
- Progressive bone resorption, which may occur gradually in some regions of the arch.
- A history of periodontal disease, a condition that may affect the supporting tissues of the teeth.
- Previous surgeries or treatments, depending on what was performed and on how healing occurred.
- Individual anatomical characteristics, including the position of the maxillary sinus and the shape of the bone ridge.
One detail is worth highlighting, because it often causes confusion. Hearing the phrase "you have bone loss" does not describe the case in full. What guides the planning is the amount of remaining bone, the region in which it is available and its relationship with the neighbouring anatomical structures. Two patients with the same phrase in their report may have quite different clinical situations.
Does little bone mean I cannot have implants?
No, not necessarily. Bone loss does not automatically eliminate the possibility of rehabilitation with implants. It changes the type of planning required.
Depending on the anatomy and on the goals of the treatment, the possibilities may include:
- Conventional implants, when there is sufficient bone in appropriate regions.
- Bone grafting, to recover volume in specific areas.
- Maxillary sinus lift, a procedure indicated in certain situations of the upper posterior region.
- Bone reconstruction, when structure needs to be recovered more broadly.
- Alternative implant positioning, making use of regions with better bone availability.
- Zygomatic implants, in selected cases of severe atrophy of the upper jaw.
None of these alternatives is superior to the others in absolute terms. Each one responds to a distinct clinical situation, and the comparison only makes sense in the face of a concrete case.
When may zygomatic implants be considered?
The assessment of this alternative usually arises in situations of severe atrophy of the upper jaw, in which bone availability in the regions habitually used is limited and conventional anchorage becomes difficult.
Some points are usually analysed in this study:
- The indication is specific to each case and does not follow merely from a report of bone loss.
- Computed tomography is an important part of the planning, because it allows the anatomy to be assessed in three dimensions.
- Systemic health conditions are considered, as are the medical and dental history.
- Local conditions of the mouth matter, including tissue health and the situation of any remaining teeth.
It is important to be clear that not every patient with bone loss needs zygomatic implants or has an indication for them. In many cases, other approaches respond better to the clinical situation presented.
Can a zygomatic implant avoid bone grafting?
This is one of the most frequent questions, and the answer calls for care. In selected cases, anchorage in the zygomatic bone may reduce or avoid the need for certain extensive grafting procedures, since stability is sought in a region different from the upper jaw.
This, however, does not always happen. It is worth considering that:
- It is not always possible, because the indication depends on individual anatomy.
- Grafting may remain the better indication in various clinical situations.
- Different approaches may be combined in certain treatment plans.
- The choice depends on the goal of the treatment, and not merely on avoiding a surgical stage.
About the expression "implants without grafting": it appears frequently in searches, and understandably so, because many patients want to avoid additional procedures. Even so, treated as a promise, the expression oversimplifies the clinical decision. What exists are situations in which the strategy adopted may dispense with certain grafts, and situations in which bone reconstruction remains the more appropriate path. That difference only becomes apparent after the assessment.
What is the difference between a conventional implant and a zygomatic implant?
The table below summarises the main differences in general terms. It is intended to guide understanding, not to define an indication.
| Criterion | Conventional implant | Zygomatic implant |
|---|---|---|
| Main anchorage area | Bone ridge of the upper or lower jaw | Zygomatic bone |
| Typical clinical situation | Preserved bone volume or localised loss | Severe atrophy of the upper jaw in selected cases |
| Bone availability required | Depends on height and thickness at the implant site | Considered when availability in the upper jaw is insufficient |
| Surgical complexity | Varies with the case, generally lower | Higher, due to the anatomy involved in the planning |
| Imaging planning | CT scan recommended during planning | CT scan is an essential part of the assessment |
| Indication | Broad, according to clinical assessment | Restricted to specific cases, after assessment |
Neither of the two approaches is categorically better than the other. They are different responses to different anatomical situations.
How is the assessment carried out?
The purpose of the assessment is to understand the real situation of your case before discussing any technique. The path usually follows these stages:
- Consultation and clinical history, including general health, medications in use and previous treatments.
- Assessment of the mouth and current condition, observing tissues, remaining teeth and prostheses in use.
- Computed tomography, which allows the anatomy to be studied in three dimensions.
- Analysis of bone availability and distribution, checking where bone exists and in what quantity.
- Definition of the possible alternatives, comparing the approaches appropriate to that anatomy.
- Individualised planning, presenting the stages and what to expect at each one.
Cases involving pronounced bone loss require attention to the anatomy of the region and to surgical planning. The practice of Dr. Jorge Fornaciari combines training in Oral and Maxillofacial Surgery with experience in Implant Dentistry, which allows the structures involved and the rehabilitation alternatives to be assessed together.
Is it possible to have fixed teeth more quickly?
In certain cases, provisional rehabilitation may be considered within a shorter period after the surgery. This possibility, known as immediate loading, depends on factors that can only be assessed individually.
Among them are the stability obtained by the implants during the procedure, the anatomy of the region, the treatment plan defined and the clinical conditions of the patient. It is not an automatic feature of any technique, including zygomatic implants.
For that reason, it is prudent to avoid expectations fixed on timescales before the assessment. The planning defines what is possible in each situation and how long it takes.
Is a zygomatic implant a more complex surgery?
Yes, in the sense that it requires specific surgical planning. The anatomy involved in the zygomatic region and its proximity to important structures make prior imaging study and surgical experience particularly relevant.
For that reason, this type of case should be assessed calmly, with appropriate examinations and with a clear discussion of the available alternatives. Well conducted planning considers both technical feasibility and what makes sense for the patient.
Dr. Jorge Fornaciari
Dental Surgeon
Oral and Maxillofacial Surgery
Implant Dentistry
CRO-SP 27.096
More than 40 years of practice in Campinas
What is the first step to find out whether I have an indication?
If you have been told that you do not have enough bone for conventional implants, the first step is not to choose a technique. It is to understand exactly how much bone exists, where it is available and which alternatives are appropriate for your anatomy.
Clinical assessment combined with a CT scan makes it possible to compare possibilities such as conventional implants, bone reconstruction, grafts and, where there is an indication, zygomatic implants. With that information in hand, the conversation stops being about the names of techniques and becomes about what makes sense in your case.
Understand which alternatives exist for your case
At Clínica Realize, the assessment considers the clinical examination and the CT scan in order to check bone availability and present the treatment possibilities, with an explanation of each stage.
Book an assessment →Frequently asked questions about zygomatic implants
It is an implant longer than the conventional one, planned to obtain anchorage in the zygomatic bone, popularly known as the cheekbone. It is considered in selected situations in which bone loss in the upper jaw makes the placement of conventional implants difficult. The indication depends on clinical assessment and on imaging.
Not necessarily ruled out. The information that there is little bone, on its own, does not define the treatment. What guides the planning is how much bone exists, in which regions it is available and what the clinical conditions of the patient are. From that assessment it becomes possible to compare alternatives.
The indication is usually studied in cases of severe atrophy of the upper jaw, when bone availability in the usual regions is limited. Beyond the anatomy, the health history, the local conditions of the mouth and the goals of treatment are considered. Not every patient with bone loss has an indication for this technique.
In selected cases, zygomatic anchorage may reduce or avoid certain extensive grafting procedures. This does not always happen. In several situations bone reconstruction remains the more appropriate indication, and there are cases in which different approaches can be combined. The decision depends on the anatomy and on the goal of the treatment.
The conventional implant seeks anchorage in the bone ridge of the upper or lower jaw. The zygomatic implant is longer and seeks anchorage in the zygomatic bone, being considered when bone availability in the upper jaw is insufficient for the conventional approach. Imaging planning and surgical complexity also differ.
In some cases a provisional rehabilitation may be considered within a shorter period, but this is not automatic. It depends on the stability obtained during the surgery, on the anatomy, on the treatment plan and on the clinical conditions. This possibility can only be assessed individually.
The assessment combines the clinical examination with computed tomography. The imaging exam allows the height, thickness and distribution of the available bone to be observed, as well as the relevant anatomical structures. Only with this information is it possible to say which alternatives are appropriate for each case.
Yes. Computed tomography is an important part of this planning, because it allows the anatomy of the upper jaw and of the neighbouring structures to be assessed in three dimensions. Without this study it is not possible to define the indication safely nor to compare the treatment alternatives.