Zygomatic Implants

A zygomatic implant is a long, special type of implant used when there is not enough bone left in the upper jaw for regular implants. Regular implants are 8–16 mm long, while zygomatic implants are 30–50 mm. They start from the back of the upper jaw inside the mouth, extend upwards and their tip is anchored in the cheekbone (zygoma).

The cheekbone is dense and strong, and it is usually not affected by the bone loss that follows tooth loss in the jaw. So even when no bone is left in the upper jaw, it can give the implant strong support.

Zygomatic implants are not used for a single tooth but to support the full set of upper teeth. In most plans, one zygomatic implant is placed on each side with regular implants at the front. If bone at the front is also insufficient, two zygomatic implants can be placed on each side. The whole set of teeth is screwed onto these implants; the idea is similar to All-on-4 and All-on-6.

• People with advanced bone loss in the upper jaw after being without teeth for a long time
• People who have had bone grafting or a sinus lift that was not successful
• Patients whose upper denture does not stay in place, keeps moving and who want fixed teeth
• People with bone loss in the upper jaw due to a tumour or trauma (in this case the plan is made individually)

Zygomatic implants are used only in the upper jaw. If bone is insufficient in the lower jaw, other methods are considered.

The general requirements for implants apply here too. Because the procedure requires general anaesthesia, general health is assessed separately. Uncontrolled diabetes, heart and lung conditions, blood thinners or certain osteoporosis medicines, heavy smoking and active or recurrent sinusitis are discussed before treatment and, where needed, we work together with the relevant doctor.

When there is not enough bone in the upper jaw, there are two main approaches:

• Build up bone first, then place implants. The jaw is rebuilt with a sinus lift and bone grafts, and if necessary grafts taken from the hip. It usually takes several months for the bone to mature, after which the implants are placed and healing is awaited again. The total time is long and more than one operation may be needed.
• Use the bone that is there. Zygomatic implants take support from the cheekbone instead of the missing bone in the jaw. In most cases no bone grafting is needed, and in suitable cases temporary fixed teeth are fitted on the same day as the operation.

Which approach is right differs from person to person. For some patients, bone grafting may still be the better option. The decision is made together after the bone, sinuses and cheekbone have been examined on a 3D CT scan.

1. Examination and 3D CT scan. The amount of bone in the upper jaw, the health of the sinuses and the structure of the cheekbone are examined in detail on the scan. If a sinus problem is suspected, it is assessed before treatment.
2. General health assessment. The tests needed before general anaesthesia are carried out and your medicines and conditions are reviewed.
3. Planning and impressions. The number, position and angle of the implants are planned on the scan. An impression or digital scan is taken in advance for the temporary teeth, and the length and colour of the teeth are discussed.
4. Operation. Under general anaesthesia, any teeth that need removing are extracted and the implants are placed. The implants are placed from inside the mouth; no incision is made on the face.
5. Temporary fixed teeth. In suitable cases, the temporary teeth prepared in advance are screwed onto the implants on the same day.
6. Permanent set of teeth. When healing is complete, usually after 3–6 months, a new impression is taken and a permanent set of teeth made from a more durable material is fitted.

Because the operation is done under general anaesthesia, some preparation is needed. You will be given personal written instructions at the examination; in general:

• Tell us about all your medicines. A plan is made together with your doctor, especially for blood thinners, diabetes medicines and osteoporosis medicines. Do not stop any medicine on your own.
• Pause smoking. Stopping at least a week before the operation and throughout healing reduces the risk of sinus and gum problems.
• Follow the fasting instructions. Do not eat or drink after the time given before general anaesthesia.
• Bring someone with you. You should not drive home on the day of the operation; it is recommended that someone stays with you the first night.
• Prepare your home. Have cold compresses, soft and lukewarm foods and an extra pillow (to keep your head raised) ready in advance.
• Plan a few days off. You will need to rest in the first days because of swelling and bruising.

A zygomatic implant is a more extensive operation than a regular implant and requires advanced experience. Knowing the risks helps you decide:

• Swelling and bruising of the cheeks and around the eyes in the first days (expected and temporary)
• Sinusitis: because the implant passes through the sinus area, this is the most commonly reported problem; it is usually resolved with medication or simple treatment
• Gum inflammation around the implant or an opening forming between the mouth and the sinus
• Temporary numbness of the cheek, upper lip or side of the nose
• Nosebleeds
• Rarely, effects on structures around the eye
• The implant not taking hold; in that case it is removed and treatment is re-planned

Many of these risks are reduced by detailed planning with a CT scan, assessing sinus health beforehand, pausing smoking and following the instructions during healing.

• First 48–72 hours. Swelling and bruising are at their peak. Cold compresses, the recommended medicines and resting with your head slightly raised. Choose liquid, lukewarm foods.
• First 2 weeks. Swelling and bruising gradually go down. Avoid blowing your nose, strenuous exercise, bending over to lift heavy things and smoking; sneeze with your mouth open. Eat soft foods.
• First 2–3 months. While the implants take hold, avoid hard foods and biting into food with the temporary teeth. Attend your check-ups.
• After the permanent teeth. Return to a normal diet. Daily brushing, interdental brushes or a water flosser, and regular check-ups. Keeping the area around the implants clean is the most effective way to prevent sinus and gum problems.