What are zygomatic implants, and who are they for?

Zygomatic implants are screws much longer than standard implants, reaching several centimetres. They anchor into the cheekbone, the zygoma, instead of the upper jawbone. Unlike the jawbone, the zygoma is much more resistant to bone loss, which is why it is offered as an alternative anchor point for patients with severe bone loss in the upper jaw.

This method comes up when the bone volume remaining in the upper jaw has become too little to support a standard implant, and closing that gap with conventional bone-grafting methods would need a long, multi-stage process. According to a Cochrane review, the main claimed advantage of zygomatic implants is that fixed teeth can be fitted earlier, without the need for a bone graft.

The difference is clear when compared with a bone graft and a sinus lift. In the conventional method, bone is added first, you wait for months, and only then is the implant placed. With zygomatic implants, this waiting period can be removed from the process, because anchorage comes from the already-solid zygoma bone and no extra bone-healing process is needed.

Cochrane's current review found only two small studies on this question, following a total of 71 people over three years. According to these studies, patients who received zygomatic implants got their fixed teeth in a much shorter time, about 1.34 days, compared with an average of 444 days in the group waiting for a bone graft. However, the same review also found a higher complication rate in the zygomatic implant group: roughly four in five people had a complication, compared with about half in the standard implant group. The review itself rates the certainty of this evidence as very low to moderate, and says more studies are needed.

The zygoma bone is not the only way of avoiding a bone graft. In some strategic implant protocols, the need for a graft is removed by angling implants into the sound bone in front of or behind the gap, or by placing them in other dense bone areas such as the pterygoid region of the jaw. This approach does not involve the zygoma bone at all and has a different surgical scope; 3D imaging determines which method suits a given patient.

Surgical scope is another point to bear in mind. Zygomatic implant surgery is technically demanding and calls for experience, and it is usually carried out under general anaesthetic or deep sedation in a hospital setting. This means a different surgical scope and recovery process from a standard implant appointment.

Sinus inflammation stands out as the most commonly reported complication in systematic reviews. Soft tissue problems and fractures in the structures fitted on top of the implants are also documented in the literature. None of this means the method should not be used, but it does add to the number of questions worth asking before you decide.

The breakdown below is the framework generally accepted in the literature and in clinical practice. The final decision rests on the imaging and examination done by the surgical team assessing you.

These steps are not a treatment timetable; they are a framework for your decision-making process. The aim is to work out whether the method being recommended is really necessary.

1. 1

   Ask for 3D imaging

   Whether you need a zygomatic implant cannot be determined without a CBCT scan assessing how much bone remains and how it is distributed.

2. 2

   Ask to have a bone graft and other alternatives explained too

   Zygomatic implants are not the only route; you should be told, with reasons, why options such as a bone graft, a sinus lift and graft-free angled placement are not suitable for you.

3. 3

   Clarify the anaesthetic plan

   Whether general anaesthetic or deep sedation will be used, who decides this, and whether your general health is suited to it: these questions should be clear before surgery.

4. 4

   Ask about the surgical team's experience

   How many zygomatic implant cases have been carried out, what the complication rates are, and how problems are managed if one arises, are all fair questions to ask.

5. 5

   Find out the follow-up and revision plan

   The route to be followed if sinus inflammation or another complication develops, any extra cost, and who is responsible, should all be set out in writing beforehand.

Zygomatic implants are not the only option. The following are methods that solve the same problem in different ways.

The following are the main problems reported in the literature after zygomatic implants. Knowing about them makes your decision easier.

The following is the general course described in the literature after zygomatic implants; it can vary by clinic and by case.

1. The first few days

   The standard recovery process after general anaesthetic, with swelling and tenderness in the surgical area on top of that.

2. The first week

   Signs related to the sinus area, such as a blocked nose, discharge or facial pain, are watched closely during this period.

3. The first few months

   The prosthesis is fitted on top and check-ups become more frequent; sinus health and implant stability are assessed regularly.

4. The long term

   Soft tissue and sinus health need regular monitoring for years afterwards; regular professional care catches complications early.

We do not give figures on this page; the scope of zygomatic implant treatment varies widely from clinic to clinic. Here are the items that determine the total:

Number of implants and surgical scope

How many zygomatic implants are used, and whether standard implants are also needed, directly affects the cost.

Anaesthetic and hospital process

Surgery carried out under general anaesthetic in a hospital setting carries a different cost item from a procedure done under local anaesthetic.

Imaging and planning

3D imaging and surgical planning are especially critical for this method; a thorough planning process can be a separate item.

Follow-up and possible revision

If a complication such as sinus inflammation or a fractured prosthesis develops, extra treatment may be needed; how this is covered should be made clear from the start.