Zygomatic Implants for Patients with Severe Bone Atrophy

How anchoring in the malar bone works when the maxilla no longer has sufficient volume, the different techniques available, and why a recent systematic review calls for caution.

Zygomatic implants are considerably long fixtures — typically between 35 and 55 millimeters, versus roughly 8-16 millimeters for a traditional implant — designed to anchor not in the upper maxilla, often too resorbed in more severe cases, but in the body of the zygomatic bone, structurally much denser and stronger. The technique was introduced by Brånemark in 1998, initially for rehabilitating patients with severe maxillary bone deficits following oncological resections, trauma or malformations, and was later extended to cases of severe maxillary atrophy in common edentulism.

The major advantage of this technique is the ability to avoid, or at least drastically reduce, the need for preliminary bone regeneration procedures — biologically demanding procedures, with long healing times and not always predictable results. Through bicortical anchoring in the malar bone, zygomatic implants often allow immediate or otherwise much faster prosthetic loading compared to the time required by traditional bone grafting followed by conventional implants.

Over the years, several variants of Brånemark's original technique have been developed: the classic intrasinus approach, which routes the implant body through the maxillary sinus; the extrasinus approach, which reduces sinus involvement; the ZAGA protocol (Zygoma Anatomy-Guided Approach), which customizes the implant path based on the patient's specific anatomy detected via CBCT; and the "quad zygoma" concept, involving placement of two zygomatic implants per side in cases of total atrophy, with no remaining maxillary bone usable for conventional anterior implants.

For scientific completeness, it's fair to also report a note of caution: a systematic literature review found that the main indication — "extreme maxillary bone atrophy" — isn't defined consistently across the available studies, a methodological limitation that makes it harder to rigorously compare results reported by different centers. This doesn't detract from the fact that, in centers with established specialist experience, zygomatic implants remain an option with good documented success rates even at ten years, but it does confirm that this is a resource to be reserved for carefully selected cases, not a first-choice alternative to conventional bone regeneration.

On Oralzon you'll find specialized surgical instrumentation for zygomatic implantology, along with the digital planning systems needed for a procedure of this complexity.