Let’s start by finding out our latitude:.

The Zygomatic implants have this name because they are placed in the zygomatic bone. For those who are older, they probably remember the former Nominal Anatomica (before 1998), in which the zygomatic bone was called malar bone. It is not a mistake per se to call it malar bone, from a lay and social point of view, but in medical and surgical terms the bone actually has the name of zygomatic bone.

The surgical technique is Placement of Zygomatic Implants or Zygomatic Transfixion, as found in the literature.

I’m not going to unfurl this any longer, nor I will dwell on surgical approaches, nor I will entangle myself in the sort of research that, nowadays, is both medical and surgical, making a surgery increasingly safe, predictable and with results that allow an even better Oral Rehabilitation, which suits our patients, as well as the scientific research in which I’m involved in several projects, whether that is the Training that I’m part of in Portugal, where I represent the brand of Implants with which we work with at CERO, or in the study and research that I’m currently developing at London University, through my Master’s Degree in Oral and Maxillofacial Surgery. Later on I will be more than happy to extend this subject with you and even share the results and breakthroughs in this field, but I do think that the purpose of this text and blog will not take us down that road.

Instead I will focus on the subject in a way that is less academic, surgical or scientific, and rather more clinic-centered, as well as practical and based on Oral Rehabilitation terms.

Subtle historical introduction

The transzygomatic fixations have been used for several decades already. They began to be used in surgical and prosthetic rehabilitations for rehabilitated patients post-tumor resection who lose a fair amount of anatomical structures that make up the face, such as jaws, orbits, nose, etc. It was used as part of a whole prosthetic complex that fixed the prosthetic obturators, along with other sort of implants that were bone-fixing bolts, used by Medicine to give back to these patients some sort of quality of life, after deeply mutilating surgeries, in which the patients need to retrieve their life quality, partially or totally. Even in terms of scientific journals, there is a test, a scale to measure the Life Quality of the patients post-surgery and rehab.

I and my Team, in my research endeavors, we have used a modified version of this questionnaire to have a better understanding and perceiving of where we must invest and conduct research to improve the less positive traits and keep or even improve the traits already positive of this sort of Oral Rehabilitation.

This sort of Oral Rehabilitation, in prosthetic terms, is very similar to the type of Full-Fixed Rehabilitations we do in total edentulous patients.

I have to add as a side note, in order to explain for those who are reading this, what the current Dental Medicine accepts, based on the guidelines of the Evidenced-Based Medicine, as total edentulous patients:

– Patients who do not have any tooth anymore or roots/dental fragments in the jaws.

– Patients who have some teeth left, however without any function given the absence of support, size or incorrect positions, or because they present a chronic inflammatory and/or infectious symptomology.

When this situation manifests itself in both jaws, the patient is total edentulous.

When the situation manifests itself only in one jaw, it is a upper or lower total edentulous patient depending on what jaw is affected.

When it comes to the Zygomatic implants, we are talking about their applicability solely to the Upper Jaw, given the anatomic proximity of the Zygomatic Bone to the Upper Jaw (Maxilla).

During the last couple of years, the surgical techniques and materials and the oral rehabilitation techniques have evolved in order to ensure that the final work, in other words, what the patient has in his mouth that he may be able to use to eat, speak, reestablish muscular formats and dimensions and soft tissues and aesthetic terms, hence being able to have a confident smile again, a smile that is built and adapted to his singularity, in a structure totally fixed to his body, in his Upper Jaw and in his Zygomatic bones.

The Zygomatic Implants can be used alongside traditional dental implants, when there is still bone left in the upper jaw, in other words, in cases of moderate or advanced bone resorption, which can still be used as a fixation during surgery or in very extreme cases, that is, those cases where bone resorption is severe or extreme, where the fixation of the prosthetic structure will only take place in Zygomatic Implants, in which we use 2 Zygomatic implants on each side in the most extreme cases.

Who is a candidate for this kind of treatment?

All patients whose:

– Degree of bone resorption is so severe or extreme that maxillary bone grafts are no longer a viable option for treatment, because one of the basic principles to accomplish a bone graft in order to augment the bone volume is having enough bone left to fixate the bone graft.

– Medical, pathophysiological conditions allow it, which are assessed through a set of medical, clinical, laboratory and radiologic examinations, used for cases where the procedure is performed with general anesthesia. Our team performs surgery in all patients in order to place Zygomatic Implants in the Hospital Environment and with General Anesthesia. Therefore it implies an Anesthesiology appointment with our Anesthesiology team.

– All Patients who have or already have failed oral rehabilitations, due to inappropriate planning, technique or surgical approach, from which the remaining bone, as a result of the removal of failed traditional Dental Implants is not, in terms of volume and quality, enough in the Upper Jaw to repeat the surgery and solely reuse the conventional dental implants.

I consider traditional dental implants those who have a normal size and format, within the international accepted measures and patterns, and scientifically accepted by all brands authorized to sell dentals implants, and that are placed in the Jaws.

The Zygomatic implants are not traditional because they have larger sizes, mainly in terms of length and despite having support or even fixation in the Upper Jaw, their main anchoring point is the Zygomatic bone.

Clinical Case 1:

X-ray: Digital Orthopantomography

The patient is a cero – M.F.F., female, 68 years old

Clinical Case 2:

X-ray: Digital Orthopantomography

C.E.R.O. Patient – C. R., female, 46 years old

This is a surgical technique executed in the midfacial level, with a surgical field superior to a conventional maxillary surgery, which requires an in-depth, skilled knowledge with specific techniques in its approach and one that must only be performed by highly trained and qualified doctors/surgeons, who already have in their CVs a specific training for this sort of surgery.

The technique, like any other, has its risks and complications which will be thoroughly explained by our Medical and Nursing Staff.

However, when properly done, alongside responsible patients capable of understanding and executing all the care and precautions, this is a thoroughly studied, safe and predictable technique.

When the bone allows us to, in terms of quality, quantity and safety regarding the obtained insertion forces of the implants (torque), the Surgery Staff informs the Rehabilitation Staff that it will be possible to rehab the patient for immediate function, in other words, having the teeth screwed on the same day and, from that moment onwards, it’s a “Teeth In 1 Day” situation, like our other patients who are rehabbed with our Traditional Dental Implants.

However, the surgical cases of Zygomatic Implants are cases of Severe or Extreme Bone Resorptions, and often we cannot perform the immediate function of the implants, nor of the Zygomatic or Traditional ones.
The Patient uses, for a 6 to 8 month period, a Full Traditional Detachable Prosthesis with a soft filling that is replaced every 3 weeks by our Rehabilitation Staff. After this period of Osseointegration, we can fix the new structures to the implants.

There is a lot more to say, a lot more to show, but hopefully I was able to clarify our followers and readers on a subject that I’m deeply fond of and that occupies a fair amount of my life, studying, teaching, researching it and, of course, in surgery.

See you soon and don’t forget to be happy. Despite everything, smiling doesn’t hurt…

If that’s the case, if smiling causes pain, nausea, or imbalance, consult your dentist.

Until next time!

Dr. Luis Pinheiro

Dr. Luis Pinheiro

- Luis Pinheiro, Dentist with exclusive practice in Oral Surgery and Implantology

- Accountable for the Oral Surgery and Implantology Department at C.E.R.O.

- Master’s Degree in Oral and Maxillofacial Surgery at Eastman Dental Institute of the University College of London

- International Scientific Consultant of D.I.S. – dental implant system

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