Prof. Cemal Ucer: Zygomatic implants, making sense of modern implant options
Today there are a great number of dental implant treatment strategies and systems available, each with different indications and their own strengths. This means that more patients can safely receive implants than ever before – more choice allows us to better tailor treatment to the needs of a patient according to their individual anatomical, aesthetic, and functional requirements.
Where there is insufficient bone to support implants, grafting can be successful, such as a sinus lift. Maxillary sinus grafting has proved a very successful long-term technique, but it also has significant drawbacks, including extended period of graft maturation followed by longer implant rehabilitation.
Failing full arch implants often result in total loss of alveolar bone, especially in the pre-maxillary region as is the case in severely atrophic maxilla, requiring major extraoral grafting surgery.
Zygomatic Implants offer a graftless alternative for the rehabilitation of the severely atrophic maxilla. Zygomatic procedures enable these patients to be fitted with implant-support prostheses without the need for bone grafts. Because these implants are anchored into the zygoma bone, rehabilitation can routinely be completed in a single day where anatomical deficiencies would have rendered other methods unacceptable.
Zygomatic implants are only viable in the maxilla; however, because edentulism in the maxilla occurs around 35 times more often than in the mandible, there are many patients who can potentially benefit from the procedure.
Since its initial development by Brånemark et al., (2004), modern zygomatic implants have undergone further scientific development by Carlos Aparicio’s ZAGA group (Aparicio et al, 2008).
The anatomically-guided ZAGA concept uses the newly launched Straumann/ZAGA implant system that involves five main surgical approaches (ZAGA type 0-IV) for zygomatic implant placement: full intrasinus, combined intra/extrasinus path, or extramaxillary trajectory.
The ZAGA technique recognises the existence of the inter- and intra-individual anatomical differences and aims to preserve the integrity of the maxillary sinus while also maximising implant primary stability and bone implant contact (BIC) by engaging the three key pillars of the facial anatomical architecture: the zygoma, alveolar bone and the lateral wall of the maxillary sinus.
For this purpose, “Tunnel” or “Channel” osteotomy techniques are employed, according to each anatomical situation. A prosthodontically-driven implant trajectory allows the head of the implant to be positioned at an optimal restorative site, while the alveolar bone and lateral wall of the sinus are preserved for optimum bone seal and stability to prevent future hard and soft tissue complications.
If you are dealing with a complex or urgent case, such as a patient with failing implants, you mighyt consider referring your patient to the Centre for Oral-Maxillofacial and Dental Implant Reconstruction, a ZAGA centre based in Manchester. The team are well-versed in complex procedures, including nerve lateralisation and repositioning, allografts, and of course zygomatic dental implants – allowing us to find the right solution for your patient’s specific needs.
ZAGA Centre Manchester, ICE Hospital, Manchester UK www.ucer-clinic.dental