In some cases, there isn’t enough bone volume and density in the upper jaw to support conventional implants. This can be through a number of reasons, either through trauma, gradual bone loss or severe gum disease. Bone can be regenerated through bone grafting procedures, however it does take a long period of time for the bone to heal and fully replenish. Furthermore bone grafting requires another surgical operation.
Zygomatic implants are an alternative to bone grafting and sinus lift procedures. Rather than be placed in the alveolar bone (upper jaw), these longer implants are supported in the basal facial structure, reaching the zygomatic bone on both sides (cheek bone). Zygomatic implants are used to replace back teeth and can support a full arch permanently fixed bridge or a removable prosthesis such as a clip-on denture.
Listen to Prof Ucer’s Podcast on Zygomatic implants ZAGA Centre Manchester
Why have zygomatic implants?
A secure alternative to dentures
After wearing and relying on dentures for many years, changing to something more secure can be life-changing. There’s no need to take them out at night and leave to soak. They are just like natural teeth and can be cleaned the same way.
Gives a foundation for the jaw
A loss in jaw structure can cause the face to start to lose volume and can give you a more aged appearance. Implants as a whole help your jaw to start functioning again and provide a stronger foundation.
Faster treatment turn around
Bone grafting is a very successful method for regenerating the lost jawbone in atrophic cases, but it can take several months before the implant treatment can be completed in stages. Zygomatic implants take less time to integrate and we can fit replacement teeth onto these implants immediately at the time of their placement or with a few days after surgery.
ZYGOMATIC IMPLANTS
Zygomatic and Pterygoid implants are indicated in patients where there is need to avoid major bone grafting that would have been normally required to treat a severely atrophic (resorbed) jaw with a permanent full jaw set of teeth in the upper jaw.
For patients with severe maxillary resorption (called bone atrophy), extensive two stage grafting procedures have been traditionally indicated to reconstruct the jaw bone before implants can be placed. Bone grafts are carried out in stages making the overall duration of treatment longer, spanning over several months. An alternative is to anchor specially designed implants into the Zygomatic bone. The Zygomatic implants are longer and stronger than the conventional implants and engage dense zygomatic process in the upper jaw bone. It enables an immediate loading protocol for graft-less treatment. This dramatically shortens time to place permanent teeth for increased patient satisfaction and allows patients with severely resorbed maxillae to return to a normal quality of life within days of having the implant treatment.
Immediate function with zygomatic implants has other benefits besides a shorter treatment time, such as fewer clinical visits and less invasive compared with grafting procedures. Zygoma implants have comparable survival rate to conventional implants of more than 95 % after 10 years
The zygomatic implants are offered as the implant of choice for cases of severely resorbed maxilla.
Patients who are missing all of the teeth in their upper jaw and have very little bone remaining are good candidates for Zygomatic Dental Implants.
Patients whose jawbone has deteriorated or shrunk widely may no longer be able to have traditional implants and may require a bone graft and/or maxillary sinus lift to create sufficient bone volume.
Unlike traditional dental implants, which are smaller, Zygomatic Dental Implants are anchored in the upper jawbone (zygoma) which is denser and cortical than the alveolar region of the jawbone. Because of the stronger anchorage offered by Zygomatic Implants, it is often possible to place the prosthesis (full jaw teeth) during the time of surgery, eliminating the need for a follow-up appointment.
Not everyone is suitable for Zygomatic implant treatment and a detailed clinical and CT scan examination is needed to check suitability for this treatment.
ZYGOMATIC DENTAL IMPLANT TREATMENT
The process will begin with a 3D (CBCT) tomography scan, which will provide us with 3D images of your bone, nerve pathways, soft tissues, and teeth, and allows us to determine optimal placement of your implant using our in-house virtual planning software.
Prior to placing the implant, a local anesthetic is administered along with daycare anaesthetic and iv sedation. Following the placement of the implant, fixed teeth can be placed on the same day for those patients who qualify for immediate loading on the same day protocol (or within a few days days ).
AFTERCARE FOR ZYGOMATIC DENTAL IMPLANTS
Following placement of your Zygomatic Dental Implants, post-operative symptoms including pain, swelling, bruising and similar complications are managed using medication and appropriate aftercare.
Common post-operative symptoms include facial bruising, moderate swelling, discomfort and pain which are managed well by appropriate medication. Occasionally limitation in mouth opening can occur for a short while. Normally post operative symptoms settle with a few days and rarely can take 7 to 10 days to subside.
Zygomatic patients are asked to observe the following post-operative advice:
- Avoid eating hard foodstuff during the first 8 to 12 weeks after your operation. During this period you will be asked to have soft food (fish, soup, mashed foodstuff, soft bread etc) to avoid biting strongly on your teeth during the bone healing process.
- Take your postoperative medication ( anti-inflammatory and antibiotics) as instructed
- Place ice packs on the area during the first 7 days
- Avoid tobacco products and alcohol, as both can slow the healing process
- Limit intense physical activity for the first few days following your operation.
- Appointment with a hygienist and therapist for aftercare hygiene instructions and to start the process of implant and periodontal maintenance
COST OF ZYGOMATIC DENTAL IMPLANTS
The cost of Zygomatic Dental Implants will depend on a variety of factors, including what type and how many implants are being placed, whether additional procedures are performed, what type of dental sedation is used and the type of prosthesis ( porcelain on titanium frame, acrylic teeth etc). Generally, the cost of full jaw permanent zygomatic implant treatment is comparable to the cost of conventional implant treatment or “teeth in a day” option ( e.g. all on 4 or all on 6 full jaw dental implant reconstructions). Full itemised cost of treatment is prepared for each case after a full clinical and radiological assessment after the first consultation appointment. This assessment allows us to gather all the facts, check your jaw condition & anatomy and find out about you and your wishes so that we can determine the possible options to allow you to select the most optimum solution in respect to your functional, aesthetic, personal and financial circumstances.
What does the treatment involve?
1. Patient Info
You will be given all the information that you need to make an informed decision about your treatment options according to your individual circumstances, budget and your wishes and expectations
2. Treatment Plan
We will look at all the treatment options that may be appropriate in your case and select the most optimum that will address your needs with your full involvement
Sometimes the bone in your jaw may have shrunk away, if this is the case we may request a 3-D scan to give us a computerised image of your jaw bones.
At the end of this appointment you will be given a written summary of your treatment planning discussion and you will be given the expected cost of your treatment.
3. Surgery
Before this appointment you would have had any routine treatment completed and your teeth and gums would have been cleaned. You may be asked to carry out some tasks around the time of this appointment these may include:
- Taking some antibiotics
- Rinsing with a mouthwash
- Not driving your car
- Bring a friend or relative with you.
4. Placing the implants
Having surgery of any type can be daunting. We offer IV sedation to help keep you at ease during the procedure, letting you relax and feel comfortable. In complex cases ( bone grafting or zygomatic implants) iv sedation may be required. In extreme cases of complexity a full general anaesthetic may be required requiring a nights stay in a private hospital.
The surgery is usually a simple and minor procedure. It is carried out under sterile conditions and is totally painless – you usually have the same anaesthetics that you do when having a filling. If intravenous sedation is used you will be provided with written instructions including when to stop eating and drinking ( nil by mouth) before your day care procedure.
Depending on each individual case you will be booked 60 mins for placement of a single implant. Once all the preparations are done the actual surgery to place an implant takes usually less than 30 mins. Complex cases such as full jaw or mouth reconstructions ( including zygomatic implants could take 2-3 hours. For same day immediate implant placement and immediate temporary prosthesis fitting you may be booked in for the whole day first for placement of the implants followed by construction of the temporary prosthesis using our digital workflow and connection of the prosthesis to the implants before being discharged back home. Depending on the specifics of your case we will plan and discuss these different options with you during the treatment planning phase.
After the surgery you may get some bruising and swelling, however this is usually adequately controlled with normal painkillers. It is very important that you follow the instructions given to you after the surgery – these are detailed in the Post operative information stage.
You will need to have your mouth checked a couple of times to ensure your healing is uneventful. One of these may be to remove the stitches after about 10 days.
The implant is normally allowed to fuse with bone for approximately 6 weeks before the crown could be fitted over the implant, this is known as “integration”. However in some cases ( e.g. zygomatic implants) when the bone density is very high, the prosthesis can be connected to the implants immediately. This technique is known as “immediate loading” When bone grafting has been carried out to build the lost bone, implant may need to be allowed to integrate over a longer period of time (up to 3 to 6 months).
5. Prosthodontic Restoration Phase
After a period of integration, where the bone heals onto the implant, the restoration is first constructed and finally fitted to the implants. This usually involves one or two appointments for single tooth restorations and can take a few appointments for impression taking (or digital scans), bite registration, cosmetic try-in when constructing full jaw prostheses or fixed bridges..
Sometimes we build in more restorative appointments if we need to change the shape of you gums, or check the appearance.
6. Temporary Devices
There may be a time during the treatment that you have gap. This can be temporised to ensure that you always have teeth. You will be able to work and live as normal with these temporary devices.
Sometimes your dentist may want you to leave the temporary device out of your mouth. If this is the case you team will tell you with plenty of notice.
A number of provisional devices are available:
- Restore the implant straight away
- Denture
- Bridge
- Essex guard – this is a clear guard lips over your teeth
Your dentist will help you decide which is best for you.
7. Maintenance and Follow-up.
You will need to look after your implants and have then checked every 6 months.
Are zygomatic implants a solution for me?
Zygomatic implant treatment is indicated for people with severe bone loss. Specifically, it is a solution when the loss of bone in the mouth is so severe that it is impossible to place regular implants. They are longer than regular implants, anchor in the cheekbone (zygomatic bone), and offer strong anchorage points to support full jaw fixed protheses or bridges.
Above all, a thorough diagnostic assessment is essential to provide an answer. Our patients contact ZAGA Centres with different medical complaints, ranging from a loss of quality of life to the desire to eat, bite, and laugh comfortably again. Furthermore, they usually suffered from a variety of complex dental history, including, for instance, implant loss or several unsuccessful implant surgeries already. Zygomatic implants are a safe solution for having an implant-supported fixed full arch reconstruction of teeth when little to no bone is available anymore. Bone loss may also be a consequence of the prolonged use of a removable denture.
The treatment with zygomatic implants is a life-changing solution. The clinical team delivers fixed teeth usually within 24h after the surgical procedure, allowing each patient to continue social life. This approach is an advanced procedure that only trained and experienced surgeons perform. ZAGA Centre Manchester under Professor Ucer’s lead is a certified and internationally recognized excellence centre for treating severe bone loss with zygomatic implants. More importantly, the objective of the ZAGA Centers is to understand each patient’s requirements and complaints deeply.
Indications and diagnostic
The jaw bone can shrink and become significantly smaller- a condition similar to muscle wasting. This phenomenon is clinically known as “bone atrophy”. The consequence of this is that there may be insufficient bone remaining for the placement of regular implants. Maxillary atrophy may originate from loss of teeth, periodontal (gum disease), wearing traditional dentures or systemic bone disorders such as osteoporosis or vitamin D deficiency. Additionally, implant failure or infection (peri-implantitis) can lead to bone loss. Only a thorough diagnostic assessment by a trained team of clinicians can identify the causes of bone loss. As a result, the little bone left prevents the placement of dental implants. Bone loss prevents dental implant placement.
Zygomatic Implant treatment can reverse the consequences of severe maxillary atrophy and restore dental function, aesthetics, phonetics and one’s quality of life.
