Zygomatic implants (special)

In 2012, Implantodent’s medical team led by Dr. Chemal Taner performed in national premiere a special technique with 4 zygomatic implants simultaneously inserted and an immediate and fixed work named “QuadZygoma” and then, in 2013 “SixZygoma” concept (identical but with 6 implants). Since then, hundreds of patients suffering from severe maxillary atrophies with no chance for fixed maxillary works regain their smiles every year thanks to immediate dental works performed exemplary in an interdisciplinary work regime by our valuable collective.

IMPLANTODENT TEAM

  • IMPLANTOLOGY SINCE 1999
  • TOTAL REHABILITATIONS BY IMPLANT SINCE 2002 (ALL-ON-4/6)
  • 2008 NATIONAL PREMIERE WITH “TOTAL FIX” CONCEPT
  • 2012 NATIONAL PREMIERE WITH “QUADZYGOMA” CONCEPT
  • 2013 NATIONAL PREMIERE (AND THE THIRD IN THE WORLD) WITH “SIXZYGOMA” CONCEPT
  • 2015 WORLD PREMIERE IN ZYGOMATIC IMPLANT LASER INSERTION
  • OVER 15.000 CONVENTIONAL AND SPECIAL IMPLANTS INSERTED
  • 5 IMPLANTOLOGY SPECIALISTS TRAINED IN USA, GERMANY, SWITZERLAND AND AUSTRIA, 3 SPECIALISTS IN IMPLANT PROSTHETICS AND 3 DENTAL TECHNICIAN MASTERS.

In the traditional way, the severely resorbed jaw, accompanied by excessive pneumatic jaw sinuses, would require multiple sinus lifting / sinus augmentation by which, with the help of bone grafts inserted into the sinus, we reclaim the bone mass the implant needs to be inserted. In cases of total edentation with severe maxillary resorption (atrophy), zygomatic implants are the only immediate rehabilitation.

Zygomatic implants are designed to allow immediate implantation of the upper jaw, often in the fixed variant, and without the need for bone grafting by inserting them into the bilateral zygomatic bones.

Depending on the severity of the maxillary bone resorption (jaw atrophy) and the position / size of the maxillary sinuses, zigomatic implants can be inserted either in combination with conventional implants (TotalFix +) or individually, 4 (QuadZygoma) or 6 (SixZygoma) allowing loading and immediate function via fixed work.

Zygomatic implants, considered special implants, revolutionized the traditional techniques and considerations of dental implant treatment of the total edentulous patient with atrophic jaw by minimizing surgical invasiveness by reducing healing time and the time to complete treatment in general.

What are zygomatic implants?

Zygomatic implants are special dental implants, of great length (between 35 and 55 mm) used in borderline cases, when encountering extremely advanced resorptions of the superior maxillary, whether in its posterior part, or generalized.

Where are zygomatic implants inserted?

As their name implies, zygomatic implants are inserted into the zygomatic bones (of cheeks). Regardless of the maxillary atrophy degree, cheekbones maintain their volume and density almost unaltered, being extremely suitable for anchoring these types of implants. Starting from the maxilla, crossing the maxillary sinuses, from within (after membrane lifting) or from outside, depending on the clinical situation and anchoring within the zygomatic bone.

Advantages of zygomatic implants

Offer patients with advanced maxillary resorption, even dramatic, the possibility of taking advantage of a fixed work, in most cases postoperatively, without requiring major additions and augmentation with bone collected from hips or limbs.

In case of dramatic resorptions, when the patient is practically condemned to live without denture, special techniques that simultaneously use 4 or 6 zygomatic implants (QuadzZygoma or SixZygoma) represent a final solution of having a fixed denture, without needing to perform expensive and risky treatments of bone addition. That is why these techniques are also called “last resort”.

Choosing the type and number of implants is carried out depending on the maxillary atrophy degree and maxillary sinuses position.

Along with teeth loss, maxillary bones start to resorb (atrophy) decreasing volume and density and maxillary sinuses increase volume, in some cases considerably.

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We very well know that sinuses are cavities filled with air, therefore air is replacing bone. As you already figured out, implants cannot anchor into air and require bone.

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Bone can be regenerated by sinus augmenting procedures but this requires prolonged healing time, expensive procedures, high costs and often additional risks.

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MAXILLARY BONE AREAS ARE CONDITIONING IMPLANTO-PROSTHETIC TREATMENT!

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  1. BONE IN AREAS I, II AND III – CONVENTIONAL IMPLANTS, AXIALLY INSERTED
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  2. BONE IN AREAS I AND II – CONVENTIONAL IMPLANTS, INSERTED INCLINED (POSTERIOR ONES) AND AXIALLY (BETWEEN THE INCLINED ONES) = “TOTALFIX” OR “ALL-ON-4” CONCEPT
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  1. BONE ONLY IN AREA I – CONVENTIONAL IMPLANTS (2,3 OR 4 PIECES) IN THE ANTERIOR REGION (BETWEEN CANINES) COMBINED WITH 2 ZYGOMATIC IMPLANTS, ONE FOR EACH SIDE, IN THE POSTERIOR REGION = “ALL-ON-4+” OR “TOTALFIX+” CONCEPT
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  1. BONE ONLY IN AREA IV – CONVENTIONAL IMPLANTS CANNOT BE INSERTED IN ANY PLACE IN THE MAXILLA AND 4 OR 6 ZYGOMATIC IMPLANTS ARE SIMULTANEOUSLY INSERTED (QUADZYGOMA OR SIXZYGOMA)
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How is severe maxillary bone atrophy manifested?

Atrophies or severe bone resorptions are massive decreases (meltings) of maxillary bone. Main cause is represented by loss of teeth, a long time ago, that no longer stimulates bone and causes it to lose its function (atrophy). Bone resorptions are dramatically accelerated by wearing mobile dentures and, often, after using them for years, there will be barely anything left from the maxillary bone, dentures will lose total stability and pain will emerge, from bearable (gum irritation) to unbearable (nerve irritation).

There are 3 kinds of maxillary bone atrophy:

  1. Vertical – translated by bone shortening;
  2. Horizontal – translated by bone narrowing;
  3. Mixt – bone is deteriorating in both directions.implanturi zigomatice 10

MAXILLARY BONE ATROPHY (moderated, advanced, severe)

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MANDIBLE BONE ATROPHY (moderated, advanced, severe)

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Are zygomatic implants different from normal implants?

Yes, zygomatic implants are dimensionally different (length) compared with conventional implants. In the case of conventional implants, their length is between 8 and 18 mm, while zygomatic implants length differs between 30 and 55 mm.

How are zygomatic implants placed within bone?

Totally different from regular implants, zygomatic implants anchor with their apical side (tip) into the zygomatic bones (cheekbones). Insertion spot (entry) is located inside the maxilla, then implant traverses inclined (diagonally), depending on the clinical situation, on the outside or through the maxillary sinus (its membrane is moved the same as in the sinus lifting procedure), anchoring with approximately 7-10 mm into the zygomatic bone.

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There are two distinct situations:

a. When patient presents:

  • Severe vertical atrophy in the posterior (back) area of the maxilla and
  • Moderate vertical atrophy in the anterior (front) area of the maxilla
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…regular implants can be inserted into the anterior (front) maxilla and one zygomatic implant on each side into the posterior (back) maxilla. In this way, the dental work could be extended into the molar region with even support on both sides.

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b. When patient presents:

  • Severe vertical atrophy in the posterior (back) area of the maxilla and
  • Severe vertical atrophy in the anterior (front) region of the maxilla
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…4 zygomatic implants are inserted (two for the anterior maxilla and another two for the posterior maxilla). The procedure is called “QuadZygoma”

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When atrophy is severe but the patient is relatively young, presenting a powerful mastication, it can resort, if the zygomatic bone volume allows it, to 6 zygomatic implants, three on each side.

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When are zygomatic implants used?

As we mentioned above, zygomatic implants are taken into consideration in extreme situations:

  • Severe atrophy (resorption) of maxillary bone which makes impossible to insert regular implants without prior bone addition treatments;
  • Maxillary sinuses (cavities filled with air positioned within the maxillary bone) with exaggerate volume enlargement, occupying almost the entire posterior maxillary area, without sufficient bone left for conventional implants insertion;
  • Patients unwilling or for whom bone additions or sinus lifting are totally contraindicated/forbidden;
  • Patients unwilling to prolong the total treatment period with 12-16 months by resorting to bone additions;
  • Patient that undergo major additions but cannot support the high costs;
  • When “TotalFix” cannot be performed due to excessive maxillary sinuses pneumatization in an anterior way, without the possibility of favorable implant distribution, so that posterior support (back of the maxilla) for the work will exist;
  • Patients that have almost no bone left in the superior maxilla but still wish for a fixed work.
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Who conducts and how is zygomatic implant treatment performed?

Zygomatic implant surgery is considered to be an extremely complex one which could only be accomplished by specialists with implantology, oral surgery or oro-maxillo-facial surgery experience in full cooperation with prosthetic specialists in dental implants.

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Preoperative investigations will be thorough, targeting general as well as local health, of the whole denture. Clinical investigations will be mandatory accompanied by radiologic investigation two and three dimensional (dental tomography) as well as a careful occlusion (bite) analysis.

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Surgical intervention, depending on the complexity degree and physical profile of the patient involves different types of anesthesia:

  • general anesthesia through intravenous drug sedation – TotalFix, sometimes TotalFix+;
  • general anesthesia through NTI (Naso-tracheal intubation) and always in an operating block with all necessary equipment. Implantodent clinics are the only private network clinics in Romania that can provide these conditions for patients requiring zygomatic implants.
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The patient requires a thorough examination during the specialty consultation within the clinic and benefits from an entire team of specialists and all the necessary investigations (digital x-ray, dental tomography, digital impressions, virtual planning, blood tests, etc.) under “the same roof” without wasting time, having to travel from one place to another.

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From examination, dental tomography, electronic analysis of occlusion (bite), planning, surgery and until the final work, everything is conducted in a single place: Implantodent clinic!

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Postoperatively, until full recovery, patients take advantage of the best care, in the clinic’s comfortable wards.

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What zygomatic implants are used at Implantodent?

Globally, there are few zygomatic implants manufacturers, the most important company being Nobel Biocare from Switzerland.

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This company holds the oldest and most extensive experience in dental implantology, being considered for many years and currently, the global leader in research and production of dental implants. In Implantodent clinics we are using Nobel Zygoma TiUnite, even if the most expensive in the world, they provide the best results for patients on a long term, producer guaranteeing them “for life”.

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