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Dental implants - Zygomatic implants

Facial Sculpture Clinic - Dr Joël Defrancq - Jaw surgery and implant reconstructive surgery In the 1990s, P.I. Bränemark (Sweden) started using the bone that forms the cheek as a anchoring point for (zygomatic) dental implants. In the year 2003-2004, documentation and data were published showing success rates with zygomatic implants were as good as with conventional implants. 

The technique of zygomatic implants has been developed over the last twenty years, and, as such, those implants are not really a point of debate. They do not rely on the alveolar jaw bone anchorage, as do conventional implants, but rely solely on the zygoma anchorage. Those implants are much longer ( 3.5 to 5 cm) than the regular dental implants (0.7 to 1.5 cm).
Facial Sculpture Clinic - Dr Joël Defrancq - Jaw surgery and implant reconstructive surgery The zygomatic bone is an excellent quality bone with sufficient bony volume in virtually all patients. In each zygoma there is enough space and volume to place one or two implants. When those implants are connected to a fixed dental bridge work, they are conceived to withstand normal chewing forces.

The zygomatic bone, as part of the facial bones, is particularly well known by MaxilloFacial surgeons since zygoma fractures occur frequently in people (fights, car accidents, work & sport accidents) and are almost exclusively treated by this specialty.

The advice to patients therefore is that somebody real well trained has to perform those zygomatic implants (i.e. a maxillofacial surgeon, with a vast knowledge of the immediate environmental structures of the zygoma bones). 

In conclusion: the Zygomatic implants are an extremely welcoming adjunct in the dental implant universe, and Defrancq is using them on a regular basis.
The indication
Facial Sculpture Clinic - Dr Joël Defrancq - Jaw surgery and implant reconstructive surgery Zygomatic implants are reserved for patients with an explicit lack of bone in the back area of the upper jaw. Older patients are good indications, since no bone grafts are necessary and the fitting supra-structure (i.e. teeth) can be made immediately (i.e. from a practical point of view, three days after implantation, with an aesthetic pass included.

With zygomatic implants patients have teeth in a couple of days, whereas if implants have to be placed into the graft approach it takes about eight months at least to finalise the extended bridge. 

Most often, one zygomatic implant on each side can be combined with regular implants in the front region.
Some times two of those implants are placed both sides in more extreme cases.
The procedure
Before the operation, an extended i-cat is taken, enabling us to study the bone structures, especially the zygoma bones in a three dimensional way. Zygomatic implants are placed in a surgical procedure under general anaesthesia.

There are two basic options:
Facial Sculpture Clinic - Dr Joël Defrancq - Jaw surgery and implant reconstructive surgery Option 1: Four zygomatic implants are placed in the totally & extremely atrophic upper jaw (no bone for regular implants), followed by a fixed supra-structure (teeth) within a few days. An extra regular implant at the front is always welcome for reasons of stability and can prevent a lot of regret afterwards.

Option 2: Two zygomatic implants are placed in the second premolar area, and three to four regular implants in the anterior upper jaw. This option is also followed by a fixed supra-structure (teeth) within a few days.

Indeed, most often some bone is still available in the anterior part of the upper jaw straight under the nose area. If a few (two to four) regular implants can be placed in the front area, then Dr Defrancq always does so. The sinuses are located in the more posterior part of the jaw, and due to the expansion of the sinuses there is often not enough bone available. Dr Defrancq places two zygomatic implants there. An immediate loading always follows the procedure, and patients have fixed teeth within a week in porcelain or chrome cobalt.
Taking care of your oral hygiene after the implants
Having a fixed bridge on zygomatic implants still means that you need to maintain regular daily oral hygiene. Along with brushing, most patients use a water-pick for routine cleaning around the implants and the bridge. Visits to a mouth hygienist on a regular basis are also mandatory for control and/of cleaning.

The mucosal area around the zygomatic implants must be checked for dehiscence. Dr Defrancq is convinced this is certainly ‘surgical technique’ sensitive.

A soft plastic mouthguard during the night may be advisable, certainly during the first year, and certainly if you know you are clenching your teeth.
Dr Defrancq’s personal description, opinion, and credo:

The zygomatic implant can be located inside, outside, or within the bony wall of the outer part of the upper jaw sinus. This housing is dictated exclusively by both ends of the implant:

  • The cranial part of the implant must be housed safely within the zygomatic bone volume. 
  • The distal part of the implant must be housed anatomically on the crest, underneath the arch form of the future crown and bridge work.
  • The result must be a non-disruptive exit for your bridgework (i.e. the exit not on the palate).

The result must also be hygienic clean tissue around the exit of the implant, without any dehiscence. Dehiscence can be prevented and is ‘surgical technique’ dependent.