Did you walk into your dentist’s office hoping to replace your missing teeth, but were told you didn’t have enough bone for a conventional dental implant? Do not despair! Chances are we can still replace your teeth with zygomatic implants. Unlike traditional implants that are anchored on to your jawbones, zygomatic implants are placed into the stronger, sturdier zygoma bone (or the cheekbone), which lies right above your upper jaw.
First introduced by Dr. Per-Ingvar Branemark in 1988, zygomatic implants have been used in the profession for over two decades. With well-documented cases and predictable outcomes, these implants are viable alternatives to bone grafting.
A list of frequently encountered dental terminologies is presented below to help you through the article.
||The jaw or jawbone, specifically the upper jaw in most vertebrates. In humans it also forms part of the nose and eye socket.|
||A bone of the human skull commonly referred to as the cheekbone or malar bone|
||The dental implant is a surgical component, shaped like the root of a natural tooth that is placed within the bone of the maxilla or mandible to support an artificial tooth like restoration.|
||The dental implant abutment is that part of the fixture that connects the artificial crown to the underlying dental implant.|
|Anterior||Front or up ahead|
|Prosthesis||An artificial replacement of a missing natural body part, which in our case is the tooth.|
|Provisional Restoration||The artificial restoration that is placed temporarily till healing completes or the final restoration is ready is called the provisional or temporary restoration.|
|Occlusion||Defined simply, occlusion is the science of contact of the surfaces of teeth in different situations, eg while biting, while chewing, while talking, swallowing, etc.|
|Atrophic bone||Severe reduction in bone structure, commonly seen in older individuals.|
|Immediate Loading||The process of placement of a prosthesis immediately after the implant surgery to assist in esthetics, function, rehabilitation and recovery.|
|Denture Conversion||The process of using a premade denture for immediate loading after the completion of surgery.|
Zygomatic implants are long implants (30–62.5 mm) that obtain their main anchorage from the zygoma bone in the presence or absence of maxillary alveolar bone. They are designed to allow for implant‐supported prosthesis placement where maxillary bone support is inadequate.
The primary requirement for replacing missing teeth with a dental implant is the presence of adequate bone structure. However, in the absence of sufficient bone volume (atrophic bone), the dental team is presented with two options – bone grafting or graftless solutions.
While bone grafting comes with its own advantages, the treatment process if often lengthy and requires multiple surgical appointments. Also, bone grafting procedures are quite invasive, resulting in donor site morbidity in case an autograft (which is considered the gold standard) is used.
Zygomatic implants are a viable alternative for the rehabilitation of the atrophic posterior maxilla with both the classical two stage and immediate loading protocols. They avoid complex grafting and sinus lift procedures and therefore contribute to a shorter and more comfortable treatment.
Furthermore, zygomatic implants can be used in case of failed conventional implant placement, failed sinus augmentation or grafting procedures.
|1. Less invasive than bone grafting and sinus lift procedures|
|2. Faster healing time|
|3. Safe procedure with long-term success rates|
|4. Immediate loading protocol offers teeth replacement on same day|
|5. One stage procedure|
|6. Immediate improvement in appearance, comfort and function|
The phases in the procedure can be simply explained with the following flow chart:
A prosthetically-driven approach always ensures the best results. Hence, the initial step involves a thorough evaluation of the patient’s clinical and medical condition. This will help the surgeon in establishing the correct ‘entry point’ for the implant placement.
Potential implant sites are determined with CBCT images (as shown in figure)
The surgical phase involves the following steps:
|1. Selection of optimum entry point in the alveolar crest based on the scanned images.|
|2. Flap reflection and placement of implants.|
|3. Verification of implant positions with a radiograph or volumetric image|
|4. Flap closure.|
The surgical procedure can also be carried out with the use of 3D printed guided stents which assist in precise placement of implants according to the plan.
The prosthetic phase begins soon after surgery when a previously made denture is converted intra-orally into temporary implant prosthesis. This temporary denture will remain in place until the permanent prosthesis is fabricated.
|PROSTHETIC PHASE (INTERMEDIATE AND FINAL):|
|1. Open tray impression with splinted impression copings|
|2. Jig verification of the implant positions|
|3. Jaw relation verification|
|4. Bridge design using CAD-CAM technology|
|5. Fabrication of all zirconia bridge or titanium framework for crown cementation|
|6. Trial and finishing|
|7. Final luting of crowns to Titanium framework (Malo bridge) and final fixation in the mouth.|
In case of poor lip support, the clinician may even opt for an implant supported overdenture as the final prosthesis to obtain optimum facial contours and esthetics.
Rehabilitation of atrophic maxilla with zygomatic implants is a predictable and cost‐effective treatment modality. The benefits of zygomatic implant reconstruction versus traditional implant reconstruction include shorter treatment time frames, avoidance of the need for bone grafting and its associated morbidity, fewer total implants required for a fixed prosthesis, and the fact that zygomatic implants allow the potential for immediate functioning.
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