Innovation and Optimization for Zygomatic Implants

Abstract

The first patient treated with zygomatic implants in Hong Kong presented with a partial maxillectomy defect after tumor resection and required unilateral reconstruction. Two zygomatic implants were installed on the same side together with two conventional implants to provide support for a fixed prosthesis. Since this first patient was treated successfully in 1999, we have employed zygomatic implants to reconstruct several hundreds of patients presenting with an atrophic edentulous maxilla in addition to a few oncology patients who received a maxillectomy. In the UK, our experience extended from patients with severe maxillary atrophy to oncology patients with extreme problems requiring unique customized solutions. Along the way, we encountered various difficulties when treating these patient groups, and sought solutions to the problems we encountered, such as the palatal location of the head of the zygomatic implants, bulky prostheses, maxillary sinusitis, and tissue recession with exposure of the threaded shaft of the implant, all well-recognized issues associated with zygomatic implant treatment. In the last two decades, the authors have modified Brånemark’s original zygomatic implant protocol in several ways in order to minimize problems and optimize outcomes. These modifications included adoption of an immediate loading protocol to restore patients’ oral function as early as possible, incorporating an extended open sinus lift procedure to keep the zygomatic implant external to the maxillary sinus, customization of zygomatic implants to suit patients’ individual needs, optimal positioning of the zygomatic implants for better biomechanics, and guided surgery to better control the zygomatic implant osteotomy. In this chapter, these innovative modifications and optimizations is presented along with some of the evolving features of newer commercially available implants.