Dental implants are recommended for patients for many different reasons, and the severity of their condition can impact how complicated the implant procedure will be. In some instances, the amount of jawbone deterioration can create too much instability for the implant to be placed, even with extensive surgical pretreatment. In these instances, clinicians may recommend placing zygoma implants, which allow for faster treatment time (usually a single intervention), a more cost-effective solution, and a long-term survival rate of up to 95.2%. Given the quick nature of the procedure, immediate loading of the implant is possible, but can clinicians feel confident recommending zygoma implants in patients with a long-term, highly atrophied jawbone?
The Journal of Oral Implantology recently published a case report outlining the use of zygoma implants in a patient with high dental anxiety and a preference for tooth-preserving treatment by collaborating researchers from the Dental Academy for Continuing Professional Development, Karlsruhe, Germany. Lead author Hans Ulrich Brauer, DMD, DPhil, MA, MSc, and colleagues state, “The present case is intended to show how, after a long period of periodontal therapy focused on tooth preservation, a fixed, immediately loaded, and definitive implant restoration in the maxilla could be achieved without extensive surgical pretreatment.”
The patient is a 45-year-old man wearing a fixed, long-term, temporary bridge for six years to replace five teeth. He was found to have 90% horizontal bone loss across another 8 of his teeth and 50% to 60% periodontal bone loss in the mandible. All his teeth were classified as non-preservable in his upper jaw, and prosthetic restoration was initially discussed. The patient rejected removable dentures and a multistage implant-supported treatment plan and opted for two posterior zygoma implants and two anterior conventional implants instead.
Due to inflammation and poor periodontal conditions, the procedure carried a high risk of implant recession and bacteria spreading into the maxillary sinus. Brauer et al. removed all the maxillary teeth and three additional nonviable teeth two months before surgery. Eight weeks after extraction, the patient was inflammation-free, and all implants were immediately loaded according to the All-on-4 concept. Follow-up occurred in weeks one, two, and four and in months three and six, all with uneventful outcomes.
The use of zygoma implants with the All-on-4 concept provided the patient with an immediate, definitive restoration after nearly a decade of temporary treatment solutions, a severely atrophied jawbone, and no salvageable upper teeth. Brauer and colleagues conclude, “As the case report has shown, periodontal therapy has certain limits. Medical education, also regarding the use of zygoma implants, should always be provided, especially when periodontal maintenance therapies are used in special exceptional cases, which, due to the severity of the disease and the patient’s age, are likely to result in a highly atrophied maxilla. In such cases, zygoma implants can offer a solution to achieve a fixed, rapid, and financially acceptable prosthetic rehabilitation despite the unfavorable initial bony situation.”
Full text of the article, “All-on-4 Concept With Use Of Zygoma Implants for Rehabilitation in the Severely Atrophied Maxilla With a Definitive Immediate Restoration,” Journal of Oral Implantology, Vol. 50, No. 3, 2024, is available at https://doi.org/10.1563/aaid-joi-D-23-00130.
About the Journal of Oral Implantology
The Journal of Oral Implantology is the official publication of the American Academy of Implant Dentistry. It provides valuable information to general dentists, oral surgeons, prosthodontists, periodontists, scientists, clinicians, laboratory owners and technicians, manufacturers, and educators. The JOI distinguishes itself as the first and oldest journal in the world devoted exclusively to implant dentistry. For more information about the journal or society, please visit: http://www.joionline.org/orimonline/?request=index-html.
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