Zygomatic Implants: A Comprehensive Review of Indications, Techniques, and Clinical Outcomes

Abstract

Introduction:
Severe maxillary bone atrophy, congenital deformities, and maxillectomy defects present significant challenges for conventional dental implant placement due to insufficient bone volume and quality. Zygomatic implants (ZIs) offer a reliable alternative by anchoring in the dense zygomatic bone, providing stability and allowing for graft-free, immediate loading protocols.

Objective:
To provide a comprehensive overview of the indications, surgical techniques, biomechanical principles, complications, and outcomes of zygomatic implants in rehabilitating severely atrophic maxillae.

Methods:
A narrative review of current literature and clinical protocols was conducted, focusing on anatomical considerations, implant design, surgical techniques (Brånemark, ZAGA, Quad Zygoma, and Inverted Support Technique), prosthodontic planning, and biomechanical stability. The use of advanced imaging tools (CBCT, guided surgery) and treatment classifications (Bedrossian, ZAGA) were examined for treatment planning. Key clinical studies were reviewed to assess survival rates, complications, and functional outcomes.

Results:
Zygomatic implants demonstrated high survival rates ranging from 94.1% to 100% over 5 years. Immediate functional loading was feasible in most cases, providing prosthetic rehabilitation within 1–3 days. Complications such as sinusitis were reported in 5–6% of cases but were generally manageable. Biomechanical analyses showed that quad-cortical anchorage and cross-arch splinting significantly reduce stress concentration and implant displacement compared to bi-cortical stabilization. The Inverted Support Technique demonstrated high accuracy in implant placement and reduced surgical risks.

Conclusion:
Zygomatic implants represent an effective and predictable solution for the rehabilitation of severe maxillary atrophy where conventional implants are contraindicated. Their use reduces the need for bone grafting, minimizes treatment time, and achieves high stability and survival rates when proper surgical planning and prosthetic principles are followed. Despite potential complications, they remain a valuable tool in advanced maxillary reconstruction.