Graftless Surgery — Zygomatic Implants & All-on-4

Zygomatic Implants

No Bone – Successful Solutions for New Teeth without Bone Grafting

What are Zygomatic Implants?

Zygomatic Implants provide a solution for patients wanting implants to provide teeth fixed in place but have severe bone loss in the upper jaw.

We can place the Implants and provide a fixed bridge on them later that day or the very next day. This immediate new set of teeth typically is a full set of teeth – literally screwed into the implants, so it is very solid. We pre-design it so it fits your face providing you a very beautiful smile, immediately! This is done start to finish in our surgical center, with the procedure being done comfortably for you while you are asleep with general anesthesia, in our modern, clean surgical suite.

Many people are told they are not candidates for dental implants because they have no bone. This is just not true. 

Zygomatic Implants are specially designed implants, longer than conventional implants, that are anchored in the dense bone of our cheek bones (Zygoma) to support upper teeth and bridges.

Pterygoid Implants

Pterygoid Implants are implants are specifically designed to go in the bone at the back of your upper jaw, called the Pterygoid Plates. This bone is very dense, exists in everyone, and we often utilize it in conjunction with Zygoma Implants. Pterygoid implants provide an additional means of support in people lacking in any bone in the upper jaw (maxilla)

History & Development of Zygomatic Implants

Many people have lost significant amounts of bone due to failing teeth and periodontal disease, or long-term denture wearing. Zygomatic Implants were developed for this and provides a highly successful solution.  Zygomatic implants have been in use since the 1980’s, being developed in Europe. In the past few years, the technique and instrumentation has evolved significantly, making this a highly successful procedure with very quick recovery and minimal pain. The success rate is equal to traditional implants, being 97-98% in the long-term. 

For many years we treated patients lacking upper jawbone by grafting bone from their hip to rebuild their upper jaw. Implants were placed in this bone graft and required 6 months to integrate prior to placing teeth on them. During this time the patient would be required to wear a denture. Placement of Zygomatic implants is a much easier procedure for patients to undergo, is more cost-effective, and provides an immediate set of teeth – securely fixed into place.     

Process of Placing Zygomatic Implants

Note:  This is a specialized surgery, requiring a specialized surgeon. Most surgeons performing this are Oral & Maxillofacial surgeons. Dr. Loetscher & Dr. Cho both are adept and skilled with this procedure and can execute this treatment with the upmost accuracy in the safest environment possible. Many dentists may be unaware of this type of procedure. 

We have developed the following treatment protocol – which occurs start to finish in our surgery centers.  

  1. Consultation Appt

We examine you, obtain radiographs including a CT scan, digital scan of your teeth, and analyze your facial esthetics with our face hunter. We provide you the cost of our treatment.  

  1. Lab work up

Our doctors work with our lab technicians to analyze your smile and functional needs.  We preplan a new set of teeth, and reverse engineer the precise positions your implants need to be in for your new teeth. From this we make surgical guides – comprised of 3 or 4 components that get attached to your bone and stack together. They are used while you are asleep to accurately position your implants. They also guide the digital scanning used to manufacture your custom teeth.

  1. Surgery

We perform your procedure in our very modern and state of the art facility. Board certified MD anesthesiologists perform your general anesthesia. 

A team of trained and experienced surgical technicians and registered nurses assist the doctors. Procedure time is typically 2-3 hours per arch. 

Recovery – there typically is very little discomfort afterwards. You awaken, typically are driven home by your escort, and return later that day, or the next day for your new teeth. It takes approximately 5 hours to manufacture your teeth. 

  1. Your new teeth

Your new set of teeth will be delivered later that day or around noon the next day. 

They are screwed onto the implants, relatively easily, not requiring numbing up. 

This first set of teeth is a provisional bridge – manufactured from a durable material called PMMA. You wear these 6-10 months until your dentist will deliver your final set of teeth manufactured from Zirconia. These are designed to last years and years.   

Note: There are two methods to fabricate your first “provisional” set of teeth. In the past – a denture was pre-made, and then retroactively fit the denture to your new implants.  This is called a “Conversion”. The downside is the denture is initially rough, needs to be smoothed out, is just an approximate fit to your mouth and gums, and requires hours of chairside time adjusting it the day of surgery.

Presently we use a digital workflow – of which we have been at the forefront of developing.  Once your implants are placed, prior to you awakening, we digitally scan and use photogrammetry to obtain data on your implant positions. This is coordinated with your predesigned teeth in our digital lab. These teeth are then manufactured, and milled that afternoon or overnight, assembled, and delivered. Their fit is precise, and they are designed properly for your face, smile, and function. 

  1. Final Set of teeth

The first set of teeth are meant to be temporary and need to be replaced by a final bridge or set of teeth in about 8-10 months. Your final bridge is made from Zirconia and is typically delivered by your dentist. 

 3 reasons the temporary teeth need to be replaced:

  1. Your gums and bone remodel during the first 6 months, and therefore the precise fit of the prosthesis (bridge of teeth) will change in the region it meets your gums. Basically, the gums open slightly because they shrink back during remodeling. This can affect speech and eating.
  2. Implants need 4-6 months to fully fuse to the bone (called osseointegration).
  3. The temporary PMMA bridge will wear out with time and discolor. It is used as your first bridge because it can be manufactured relatively quick and at a low cost.

Your final Zirconia Bridge

Your final Zirconia bridge takes several days to manufacture, requires sintering in an oven overnight as part of the process, and is much more complex to manufacture. However once made they are designed for a lifetime of use.  Zirconia also has extreme luster and does not stain. During this process your provisional bridge is worn – so you never go without teeth. 

Who is a candidate for Zygomatic Implants?

Most people are candidates for this treatment. Our typical patient has failing teeth, with significant bone loss often from periodontal disease, dental infections, or long-term denture wearing. There are very few medical or health reasons that would prevent this treatment.  In fact – it opens the door for many people with advanced medical issues that otherwise would not do well with major bone grafting. 

 What are the Benefits of Zygomatic Implants?

-Improved Appearance

-Improved self-esteem

-Improved Speech

-Ability to eat any foods

-A very confident smile and laugh

-Teeth that don’t come out

-Immediate teeth and function

-Very quick recovery

-Elimination of denture sore spots

-Ability to use Zygoma implants to treatment with a mouth full of failing implants

 What is the Cost of Zygomatic Implants?

Because zygomatic implants are typically placed as part of a package to complete a new set of teeth, the additional cost of utilizing zygomatic implants may not be significant. Zygomatic implants have a higher cost than regular implants, and your typical treatment may cost between one to three thousand extra for your total treatment fee. You will get an accurate quote during your consultation. 

How Successful are Zygomatic Implant Treatments?

Zygomatic Implants have equal success with traditional implants. Modern technology has improved all Implant treatment in general. Traditional success rates for implant supported prosthetics (bridges) approximates 95% after 25 years. 

Factors affecting their success are proper placement for hygiene, implant positioning for hygiene, and importantly properly surgical execution and planning. Also important is prosthesis design so it is cleansable in your home environment. 

Regular appointments with a dental hygienist are recommended to clean area that you cannot get with your home hygiene. When patients follow their dentist’s advice and guidelines, zygomatic implant treatment and their prosthesis can last a lifetime.   

 Examples of Zygomatic Implants:

#1:

One Zygomatic Implant per side, 4 additional implants in upper jaw

All-on-4 on lower jaw

#2

Two Zygomatic Implants per side (quad Zygomatic), and one Pterygoid

Implant per side. 

 #3