REHABILITATION PROTOCOLS WITH ZYGOMATIC IMPLANTS: INDICATIONS FOR SEVERE MAXILLARY ATROPHY AND BONE RESORPTION

Abstract

The rehabilitation of patients with severely atrophic maxilla represents one of the central challenges in contemporary implant dentistry. The loss of alveolar bone volume, accentuated by maxillary sinus pneumatization and prolonged use of complete dentures, limits or makes the placement of conventional implants unfeasible, thus requiring complementary surgical strategies. In this context, zygomatic implants—originally introduced by Brånemark et al. in the late 1980s as an alternative to extensive bone grafting procedures—have been established as a documented therapeutic option for patients with advanced maxillary atrophy. The present study consists of a comparative analysis of three recent scientific publications: a systematic review on success rates (Solà Pérez et al., 2022), an international consensus report developed by the International Team for Implantology—ITI (Al-Nawas et al., 2023), and a systematic review on clinical indications (Polido et al., 2023). The analyzed data include follow-ups of up to 11.8 years and encompass hundreds of patients across multiple international centers. Cumulative survival rates ranged from 96.1% to 98.5% depending on the follow-up period, with slightly higher rates observed for immediate loading protocols compared to delayed loading (98.1% versus 95.0%). Documented indications include extreme bone atrophy, previous implant or graft failure, oncologic resection, trauma, and congenital defects. The most prevalent complications were maxillary sinusitis (14.2%) and soft tissue dehiscence (34.7%), while prosthetic mechanical failures accounted for 17.8% of the reported adverse events. The body of reviewed evidence supports that zygomatic implants represent a safe, predictable, and long-term effective alternative for the rehabilitation of atrophic maxillae. However, given the anatomical risks involved and the heterogeneity in success criteria adopted in the literature, the procedure should be reserved for centers with specialized surgical and rehabilitative expertise.