Is That Why The Zygomatic Implant Doesn't Work?
Yes, it is. That's why the zygomatic implant doesn't work!
Many professionals still believe that zygomatic implants are outdated and do not bring good clinical results. But is this a problem with the zygomatic implant technique, the misuse of the method, or the product of bad science?
There is only one thing more dangerous than the professional who does not study. That is the professional who blindly believes in everything he read, and in this post, you will practically understand this through 2 weird examples when it comes to zygomatic implants.
Understand: There are two extremes. At one extreme, we have dentistry that does not follow evidence-based conduct, which is a problem. At the other extreme, we have the repeaters of ideas, those who only recite excerpts from books and articles literally and confuse information with knowledge.
And we have a third area, which is the optimum area, where reality, practical experimentation, and clinical results reside. It is here that there is the so-called critical thinking and systemic thinking. You base your conduct on evidence, but at the same time, you triangulate them with practical insights and assess situations from various perspectives. You can contextualize what you are reading and not passively accept everything.
The zygomatic implant has been the dentistry area most affected by this simplistic approach and later claims that the zygomatic implant does not work.
Let's see this in practice.
Take a look at this article published in the Journal of Prosthodontics (1).
The authors propose a way to optimize the trajectory of the zygomatic implant. But take a look at this zygomatic implant on the right side. The zygomatic implant is already violating the orbital cavity in virtual planning!
We all know that it can have a tremendous apical deviation in the trajectory of a long implant (as a zygomatic implant). You add a potentially significant apical variation with such bad planning, which can result in a catastrophic error! Do you understand now why they say that zygomatic implants don't work? If that's what they publish, imagine the rest.
Is that why the zygomatic implant doesn't work?
But let's go ahead, an article published in the renowned International Journal of Oral & Maxillofacial Implants (2). They wanted to evaluate the influence of alveolar defects in the distribution of stress when using 4 zygomatic implants (Quad Zygoma).
Now let's assess how these implants were installed.
We can see that all zygomatic implants were installed in an excessively posterior position in the alveolar ridge region. The prosthetic screw emergence of the posterior zygomatic implants would come out there in the third molar region, or even far beyond.
Another problem: the distal implants were installed crossing the infratemporal fossa, taking only a small portion of the most terminal part of the zygomatic bone, close to the zygomatic arch, where the bone is much thinner and has a bad bone anchorage. In such conditions, the implants may even be unstable and have movement on pressure, then I ask:
Is that why the zygomatic implant doesn't work?
This unfavorable, more posterior position makes shorter zygomatic implants necessary. Do you understand now why companies make zygomatic implants that are shorter than ideal? They don't know about these technical details. This issue is critical, and I talk more about zygomatic implant lengths in this post and zygomatic implant systems in this post here.
Take a look at the disposition of the implants' emergence concerning the prosthesis and look at the anterior cantilever's size. This is bizarre and clinically unviable.
Then a zygomatic implant fracture occurs, and companies think the solution is to create thicker zygomatic implants. It's a mistake, Nobel Biocare! It's not a problem with the thickness of zygomatic implants. It is a problem with the length of the implants.
When the head of the zygomatic implants is more anterior in the ridge, the anterior cantilever is much smaller. However, to do this, we need zygomatic implants larger than 52.5mm. (I talk more about that in my book ZYGOMA 2.0 - The New Age of Zygomatic Implants [sold out]) and also in this post.
But anyway, the zygomatic implant is an incredible technique; it removes the patient from the bone graft and allows immediate loading with a high success rate in the short and long term (around 95% success after 12 years(3)). However, if you really want to learn zygomatic implants, start studying and be critical of what you see in Facebook groups and even in scientific articles. It is not because something is published that it is an absolute truth.
Another issue is that scientific articles that published long-term follow-up often used techniques for installing zygomatic implants that we no longer use today (such as the Brånemark Technique). In the future, new publications will most likely show an even more significant increase in success rates and a massive decrease in the rate of complications.
Only by having the courage to apply a critical way of evaluating studies will we perform and teach zygomatic implants responsibly and with a commitment to our clinical outcome and our patients.
This post is not a personal criticism of any company or author but a way to stimulate the advancement of science, critical thinking, and, consequently, the truth.
Share your thoughts below!
References
(1) Wang CI, Cho SH, Cho D, Ducote C, Reddy LV, Sinada N. A 3D-Printed Guide to Assist in Sinus Slot Preparation for the Optimization of Zygomatic Implant Axis Trajectory. J Prosthodont. 2020 Feb; 29 (2): 179-184. doi: 10.1111 / jopr.13139. Epub 2020 Jan 11. PMID 31889369.
https://onlinelibrary.wiley.com/doi/abs/10.1111/jopr.13139
(2) Duan Y, Chandran R, Cherry D. Influence of Alveolar Bone Defects on the Stress Distribution in Quad Zygomatic Implant-Supported Maxillary Prosthesis. Int J Oral Maxillofac Implants 7 , 203-211 (1992). 2018 May / Jun; 33 (3): 693-700. doi: 10.11607 / jomi.4692. PMID 29763505.
http://quintpub.com/journals/omi/abstract.php?iss2_id=1533&article_id=18448#.X8ThKi2cZGM
(3) Chrcanovic BR, Albrektsson T, Wennerberg A. Survival and Complications of Zygomatic Implants: An Updated Systematic Review. J Oral Maxillofac Surg. 2016 Oct; 74 (10): 1949-64. doi: 10.1016 / j.joms.2016.06.166. Epub 2016 Jun 18. PMID 27422530.
https://pubmed.ncbi.nlm.nih.gov/24679842/
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