Included contraindications to the use of zygomatic implants include acute sinus infection, upper jaw pathology, and patients unable to undergo implant surgery. Due to an underlying uncontrolled or malignant systemic disease. Relative contraindications include chronic infectious sinusitis, the use of bisphosphonates and smoking more than 20 cigarettes a day.
Although zygomatic implants are an excellent solution for patients with severe upper jaw bone loss, they are not suitable for everyone. A comprehensive clinical examination, CBCT scan, and medical evaluation are necessary to determine whether the procedure is appropriate. Factors such as uncontrolled systemic diseases, active sinus infections, poor oral hygiene, or certain medications may affect treatment eligibility and healing outcomes.
Who is not suitable for zygomatic implant?
Patients with uncontrolled systemic diseases, active sinus infections, untreated gum disease, heavy smoking habits, poor oral hygiene, or medical conditions that make oral surgery unsafe may not be suitable candidates for zygomatic implants. A comprehensive clinical examination and CBCT scan help determine eligibility.
Absolute and Relative Contraindications
Some conditions may make zygomatic implant surgery temporarily or completely unsuitable, while others only require additional precautions. Active uncontrolled infection, untreated disease in the cheekbone or maxillary sinus, and a medical condition that makes surgery unsafe may prevent treatment. Smoking, controlled systemic illness and certain medications are generally assessed as relative risk factors rather than automatic exclusions.
Sinus Problems and Zygomatic Implants
Patients with acute sinusitis or chronic sinusitis associated with blockage of normal sinus drainage may not be immediately suitable for zygomatic implants. A CBCT scan is required to evaluate the maxillary sinuses and surrounding anatomy. In selected cases, an ENT consultation or treatment of the sinus condition may be advised before implant surgery. Sinusitis is one of the most frequently reported biological complications after zygomatic implant treatment.
Limited Mouth Opening and Unfavourable Anatomy
Zygomatic implant surgery requires adequate mouth opening and safe access to the upper jaw and cheekbone. Severely restricted mouth opening, abnormalities of the zygomatic bone or unfavourable anatomy may make treatment difficult or unsafe. A systematic review reported mouth opening below approximately 30 mm and abnormalities of the zygomatic bone among the local contraindications described in the literature.
According to Bedrossian et al. (18) the maxilla can be divided into zones:
- Firstly Zone 1, the premaxilla
- Secondly Zone 2, the premolar area
- Thirdly Zone 3, the molar area
CBCT report for Zygomatic Implant
The amount of bone is estimated by cone beam computed tomography. Also in the zygomatic arch, in both horizontal and vertical dimensions.Β Moreover, any pathology in this area, as well as in the maxillary sinuses; needs to be verified pre-operatively. In the presence of adequate bone in zones 1 and 2. The clinician can consider the use of four to six conventional implants, tilting the most distal. One on each side to achieve good load distribution.Β As such, one can bypass the need for bone grafting. The anterior extent or position of the sinuses, as well as the slope of the anterior sinus walls, determine both the most posterior position of the distal implant as well as its angulation.
Management for Zygomatic Implant after treatment
Once the clinical examination is complete, radiographic examination allows for further appropriate treatment planning of the zygomatic implant .Β Computed tomography is crucial for evaluation of the zygomatic implant site and the sinus status. The amount of bone in the zygomatic arch and in the residual alveolar crest is explored.Β The angulation, expected emergence site and the relationship of the implant body to the maxillary sinus and the lateral wall is considered. With the original technique, the path of the zygomatic implant was inside the maxillary sinus.Β
Bleeding or infection
Do not disturb the wounds or any stitches placed. Avoid rinsing, spitting, or touching the wound on the day of surgery. A certain amount of bleeding expected following surgery. Slight bleeding, oozing,or redness in the saliva is not uncommon in the first two days following the procedure. If there is excessive bleeding, fold a moistened piece of gauze thick enough to bite on and plac. It directly on the extraction site biting firmly for 30 minutes. Repeat if necessary.
Swelling and infection
After surgery most patients experience swelling around the mouth, cheeks, eyes and sides of the face. The swelling may not become apparent until the day following surgery. It may not reach its maximum until two to three days post-operatively. To minimize swelling apply ice on your jaw for the first 48 hours (15 minutes on then 15 minutes off).
Stitches
The type of stitches used will depend on the surgery performed. You advised if you had stitches placed in your gums and if they will dissolve and fall out on their own. In approximately 1 to 2 weeks or if you will need to return to have them removed by the surgeon. If they come out earlier it is not usually a concern unless persistent bleeding occurs.
Medication and Antibiotic Mouth Rinse
Be sure to take prescribed medication or mouth rinses (such as Peridex) as directed to help reduce the chance of infection. Not all patients will have such prescriptions, depending on the particular situation. Discontinue antibiotic use in the event of a rash or other unfavorable reaction and contact the office immediately.
Right Diet
In most cases, straight-forward implant surgeries result in minimal disruption of normal routine and the surgical area can simply for several days. More complicated cases may require more specific instructions. The day of surgery begin with clear fluids (juice, broth, jello) and progress slowly eating soft foods (pudding, yogurt, soups, pasta, well-cooked veggies) by chewing away from the surgical sites. Remember it is important to hydrate and maintain adequate nutrition for optimal healing to occur.
Oral Hygiene
Good oral hygiene is essential to good healing. Start rinsing your mouth with warm salt water rinses (1/2 tsp of salt in a cup of warm water) 24 hours following surgery. You should do this every 4-6 hours, especially after meals, for several days until the tenderness is gone. It is important to brush and floss your other teeth, but avoid the surgical site(s) and stitches completely for a few days.
To allow initial healing, and then be very gentle with brushing these areas for 1 to 2 weeks. If you have a healing abutment (metal post) or an actual temporary crown (cap or artificial tooth) protruding through the gums. You may follow the same instructions and brush it gently after a few days. Avoid flossing the healing abutment or temporary crown/cap until instructed to do so.
Medical Conditions, Smoking and Medicines
Uncontrolled medical conditions, poor healing capacity and heavy smoking may increase the risk of infection or implant complications. Patients should inform the surgeon about diabetes, heart conditions, immune disorders, previous cancer treatment and medicines such as antiresorptive drugs. These factors do not always rule out treatment, but they may require medical clearance, risk modification or an alternative rehabilitation plan.
FAQs
Who should not get zygomatic implants?
Patients with uncontrolled medical conditions, active infections, severe sinus disease, or those unable to undergo oral surgery may not be suitable candidates.
Are zygomatic implants safe?
Yes. When performed by experienced oral and maxillofacial surgeons, zygomatic implants are a safe and predictable treatment option for severe upper jaw bone loss.
Do zygomatic implants require bone grafting?
In many cases, no. One of the main advantages of zygomatic implants is that they can often eliminate the need for extensive bone grafting in the upper jaw.
How long does recovery take?
Most patients recover from the initial surgery within a few weeks, while complete healing and integration occur over several months.
What is the success rate of zygomatic implants?
Studies have shown high long-term success rates when treatment is carefully planned and performed by experienced clinicians.
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Medical Disclaimer
This article is for patient education only. Dental treatment should be planned after clinical examination, medical history review, and X-rays or scans where required. Treatment suitability, cost, timeline, healing, and results vary from patient to patient.
