Extrasinus zygomatic implants: three year experience from a new surgical approach for patients with pronounced buccal concavities in the edentulous maxilla.

BACKGROUND The surgical protocol for zygomatic fixtures prescribes an intrasinus approach ideally maintaining the sinus membrane intact and the implant body inside the sinus while gaining access to the zygomatic bone. In the presence of a pronounced buccal concavity, the implant head has to be placed far from the alveolar crest in a palatal direction, which results in a bulky bridge construction. PURPOSE The aim of this study was to report on the preliminary experiences with zygomatic implants placed with an extrasinus approach in order to have the implant head emerging at or near the top of the alveolar crest. MATERIALS AND METHODS Twenty consecutive patients with pronounced buccal concavities in the edentulous posterior maxilla were treated with 104 regular and 36 zygomatic implants as support of fixed dental bridges. Sixteen patients were treated bilaterally and four patients were treated unilaterally. The zygomatic implants were inserted by using an extrasinus surgical approach with the implant body passing from the alveolar crest through the buccal concavity into the zygomatic bone. This enabled placement of the implant head at or close to the alveolar crest. The patients were followed from 36 to 48 months after occlusal loading with a mean follow-up of 41 months. The relation of the zygomatic implants to the crest was measured and compared with a control group of 20 patients treated with conventional placement of zygomatic implants. RESULTS No implants were lost during the study period. No pain, discomfort, or complications related to the extrasinus path of the zygomatic implants were recorded after the initial healing period and up to the 36th-month checkup. The zygomatic implants emerged, on average, 3.8 mm (SD 2.6) palatal to the top of the crest compared with 11.2 mm (SD 5.3) to the conventional technique. CONCLUSION The present 3-year clinical study shows that an extrasinus approach can be utilized when placing zygomatic implants in patients with pronounced buccal concavities in the posterior maxilla. Moreover, the technique results in an emergence of the zygomatic fixture close to the top of the crest, which is beneficial from a cleaning and patient-comfort point of view.