Zygomatic implants are used for the dental rehabilitation of the upper jaw for patients that suffer from severe bone loss. They are also called zygoma implants.
It is mainly conventional implant dentists who use zygomatic dental implants to avoid sinus lift and bone grafting. Basal implant dentists prefer Pterygoid dental implants that are positioned behind the sinuses. But this technique requires additional qualifications and experience.
Zygomatic dental implants are anchored into the zygomatic cheekbone. They are often used by conventional implantologists who practise All-on-4 or All-on-6. All-on-4 Xtra is an upgrade on these dental restoration systems. Pterygoid dental implants are used instead of the zygoma implants to resolve the issue of bone loss on the upper jaw
Zygomatic implants restore chewing function in cases of severe bone atrophy by anchoring in the cheekbone instead of the jaw. They can work. But they also carry risks that fewer patients hear about before they sign up for treatment. This page explains how zygomatic implants work, how they’re used alongside All-on-4 and All-on-6 systems, and why many basal implantologists choose tubero-pterygoid implants instead.
Zygomatic Implants
When do dentists recommend zygomatic implants?
Zygomatic implants are extremely long implants, usually 30 to 50mm, that pass through the upper jaw and the maxillary sinus to anchor in the zygomatic bone (your cheekbone). Dentists turn to them when bone loss in the upper jaw is so severe that even bone grafting or a sinus lift won’t create enough bone for conventional implants.
The appeal is straightforward. The cheekbone is dense and doesn’t resorb the way jawbone does after tooth loss, so it gives the implant something solid to hold onto. That’s also, as you’ll see below, where the risk comes from.
Zygomatic Implants For All-on-4 and All-on-6
Why would I need zygomatic implants if I'm already getting All-on-4 or All-on-6?
All-on-4 and All-on-6 rely on a small number of conventional implants placed in the front of the jaw, where bone is usually still present. The problem is the back of the jaw. In patients with severe bone atrophy, there often isn’t enough bone under the sinuses to place the back implants at all, let alone angle them for extra support.
This is where zygomatic implants come in. Conventional dentists use one or two zygomatic implants on each side to replace the missing back implants in an All-on-4 or All-on-6 plan, anchoring the bridge in the cheekbone instead of the resorbed jaw. It solves the bone problem, but it does so by routing the implant straight through the sinus cavity, which is where the added risk begins.
The Risks of Zygomatic Implants
What could go wrong with zygomatic implants?
Because the implant passes directly through the maxillary sinus, it creates a permanent opening between your mouth and your sinus cavity. This is the source of most of the complications reported with zygomatic implants:
- Chronic sinusitis. Studies show significantly higher rates of sinus infection in zygomatic implant patients compared to other implant types, and the problem can recur for years.
- Sinus membrane perforation. The invasive path through the sinus makes membrane damage a frequent finding during and after placement.
- Nerve damage. The implant path runs close to facial nerves, which can lead to numbness, tingling, or pain in the cheek and upper teeth.
- Vision disturbances. Rare, but reported in cases where the implant was placed too close to the eye socket.
- Difficult removal. If a zygomatic implant fails or causes complications, taking it out is a far more complex procedure than removing a conventional or basal implant, because it’s embedded deep in the cheekbone.
- No protection against further bone loss. Zygomatic implants don’t stop the jaw itself from continuing to shrink over time.
The surgery also demands a high level of skill and experience, and even in expert hands, complication rates remain higher than with implants placed away from the sinus.
Tubero-Pterygoid Implants: A Safer Alternative
Is there a way to treat severe bone loss without going through the sinus?
Yes. Tubero-pterygoid implants solve the same problem as zygomatic implants, restoring the back of the upper jaw when bone has resorbed, without passing through the sinus at all. Instead, they angle backward and anchor in the pterygoid process, a dense plate of bone at the base of the skull, just behind the maxillary sinus.
This bone doesn’t resorb after tooth loss, so it stays dense and reliable even in patients with extreme atrophy. Because the implant reaches behind the sinus rather than below or through it, there’s no sinus penetration, no sinus lift, and no bone graft required. Most experienced basal implantologists choose tubero-pterygoid placement over zygomatic implants for exactly this reason.
Zygomatic vs Tubero-Pterygoid Implants
| Factor | Zygomatic Implants | Tubero-Pterygoid Implants |
|---|---|---|
| Anchorage point | Cheekbone (zygoma) | Pterygoid process, behind the sinus |
| Passes through sinus | Yes | No |
| Sinusitis risk | Elevated | None |
| Implant length | 30-50mm | 40-52mm |
| Removal if failed | Complex, invasive | More straightforward |
| Dental Restoration System | All-on-4, All-on-6 | Basal implant Full Dental restorations |
| Bone graft or sinus lift needed | No | No |
Basal Implantology: More Implants and Better Distribution
Why does my basal implantologist place so many implants?
All-on-4 and All-on-6 concentrate the entire bridge on four to six implants, which is exactly why they run into trouble when bone is missing at the back of the jaw. It’s also why they sometimes need zygomatic implants to make up the difference.
Basal implantology takes a different approach. Rather than relying on a few implants to carry the whole bridge, a basal implantologist typically places 10 to 12 implants across the upper jaw and 8 to 10 across the lower jaw, distributed along the entire length of each arch rather than clustered at the front. This includes tubero-pterygoid implants at the back to support the molars. Spreading the load across more implants reduces the mechanical stress on any single one, and it means full chewing function is restored across the whole mouth, not just the front teeth.
For patients with severe bone loss, this wider distribution is often what makes immediate loading possible without a bone graft, a sinus lift, or a zygomatic implant.
Frequently Asked Questions on Zygomatic Implants
Do basal implantologists use zygomatic implants?
No. Basal implantologists use tubero-pterygoid implants instead, placed behind the sinuses rather than through them. This provides the same molar support as zygomatic implants without the added sinus penetration risk.
What is the main advantage of basal implants for patients with severe bone loss?
Basal implants avoid the need for bone grafting, sinus lift, and zygomatic implants, all of which carry the risk of additional complications. They anchor into cortical bone that doesn’t resorb, giving patients a faster and lower-risk route to Full Dental restoration.
What are the risks of zygomatic implants?
Zygomatic implants require additional training and experience. Only a qualified and experienced implant dentist should perform this procedure. Some of the most common complications associated with zygomatic implants include pain and discomfort in the upper jaw, bruising and swelling around the implant and infection due to poor oral hygiene. There are risks of temporary sensory nerve deficits, orbital injury. There is also a danger that the zygomatic implant is not integrated into the zygomatic bone where it is anchored.
But, the most common side-effect is chronic sinusitis. The zygomatic implant passes from the mouth to the closed cavity of the sinuses. It brings bacteria passing from the mouth to the sinuses that results in an infection of the sinuses that can become chronic. Chronic sinusitis can be treated with antibiotics. In some cases it needs to be treated with functional endoscopic sinus surgery. The lack of osseointegration can be treated by the removal of the implant and bone grafting.
Comparison between zygomatic and pterygoid dental implants
Zygomatic implants are placed through the sinuses whilst pterygoid implants are anchored behind the sinuses in the pterygoid process of the sphenoid bone.
The advantages of pterygoid implants
Pterygoid dental implants are a better solution for a full dental restoration of the upper jaw with severe bone atrophy because it avoids the risk of chronic sinusitis.
Pterygoid Dental Implants
Behind the sinuses
Full set of 14 crowns
Zygomatic Dental Implants
Risk of sinusitis
Less implants
Advice on zygomatic implants
How to find a good basal implant dentist for a full dental restoration with zygomatic dental implants?
We will help find the appropriate dental implant surgeon for full mouth dental restoration with basal dental implants based on your dental condition, location and budget.
Not all dentists are equal. Basal implantology with basal implants requires additional qualifications. And not all qualified basal implantologists are sufficiently experienced to treat patients with severe bone atrophy. We can help you find the right implant dentist.
And when you find a dental implant surgeon ask for before and after photos of his patients. Check his diplomas. And check his previous experience by analysing the OPG panoramic x-rays of the patients he treated and compare it to your own volume of jaw bone. We can help you check if you have an appropriate basal implant dentist.
Alternatives to zygomatic dental implants
There are several alternatives to zygomatic dental implants. Some have their draw-backs.
Pterygoid implants
Tubero-pterygoid implants are fixed behind the sinuses to complete the strategic basal implantation. They avoid the need for zygomatic implants.
Bone Grafting
No bone graft needed because it often fails for edentulous patients with severe bone loss.
Sinus Lift
Sinus lift can cause chronic sinusitis. Basal implants avoid the need for lifting the sinuses that can cause complications.
All this information is provided solely as educational content. It is not medical advice. Our aim is to clarify the terminology and concepts relating to implantology and dental restoration with basal dental implants. For professional dental advice please consult multiple qualified implant dentists and compare their answers.