Zygomatic Implants After 20 Years: Systematic Overview and Global Perspective

In the 1980s, P-I Brånemark conceived the creation of zygomatic implants for totally edentulous patients presenting with advanced bone resorption of the posterior maxilla as well as moderate-to-severe atrophy in the premaxilla. Trusting his experience in hemimaxillectomy cases where he could find a strong anchorage in the zygoma, he imagined a long implant entering at the position of the second premolar from the palatal side of the maxillary crest, through the sinus to ultimately attain anchorage in the zygoma. Since then, zygoma implants have been developed in several lengths, made of pure titanium, and a two-stage protocol has been utilized: First, a surgery with the placement of the implants and, 6 months later, the loading of the implants with a fixed prosthesis. The zygoma concept was launched internationally in 1997 through a multicenter study in which 16 centers participated. The author of this chapter participated in this study at the Université Libre de Bruxelles where the first cases of zygomatic implants used for atrophied maxillae without discontinuity outside Sweden were performed. The two-stage protocol yielded very high survival rates of around 98%. In 2004, surgeons confronted with significant atrophy of the anterior part of the maxilla as well as the posterior part began placing four zygomatic implants instead of two. Over the past 20 years, the zygoma implant surface and the surgical protocol have been revised. A one-stage procedure with immediate loading was developed and yielded high survival rates. The zygoma concept including surgery as well as prosthetic rehabilitation became the first choice for restoring the quality of life of the patients with significantly atrophic maxillae. This chapter reviews more than 20 years of experience at ULB where the first zygomatic implants were placed in December 1997. The author shares the different modalities developed over the years. These modalities will be further explained in other chapters.SCOPUS: ch.binfo:eu-repo/semantics/publishe