Zygomatic Implants with Conventional Implants as a Treatment Modality for Severely Atrophic Maxilla- Case Series

Severe atrophy of the posterior maxilla poses a significant challenge for conventional implant placement due to insufficient bone height and density. Traditional solutions such as bone grafting or sinus lift procedures extend treatment time, increase patient morbidity, and are associated with varying degrees of success. Zygomatic implants have emerged as a predictable, graft-free alternative by anchoring in the dense zygomatic bone, bypassing the atrophic posterior maxilla altogether. However, they are biomechanically stressed, and their long-term success depends heavily on appropriate prosthetic support and load distribution. This study aimed to evaluate the clinical efficacy and added stability of combining bilateral zygomatic implants with conventional anterior implants in patients with severely atrophic maxillae. A total of five patients (three males and two females), aged 23 to 65 years, with CBCT-confirmed posterior maxillary atrophy (residual ridge height ≤6 mm), were selected for this prospective study. Each patient received two zygomatic implants (length 40 to 55 mm) placed bilaterally using the extra-sinus technique, along with two to four conventional implants in the anterior maxilla. Implant stability was assessed using Resonance Frequency Analysis (RFA) at implant placement, two weeks, two months, six months, and twelve months. All implants were immediately loaded with a provisional fixed prosthesis. The results demonstrated high primary stability for both zygomatic and conventional implants, with mean initial ISQ values of 72 ± 3 and 68 ± 4, respectively. These values remained above the accepted threshold for osseointegration throughout the 12-month follow-up. No implant failures or major complications were reported. One patient required minor prosthetic adjustment. Patient-reported outcomes indicated satisfaction with esthetics, function, and comfort. The study concluded that additional anterior conventional implants provide supplemental support and biomechanical stability to zygomatic implants, enhancing the overall success of rehabilitation in severely atrophic maxillae.