Transzygomatic and Transnasal Dental Implantation
In such cases, highly effective alternatives for replacing lost teeth and restoring chewing function include angular implantation techniques, such as transzygomatic (zygomatic), transnasal, trans-sinus, or pterygoid dental implantation.
Angular implantation allows for implants to be anchored in bone regions not affected by atrophy — including the zygomatic bone, pterygoid process of the sphenoid bone, border of the piriform aperture, and nasal septum.
Moreover, this technique enables immediate loading of implants on the day of surgery.
This means that temporary prosthetics can be fabricated immediately after surgery to restore chewing and aesthetics.
Permanent prosthetics are typically made 6–12 months later.
The technique of placing transzygomatic implants has been known since the 1960s, when P.I. Brånemark first introduced it for treating patients with post-resection jaw defects.
Later, in 1993, C. Aparicio proposed using zygomatic implants in patients with severe atrophy.
Since then, this method has become a reliable alternative to bone grafting in the upper jaw, especially in cases of long-term total atrophy, “flat” sinuses, and other complex anatomical challenges.
To this day, I still encounter criticism and skepticism from some colleagues regarding this technique.
In reality, the issue lies in properly identifying indications and contraindications, thorough preoperative planning, and the surgeon’s skill and choice of surgical technique.
I would like to demonstrate the effectiveness of this approach in rehabilitating patients with severe bone atrophy through a series of clinical cases.
Placement of Transzygomatic Implants
Presented with complaints about the unsatisfactory appearance of his teeth, their mobility, and the inability to chew food properly.
His medical history included wearing a removable partial denture (a metal framework prosthesis) for over 15 years, which led to severe bone atrophy.
The patient had been refused treatment by multiple dental clinics due to the critical condition of the upper jaw bone.
A review of the patient’s CT scan revealed the following issues:
radicular cysts near teeth 1.3 and 2.7 with the formation of large bone defects, and complete bone atrophy in the posterior upper jaw, with remaining bone thickness reduced to 0.5–1 mm.
The CT also showed an unfavorable flat alveolar bay on the right side, which significantly increases the risk of complications during a sinus lift procedure.
Given all these findings, it was decided to rehabilitate the patient using a combination of transzygomatic implantation and conventional implantation with fixation of implants in the nasal septum.
Transzygomatic and Transnasal Implantation
Five years earlier, six implants had been placed in the 1.3–2.3 region (from canine to canine).
After four years, the implants failed due to their placement in insufficient bone volume.
At the time of the patient’s consultation at our clinic, the CT scan showed vertical and horizontal bone atrophy down to 0.5–1 mm.
The process of implant disintegration was accompanied by inflammation of the surrounding tissues and subsequent lysis, which led to a significant bone defect and partial loss of the bony wall in the nasal cavity area.
While rehabilitation using bone grafting could be considered in such cases, in my opinion, it is a pointless undertaking — due to the high invasiveness at both the recipient and donor sites, the unpredictability of the outcome, and the long duration of treatment (at least 1.5 to 2 years).
For this reason, we chose a different approach: placement of two transzygomatic implants (anchored in the zygomatic bones) to serve as distal support for the future prosthesis (positions 5–6), and two transnasal implants installed in the conchal crest area using the Vanderlim technique.
Thus, four implants were placed, and on the day of surgery, a fixed prosthesis was fabricated using the patient’s old removable denture.
The “after” photo shows the patient seven days post-op, with minimal swelling.
A metal-acrylic prosthesis is scheduled to be fabricated in 6 months, and a permanent prosthesis may be made after 1 year.
Regarding this clinical case, I had an interesting exchange with the esteemed Prof. Vanderlim — the developer and author of the transnasal dental implantation technique.
The professor confirmed the soundness of my clinical reasoning and my approach to minimally invasive implantation in cases of fully edentulous, severely atrophic jaws.
If there is an opportunity to avoid the quad-zygoma protocol by replacing the medial implants with transnasal or conventional ones — it should be taken.
This approach reduces the risk of complications such as sinusitis.
My own research shows that sinusitis tends to occur more frequently when using the quad-zygoma protocol.
That said, there are certainly cases where quad-zygoma is the only viable solution for the patient.
In my practice, I follow a philosophy of minimally invasive treatment, predictable outcomes, and reduced total rehabilitation time for the patient.
Every treatment plan I create is a carefully considered and academically grounded protocol — developed as a scientist — which I follow throughout your treatment and rehabilitation.
The sooner a patient regains the ability to smile confidently — without compromising treatment quality — the greater their psychological comfort and sense of inner peace.
Outpatient Appointments
Stimul Clinic
121552, Moscow, Yartsevskaya St., 28
Inpatient Care
Ilyinskaya Hospital
143421, Moscow Region, Krasnogorsk Urban District,
Glukhovo village, Rublyovskoye Predmestye St., 2, Building 2
Sochi
(Zygomatic implants, full rehabilitation of upper and lower jaw, orthognathic surgery)
Gur.U Clinic
354000, Sochi, Yunykh Lenintsev St., 1
