Implant Placement despite Bone Atrophy:
the Zygoma Handpiece in Clinical Use

In cases of advanced bone atrophy or following maxillary resections, the rehabilitation with implant-supported prostheses presents a particular challenge. Zygoma implants offer an alternative to conventional augmentation procedures and, when appropriately indicated, enable functional and long-term stable rehabilitation. This approach requires not only extensive surgical experience, but also specially designed instruments to ensure precise and safe execution.

Augmentation and their Limitations: when are Zygoma Implants indicated?

Especially in cases of severe maxillary bone atrophy, conventional implants reach their limits. Complex augmentation procedures are then required to provide sufficient bone for implant placement. Although implants placed in augmented bone demonstrate success rates comparable to those in native bone, this approach is associated with specific limitations:

• Additional surgical interventions (e.g., harvesting of autologous bone)
• Delayed prosthetic rehabilitation due to prolonged healing periods

Zygoma implants provide an augmentation-free solution, particularly for patients seeking a less invasive treatment. These implants are anchored in the zygomatic bone (Os zygomaticum), thereby eliminating the necessity for bone grafting in the maxilla. Studies have shown high patient satisfaction with this treatment approach.

Demonstration of drill positioning for a zygoma implant in the posterior maxilla.

Surgical Implementation: the Role of the Zygoma Handpiece

The placement of zygoma implants often occurs under limited visibility and restricted access. Due to the complex anatomy, precise instrument guidance is essential. Specially developed handpieces, such as the "SZ-75" by W&H, can facilitate this procedure. The technical features of the handpiece include:

The SZ-75 zygoma handpiece from W&H combines optimized angulation, spray cooling, and high rotational precision to enable accurate drilling in anatomically challenging regions.

• Angled design for improved access
• Spray cooling with a targeted exit point
• High concentricity for precise drilling guidance

These characteristics can support surgical access in this particularly challenging anatomical region. However, the clinical benefit largely depends on preoperative planning and the surgeon’s experience.

Evidence Base: long-term Data and Indications

The scientific evidence on Zygoma implants has significantly improved in recent years. A systematic review by Roper et al. (2023) reports implant survival rates of 95% after six years. Fan et al. (2025) demonstrated in a retrospective study with a mean follow-up of over 10 years a 100% survival rate for zygoma implants. These results are comparable to those of conventional implants, provided that indications are carefully established.

Polido et al. define the main indication for zygoma implants as severe maxillary bone atrophy. However, since the term "severe atrophy" is interpreted differently in the literature, individual clinical assessment by experienced clinicians remains essential.

Conclusion: a scientifically supported Alternative

Zygomatic implants offer a reliable alternative to conventional two-stage procedures in selected cases, especially when bone augmentation is not possible or refused by the patient. Preoperative planning utilises imaging techniques and specialised software to optimally assess individual anatomy and determine prosthetically appropriate implant positioning.

Intraoperatively, specialised handpieces such as the "SZ-75" by W&H can facilitate the procedure through their specific design. Nevertheless, surgical experience and consideration of the individual anatomical situation remain crucial for treatment success.

References

1. Tatli U, Cavana A, Tukel HC, Benlidayi ME. Effects of Bone Augmentation on Implant Success and Survival: A Retrospective Analysis With 6-Year Mean Follow-Up. Clinical Implant Dentistry and Related Research. 2025 Apr;27(2):e70021. doi:10.1111/cid.70021.
2. Pommer B, Mailath-Pokorny G, Haas R, Busenlechner D, Fürhauser R, Watzek G. Patients' preferences towards minimally invasive treatment alternatives for implant rehabilitation of edentulous jaws. European Journal of Oral Implantology. 2014 Summer;7 Suppl 2:S91-109.
3. Roper MB, Vissink A, Dudding T, Pollard A, Gareb B, Malevez C, Balshi T, Brecht L, Kumar V, Wu Y, Jung R. Long-term treatment outcomes with zygomatic implants: a systematic review and meta-analysis. International Journal of Implant Dentistry. 2023 Jul 5;9:21. doi:10.1186/s40729-023-00479-x.
4. Fan S, Davo R, Al-Nawas B, Valmaseda Castellón E. The Rehabilitation of Partially Edentulous Maxilla With Unilateral Zygomatic Implants: A Retrospective Study up to 23 Years Follow-Up. Clinical Oral Implants Research. 2025;36:228–239. doi:10.1111/clr.14377.
5. Polido WD, Machado-Fernandez A, Lin WS, Aghaloo T. Indications, surgical techniques, and complications of zygomatic implants: a systematic review. International Journal of Implant Dentistry. 2023 Jul 1;9:17. doi:10.1186/s40729-023-00480-4.