Dental implants when there is no bone: zygomatic implants in Costa Rica

If you were told you don't have enough bone for upper implants, there may still be options. When the upper jaw has lost so much bone that a conventional implant won't fit without major grafting, zygomatic implants anchor in the cheekbone and can support fixed teeth. They aren't for everyone: first I measure on a CT scan how much bone is left. I am an oral and maxillofacial surgeon (specialty at UNAM, 2013), certified by the Mexican Board of Oral and Maxillofacial Surgery and a professor at the University of Costa Rica since 2006; I see patients in Tower 1 of Hospital CIMA.

Who it's for

Upper jaw with advanced bone loss

Imaging

3D CT scan (CBCT) of the face

Temporary teeth

Fixed within days, if the implants are stable

Consultation

60,000 colones · by video, 20,000

When it's indicated

• The CT scan shows advanced resorption: a conventional implant won't fit without major grafts.
• Previous bone grafts or implants have failed.
• You want to avoid staged grafting, which stretches treatment over months; if the implants are stable, fixed teeth arrive within days.
• Part of the upper jaw is missing after a tumor, trauma or a birth defect; then radiation therapy and control of the disease also weigh in.

Before surgery

• If you already have a CT scan, send it to me; we can review it first by video.
• Bring a list of your medications and tell me if you take or have taken bone medications (for osteoporosis or cancer) or had radiation therapy to the head and neck: they change the plan.
• If you smoke, stop: across 107 studies, 6.35% of implants failed in smokers versus 3.18% in non-smokers.
• Congestion, discharge or facial pain: tell me; a sinus problem is treated before surgery.
• Diabetes or another chronic condition: under control, with your doctor. For surgery, fast as my written instructions say and come with someone.

How I plan it

How I do it

1. 01ConsultationI review your CT scan, health and medications, and tell you whether a zygomatic implant is your option.
2. 02AnesthesiaGeneral, or sedation with local anesthesia, depending on the case; we decide together.
3. 03PlacementEach zygomatic implant goes through the upper jaw and anchors in the cheekbone, together with the implants in front if there are any. I use the CT scan as the map and operate with a direct view of the field to protect the eye socket.
4. 04Temporary teethIf the implants are stable, a fixed temporary is screwed in within hours or days; if not, we wait for the bone to integrate them. I know during surgery, not before.
5. 05Final prosthesisMonths later, the temporary is replaced with the final one; in the randomized trial comparing zygomatic implants with grafting, it was at 4 months.

Recovery

• The first few days are the hardest: swelling and bruising on the cheek, discomfort and, sometimes, a little bleeding from the nose.
• In the randomized trial, people who received zygomatic implants reported on average 7.17 days of total and 12.17 days of partial impaired activity.
• Soft food while you heal and while you wear the temporary teeth, with written instructions.
• The first year may carry more risk of losing an implant (2% that year versus 0.5% per year after, according to the ITI consensus): that is why the first check-ups are more frequent.
• For life: hygiene, cleanings and check-ups; these implants may need more maintenance, have limits on chewing force, and sinusitis can appear years later.

Risks and how I prevent them

Sinusitis

The most reported complication: 2.4% in one large review and 14.2% at 5 years in another; it can appear years later. I prevent it by checking the sinuses first and choosing the implant path for your anatomy. It is treated with antibiotics or drainage surgery; if it does not respond, the implant may be lost.

Cheek or lip numbness

It involves the nerve that exits below the eye: 0.55% to 10.78% depending on the technique; fifteen publications report it as temporary. CT planning reduces it.

Gum infection around the implant

Between 2.0% and 7.50%, depending on the review and technique. It is prevented with hygiene and check-ups, and treated with cleaning, antibiotics or minor surgery.

Opening between the mouth and the sinus

Uncommon: 0.4% to 4.58% depending on the review and technique. If it happens, it is closed surgically.

Eye socket injury

Serious, without a reliable rate: the ITI consensus gathers four cases of orbital penetration in three studies. I plan on the CT scan and operate with a direct view; if there are eye symptoms, immediate care with an ophthalmologist.

Fewer failures than grafting, but more complications

In the randomized trial (71 patients), at one year 1 prosthesis failed or was not delivered with zygomatic implants versus 6 with grafting, but more patients had complications: 28 vs. 14. In the 4-month report, the zygomatic group's complications resolved on their own or could be managed. An overview of systematic reviews warns complications may be underestimated.

Other options

Not operating

Keeping a full denture, adjusted or remade, is valid, especially if there are medical risks or you don't want surgery.

Bone grafting, then conventional implants

According to the latest Cochrane review (a single trial for this comparison), zygomatic implants probably have fewer implant failures, but more complications. In that trial, fixed teeth arrived on average at 1.34 days with zygomatic implants and at 444.32 with grafting.

If some bone is left

Tilted implants (as in an All-on-4 hybrid prosthesis), short implants or a sinus lift, less invasive in borderline cases.

Other graftless techniques

Pterygoid, transnasal or custom subperiosteal implants, for very selected cases: I explain them at my dedicated practice.

Frequently asked questions