The atrophic maxilla needs special care in treatment planning to ensure a good implantation outcome. Therefore Dr. Wolfgang Bolz, Munich/Germany, starts with the clinical and radiological evaluation of the initial situation and discusses the three-dimensional planning of the zygomatic implants at the extremely atrophied upper jaw is discussed. Subsiquently he shows the insertion and immediate loading of the zygomatic implants.

Due to the reduced bone available, zygomatic implants are inserted into the upper jaw during this procedure to facilitate fixed dentures. Several weeks prior to the surgery performed by Dr. Bolz, the upper jaw dentition was extracted and full dentures integrated, which are now reworked into fixed temporary dentures. Despite the limited height of the alveolar ridge, it is possible to insert zygomatic implants, thus ensuring sufficient primary stability for immediate restoration.

Following exposure and levelling of the alveolar ridge, the zygomatic bone is exposed and the maxillary sinus opened through preparation of a large access window in the bone while taking care not to damage the membrane. Following completion of sinus augmentation, the insertion site for the zygomatic implant is marked using a long round burr. Drilling is then performed and the zygomatic implant inserted while taking care not to damage the sinus mucosa.

To facilitate successful healing, the zygomatic implant is covered with bone substitute as well as two membranes comprised of compact bone and collagen. A stable layer of connective tissue can be expected, however whether osseointegration is also likely has not yet been sufficiently explored by scientific research. Once the zygomatic implant has been inserted, the position of the anterior implants is selected using a drill template. The fixed dentures can already be integrated just a few hours after surgery has been completed.