"I was told I have no bone and that nothing can be done." This sentence is sometimes heard after a consultation at which a patient has been told that placing implants in the upper jaw is impossible. To many people it sounds like the end of the matter: if there is no bone, there is nothing to discuss. Yet the sentence is incomplete, and completing it changes its meaning. Zygomatic implants are a solution designed for precisely these situations — with one caveat: they are not an easier version of standard treatment, but a more demanding one.
What "there is no bone" actually means
The upper jaw is not a single uniform block. Its lower part is formed by the alveolar ridge (the section of bone in which the roots of the teeth are seated). The ridge exists in order to hold the teeth, and it behaves in accordance with that function: once the teeth are gone, it no longer receives mechanical stimulation and gradually recedes. The process takes years, advances most rapidly in the first period after tooth loss and, in some patients, leads to a state in which only a thin plate of bone remains where the teeth used to be.
It is this ridge that a clinician has in mind when saying "there is no bone". The whole of the upper jaw does not disappear, nor does the facial skeleton — a single, specialised part of it atrophies.
The zygomatic bone, commonly known as the cheekbone, belongs to an entirely different anatomical order. It forms the prominence of the cheek, contributes to the lateral wall and floor of the orbit, and transmits masticatory forces from the upper dental arch to the rest of the skull. It does not hold teeth, so the loss of dentition does not affect it — it retains its volume and stability even when the alveolar ridge has all but disappeared. The entire concept of the method rests on this: zygomatic implants — named after the zygomatic bone, the cheekbone — do not use the ridge at all; they bypass it and anchor in the zygomatic bone
In conversations with patients coming to Modern Dental & Orthodontics (Klinika MDO), one question recurs: whether the refusal they were given earlier is final. That question can rarely be answered without imaging. A panoramic radiograph produces a flattened image and does not reliably reproduce either the thickness of the bone or the course of the walls of the maxillary sinus. Qualification rests on cone-beam computed tomography, that is a CBCT scan — and it is the analysis of that scan, rather than the conversation alone, that determines which solutions are viable at all. You will find more about the differences between imaging examinations in our guide to dental radiology.
What a zygomatic implant involves and how it differs from a conventional one
In short: zygomatic implants are long implants angled from the region of the resorbed alveolar ridge up to the zygomatic bone. They bypass the site where bone is missing and rest on the cheekbone, which does not atrophy after tooth loss. As a result, in most cases they do not require prior bone augmentation.
A conventional implant is a relatively short fixture placed in the alveolar ridge — most often along an axis close to that of the lost tooth, although it is sometimes deliberately tilted. A zygomatic implant is several times longer and angled: it begins in the region of the former ridge, runs along or within the lateral wall of the maxillary sinus, and ends anchored in the zygomatic bone. It therefore derives its stability not from the bone that is missing, but from the bone that has remained intact.
The implant trajectory is not identical in every patient. An intrasinus approach is described, in which the implant passes through the sinus cavity, and an extrasinus approach, in which it runs along the outer aspect of the sinus wall. The choice is dictated by the shape of the anterior sinus wall rather than by the operator's preference — this premise underpins the ZAGA concept, an approach based on tailoring surgery to the anatomy of the individual patient. The same principle extends to soft tissue planning: a paper published in 2025 in the International Journal of Periodontics & Restorative Dentistry presents a decision tree for selecting the incision and flap, based on five anatomical factors — among them the thickness of the palatal mucosa and the width of the keratinised gingiva. Adequate soft tissue coverage of the implant matters both for healing and for complications in the years that follow.
In practice, zygomatic implants are rarely used singly. Most often they form part of a full-arch restoration: in the hybrid variant they are combined with conventional implants in the anterior segment, while in the most severe atrophy a protocol based on four zygomatic implants, two on each side, is used. The choice of variant follows from how much bone remains in the anterior segment of the upper jaw. A retrospective analysis of nineteen patients treated with two zygomatic protocols, published in 2026, recorded no implant or prosthesis failures — this was, however, a small group and a short follow-up.
This does not mean that bone augmentation is an inferior route — only that in some cases it ceases to be a prerequisite. The bone reconstruction techniques themselves are discussed separately, in our article on bone augmentation before an implant.
Four levels of maxillary atrophy — what is considered when
The following overview sets out the logic of qualification. It does not allow you to establish on your own which group you belong to — that is determined by a CBCT scan.
Level 1 — sufficient bone in both the anterior and the posterior segment
Conventional implant placement or a standard full-arch protocol. Zygomatic implants are not considered.
Level 2 — limited bone in the posterior segment of the upper jaw
The options include tilting the posterior implants so as to bypass the sinus, or a sinus lift followed by implant placement in the reconstructed site.
Level 3 — advanced atrophy
Extensive bone augmentation with implant placement deferred by several months is considered, or a hybrid protocol in which some implants are anchored conventionally and some in the zygomatic bone.
Level 4 — extreme atrophy, in which augmentation carries a high risk
Here a protocol based solely on zygomatic implants is sometimes the option considered first, where a fixed restoration is the goal. The 2023 ITI consensus identifies precisely maxillary bone atrophy or deficiency as the principal indication for this method.
The key point is that zygomatic implants are chosen not for convenience, but where the possibilities of conventional implant placement end — including implant placement preceded by bone reconstruction.
What you must disclose before surgery, and when the method is not an option
Qualification for zygomatic implants does not end with a CBCT scan. Some factors have nothing to do with the quantity of bone and can nevertheless change the plan or postpone surgery.
Medicines affecting bone remodelling. Bisphosphonates, denosumab and other antiresorptive medicines — taken for osteoporosis or in the course of cancer treatment — are associated with a risk of osteonecrosis of the jaw. They must be disclosed explicitly, giving the name of the preparation and the duration of treatment, including where that treatment ended several years ago.
Previous radiotherapy to the head and neck. Irradiation alters the blood supply and the healing of bone. This is not an automatic exclusion, but it calls for separate assessment and coordination with the team providing the oncological care.
Disorders of the maxillary sinuses. The sinus is an immediate neighbour of the implant throughout the whole period of its service. Active or chronic inflammation, polyps or previous sinus surgery must be clarified before the procedure.
Smoking, poorly controlled diabetes, anticoagulants, conditions that impair healing. These rarely rule treatment out altogether — more often they postpone it or alter the preparation for surgery.
It must be said honestly that the peer-reviewed literature lacks studies establishing by how much each of these factors increases the risk of failure specifically with zygomatic implants. The decision is therefore made individually, once a full medical history has been taken — and withholding information about the medicines you take works solely to your own detriment.
The course of treatment and the point at which the patient gets teeth back
Treatment begins with diagnostic imaging. An expert survey conducted as part of the first global consensus on the rehabilitation of the edentulous maxilla, published in 2026 in Clinical Oral Implants Research, found a very high level of agreement on several points — among them the routine use of computed tomography in planning and the assessment of the maxillary sinus where sinus pathology is suspected. This is not a formality — the condition of the sinus determines both the course of surgery and the risk of complications in the years that follow.
Surgery itself is usually performed under general anaesthesia or sedation, on both sides of the upper jaw in a single session. It takes longer than conventional implant placement and requires a team prepared to work in this region.
The point at which teeth are restored tends to matter most to patients. In zygomatic protocols, immediate loading has become the standard, that is the fitting of a provisional bridge within the first days after surgery. This is not solely a matter of comfort: a 2023 meta-analysis published in the International Journal of Implant Dentistry found that immediately loaded implants survived better than those loaded after a delay, and the difference was pronounced enough to make chance an unlikely explanation. The meta-analysis does not, however, explain the reason for that difference. In studies of the newer, anatomy-guided approach, immediate loading was used in close to nine cases out of ten; with the older technique, in slightly more than two out of ten.
The definitive prosthesis is made after healing, usually several months later. In the meantime the provisional bridge functions as a fully fledged restoration — the patient is not left without teeth.
A satisfaction study published in 2025 in Clinical Oral Implants Research, covering twenty-two consecutive patients treated with immediate loading, found high overall ratings at six months in close to three quarters of those assessed; aesthetics and chewing were rated similarly. Satisfaction with chewing increased over time — between the second week and the sixth month. This was a single-centre study in a small group, so its findings should not be read as a promise.
The first days after surgery
Under general anaesthesia the patient does not experience the procedure; with sedation combined with local anaesthesia, sensations are limited and recollection of surgery is usually fragmentary. Discomfort appears only once the anaesthesia wears off and, in most people, can be managed with the analgesics prescribed by the treating clinician.
Swelling of the cheeks is often more troublesome, sometimes with bruising around the eyes. It usually builds over the first two to three days and then subsides. During this time a soft diet, cooling of the area and sleeping with the head elevated are advised.
There is also one instruction that is easy to forget and that follows directly from the proximity of the sinus: for the first few weeks you should not blow your nose forcefully, and it is better to sneeze with your mouth open. A rise in pressure within the sinus during healing is undesirable. Smoking is particularly harmful at this stage.
Most patients return to desk work within a few days; physical exertion is deferred for longer. The course varies, and the instructions of the treating team are decisive.
Complications and limitations — what you need to know beforehand
The most common biological complication of zygomatic implants is maxillary sinusitis. The ITI consensus reports that sinusitis was described in around fourteen cases out of a hundred over a mean follow-up of more than five years — that is, in roughly one case in seven. It is also the complication that may lead to loss of the implant.
More important than the figure itself, however, is how these events are distributed over time. A large 2023 cohort analysis published in Clinical Oral Implants Research, covering more than nine hundred zygomatic implants and almost eight years of follow-up, found that sinusitis appeared on average only around four and a half years after surgery. This is a late complication rather than a perioperative one — and that is an argument for having treatment of this kind carried out at a centre that provides follow-up over years, not merely over the first months. In the same paper, sinusitis, infection of the zygomatic region and oroantral communication proved to be associated with subsequent implant loss.
The risk is probably not constant and depends on the technique, although it must be said at once how cautiously these data should be read. A systematic review covering more than two thousand zygomatic implants compared the older original technique with an approach tailored to the patient's anatomy. Complication rates recorded with the older technique were higher: sinusitis was described there in around one case in ten, and with the anatomy-guided approach in fewer than one in twenty. A similar direction applied to sensory disturbance in the cheek, the ala of the nose and the upper lip — with the older technique this was recorded in roughly one case in ten, with the newer one only sporadically. The authors emphasise, however, that the studies were sufficiently heterogeneous that no statistical comparison of the two techniques was possible, and that implant survival was comparable in both groups. This comparison therefore indicates a direction, not a proven advantage. Moreover, studies with follow-up as short as six months were included in the review — and since sinusitis usually appears after years, the reported rates are more likely to be underestimates than overestimates.
Possible complications also include soft tissue infections, oroantral fistula (a persistent communication between the oral cavity and the sinus) and recession of the peri-implant mucosa, that is a drop in the soft tissue in the region of the implant platform. Anatomy also matters here: the implant trajectory runs in the vicinity of the orbit, which is in itself sufficient reason to plan surgery digitally and to entrust it to a team that performs it regularly.
Mechanical complications of the restoration supported by zygomatic implants form a separate group. In a large cohort analysis, the most frequent of these proved to be fracture of the prosthetic screw — twenty-nine such events were described, on average four years after surgery. This is a repairable complication, but one that requires an appointment rather than resolving on its own.
How does durability look against this background? A meta-analysis covering more than one thousand three hundred zygomatic implants found that, after a mean follow-up of more than six years, around ninety-six implants in every hundred remained in place. Expressed on an annual basis, this amounts to the loss of roughly seven per thousand. A separate cohort analysis, covering patients treated over a period of more than twenty years and followed for a mean of almost eight years, reports a lower figure — close to ninety implants in every hundred. The discrepancy is itself informative: a meta-analysis gathers selected studies, whereas a single cohort shows the full cross-section of one group of patients, including implants placed in the 1990s, when different implant surfaces were in use. There are therefore several reasons for the difference, and it cannot be reduced to one.
A meta-analysis comparing zygomatic implants with conventional ones over follow-up of at least five years, in turn, found no significant difference in survival between them. None of these figures is a guarantee for an individual, however — studies describe populations, not individual patients.
Symptoms that call for prompt attention
Because the most common complication of zygomatic implants can appear only after years, it is worth recognising its signals:
- unilateral nasal obstruction persisting despite treatment,
- purulent or foul-smelling nasal discharge, or discharge running down the back of the throat,
- pain and a sense of pressure in the cheek or below the orbit,
- a sensation of air or fluid passing between the oral cavity and the nose,
- swelling that increases rather than subsides after a few days, particularly with fever,
- mobility of the bridge or a change in the way the teeth meet.
None of these symptoms in itself confirms a complication, but each is a reason to contact your clinician rather than to wait.
Zygomatic implants versus conventional implant placement preceded by augmentation
| Dimension | Zygomatic protocol | Implant placement after augmentation |
| Total treatment time | Usually shorter — bone reconstruction does not precede implant placement | Usually longer — after bone reconstruction, a healing period is needed before implant placement |
| Number of surgical procedures | Most often one main procedure | Usually at least two surgical stages |
| Point at which teeth are restored | Zwykle obciążenie natychmiastowe — most tymczasowy w pierwszych dniach | Zęby stałe dopiero po wygojeniu przeszczepu i integracji wszczepów |
| Profil powikłań | Usually immediate loading — a provisional bridge within the first days | Fixed teeth only after the graft has healed and the implants have integrated |
| Requirements of the centre | Digital planning, dedicated team training, regular performance of the procedure | Experience in regenerative surgery and longer supervision of healing |
The table serves to organise the picture. It must be stated honestly that the peer-reviewed literature lacks studies directly comparing the two routes in terms of total treatment time — the differences in that row follow from the design of the protocols themselves, not from measurement in a clinical study.
Living with the restoration, and what happens if something fails
A bridge on zygomatic implants is a fixed structure, screwed to the implants — the patient does not remove it themselves. Cleaning therefore covers not only the tooth surfaces but also the space beneath the pontic: interdental brushes, dental floss with a stiffened threader and a spongy section, and a water flosser are everyday tools here rather than optional extras. Speech usually requires several weeks of adaptation.
Follow-up appointments are scheduled regularly and with no predetermined end point. They also include assessment of the sinus region — the most common complication appears with a delay measured in years, so the interval between visits matters more here than with conventional restorations. In a large cohort analysis, implant loss occurred on average after just under five years, and most losses fell within the first five years of follow-up.
A separate question is what happens if an implant is lost. The answer depends on how many supports remain and on the condition of the zygomatic bone. The loss of one implant out of several need not mean the loss of the whole restoration, but it can also be the case that the structure has to be redesigned. The literature on management in such situations is sparse — and that in itself is an argument for discussing this scenario before surgery rather than after it.
What to expect of a centre, and what to ask at your consultation
In the 2026 expert survey, the highest level of agreement — above ninety-five per cent of responses — covered, among other things, the statement that the placement of zygomatic implants requires dedicated, specialist training. This is one of the few points on which expert agreement was so clear-cut — and a useful benchmark when choosing where to be treated.
From the perspective of the clinical team at Modern Dental & Orthodontics (Klinika MDO), what matters is that a discussion of the method only makes sense once a CBCT scan has been performed — before that we remain in the realm of supposition. Before a decision is made, it is worth asking at the consultation:
- Has a cone-beam CT scan been performed, and what exactly does it show in my case?
- Has the condition of the maxillary sinuses been assessed before surgery?
- Which options other than the zygomatic protocol were considered, and why were they ruled out?
- Is the procedure planned digitally, on the basis of the CT data?
- How often does the team perform this procedure?
- What does the follow-up plan look like over the coming years, and who carries it out?
- What happens if an implant is lost — what are the options then?
Evasive answers on points concerning diagnostics and long-term follow-up are a signal that it is worth seeking a second opinion.
Frequently asked questions
What are zygomatic implants?
They are implants several times longer than conventional ones, angled from the region of the former alveolar ridge up to the zygomatic bone, that is the cheekbone. They anchor in bone that does not atrophy after tooth loss, which means that in most cases they do not require prior bone reconstruction in the upper jaw.
Who are zygomatic implants for?
For people with advanced or extreme atrophy of the maxillary bone in whom conventional implant placement is not possible — including after bone reconstruction has been considered. Qualification is carried out on the basis of a cone-beam CT scan. This is not an alternative to standard implant placement where sufficient bone is present.
Is bone augmentation needed with zygomatic implants?
Usually not. The whole point of the method is to bypass the resorbed alveolar ridge and anchor the implant in the zygomatic bone, which remains stable. In some cases, however, conventional implants are additionally placed in the anterior segment of the upper jaw, which may involve separate indications and different qualification.
What are the complications of zygomatic implants?
The most common is maxillary sinusitis — studies described it in around fourteen cases out of a hundred over follow-up of several years, often only some years after surgery. Less frequent are soft tissue infections, sensory disturbance in the cheek, the ala of the nose and the upper lip, oroantral communication and soft tissue recession around the implant.
When do you get teeth after surgery?
In zygomatic protocols the standard is immediate loading: a fixed provisional bridge is usually fitted within the first days after surgery, so the patient is not left without teeth. The definitive prosthesis is made after healing, most often several months later. The course depends on the clinical situation and may vary.
Is the procedure painful?
Surgery is performed under general anaesthesia or under sedation with local anaesthesia, so the patient either does not feel it or feels it only to a limited degree. Discomfort appears once the anaesthesia wears off and, in most people, can be managed with analgesics. Swelling of the cheeks is often more troublesome, usually building over two to three days, sometimes with bruising around the eyes. The course is individual.
How long do zygomatic implants last?
In a meta-analysis covering more than one thousand three hundred implants, around ninety-six in every hundred remained in place after a mean of more than six years. In a cohort followed for almost eight years the figure was lower. The prosthetic structure itself survived somewhat less often than the implants in these studies. Durability depends on anatomy, hygiene and regular follow-up — it cannot be guaranteed.
Does every clinic perform such procedures?
No. Experts agree that the procedure requires dedicated specialist training, digital planning based on a cone-beam CT scan, and a team that performs it regularly. Before deciding, it is worth asking directly about the team's experience, about assessment of the sinuses and about how follow-up is conducted in subsequent years.
Summary
The phrase "there is no bone" usually describes atrophy of the alveolar ridge rather than of the whole upper jaw. The zygomatic bone remains intact, and it is there that zygomatic implants anchor. The method makes it possible to bypass bone reconstruction and usually to give the patient a fixed restoration within a few days, but it carries a different risk profile from conventional implant placement — with maxillary sinusitis foremost and with complications that may appear even years later. It is a solution for situations in which other routes have been exhausted, not a shortcut. Whether it is considered at all is determined by a cone-beam CT scan, not by conversation alone.
Read more:
- Implantology — implant treatment
- All-on-X implants Warsaw
- All-on-4 or All-on-6 — how full-arch protocols differ
- Bone augmentation before an implant — when it is needed
- A guide to dental radiology
Content and liability disclaimer
This article is informational and educational in nature and does not constitute medical advice, a diagnosis or a therapeutic recommendation — it does not replace a consultation with a specialist. If you are experiencing symptoms, have doubts or are facing a decision about treatment, consult a dentist. The methods described and the data cited are general in nature. The results of scientific studies relate to populations, not to an individual patient. The course and outcome of therapy depend on the individual clinical situation and may vary between patients. No information contained in this article constitutes a guarantee of result. The content has been prepared with due care, based on publicly available medical knowledge and the scientific publications indicated in the Sources section. We do not advise taking or refraining from any health-related action solely on the basis of the content of this article, without prior consultation with a doctor.
Sources
Source 1
Links https://doi.org/10.1186/s40729-023-00479-x │ https://pubmed.ncbi.nlm.nih.gov/37405545/
Description Brennand Roper M, 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;9(1):21.
Source 2
Links https://doi.org/10.1111/cid.13153 │ https://pubmed.ncbi.nlm.nih.gov/36373779/
Description Moraschini V, de Queiroz TR, Sartoretto SC, de Almeida DCF, Calasans-Maia MD, Louro RS. „Survival and complications of zygomatic implants compared to conventional implants reported in longitudinal studies with a follow-up period of at least 5 years: A systematic review and meta-analysis.” Clinical Implant Dentistry and Related Research. 2023;25(1):177-189.
Source 3
Links https://doi.org/10.1111/clr.14027 │ https://pubmed.ncbi.nlm.nih.gov/36541107/
Description Vrielinck L, Moreno-Rabie C, Coucke W, Jacobs R, Politis C. „Retrospective cohort assessment of survival and complications of zygomatic implants in atrophic maxillae.” Clinical Oral Implants Research. 2023;34(2):148-156.
Source 4
Links https://doi.org/10.1186/s40729-023-00478-y │ https://pubmed.ncbi.nlm.nih.gov/37198345/
Description Kämmerer PW, Fan S, Aparicio C, Bedrossian E, Davó R, Morton D, Raghoebar GM, Zarrine S, Al-Nawas B. „Evaluation of surgical techniques in survival rate and complications of zygomatic implants for the rehabilitation of the atrophic edentulous maxilla: a systematic review.” International Journal of Implant Dentistry. 2023;9(1):11.
Source 5
Links https://doi.org/10.1186/s40729-023-00489-9 │ https://pubmed.ncbi.nlm.nih.gov/37698775/
Description Al-Nawas B, Aghaloo T, Aparicio C, Bedrossian E, Brecht L, Brennand-Roper M, Chow J, Davó R, Fan S, Jung R, Kämmerer PW, Kumar VV, Lin WS, Malevez C, Morton D, Pijpe J, Polido WD, Raghoebar GM, Stumpel LJ, Tuminelli FJ, Verdino JB, Vissink A, Wu Y, Zarrine S. „ITI consensus report on zygomatic implants: indications, evaluation of surgical techniques and long-term treatment outcomes.” International Journal of Implant Dentistry. 2023;9(1):28.
Source 6
Links https://doi.org/10.1111/clr.70015 │ https://pubmed.ncbi.nlm.nih.gov/41732056/
Description Strauss FJ, Brunello G, Thoma DS, Kopp I, Stilwell C, Jung RE, Wang HL, Schwarz F. „1st Global Consensus for Clinical Guidelines for the Rehabilitation of the Edentulous Maxilla: A Single-Round Survey on Standard, Short, and Zygomatic Implant-Supported Prostheses.” Clinical Oral Implants Research. 2026;37(Suppl 30):S135-S154.
Source 7
Links https://doi.org/10.11607/prd.7862 │ https://pubmed.ncbi.nlm.nih.gov/41052291/
Description Aparicio C, Sanz A, Tahmasebi S, Broumand V. „Incision and Flap Design in Zygomatic Implant Surgery: A ZAGA-Based Decision Tree.” International Journal of Periodontics & Restorative Dentistry. 2025 (publikacja elektroniczna przed drukiem):1-44.
Source 8
Links https://doi.org/10.11607/prd.7493 │ https://pubmed.ncbi.nlm.nih.gov/39775712/
Description Ferrigno N, Laureti M, Alrmali AE, Lorenzi C, Wang HL, Carosi P. „Comparative Clinical Outcomes of Two Different Zygomatic Implant Protocols for the Rehabilitation of Severely Atrophic Maxillae: A Retrospective Analysis.” International Journal of Periodontics & Restorative Dentistry. 2026;46(1):74-87.
Source 9
Links https://doi.org/10.1111/clr.14432 │ https://pubmed.ncbi.nlm.nih.gov/40105036/
Description Rodrigues A, Abi Nader S, Daniel N, Emami E. „Patient-Reported Outcomes With Immediate-Loaded Zygomatic Implant Fixed Rehabilitation in Patients With Edentulous Atrophic Maxilla: A Retrospective Practice-Based Clinical Study.” Clinical Oral Implants Research. 2025;36(7):871-878.