Zygomatic Implants in Brazil: Treatment When You Have Been Told You Have No Bone

“I was told I have no bone.” Of all the sentences I hear from people who contact me from abroad, this is the most common, and it usually comes with a second one: “so I would need a bone graft first, and I do not know if I want that.” If that is where you are, this text is for you.

I will explain what a zygomatic implant is, when it is an option, what the largest reviews report, how treatment works in practice and what to check before you travel anywhere for surgery, my clinic included. I will also tell you where the evidence is thinner than a web page usually admits.

What a zygomatic implant is

A conventional implant is placed in the maxilla, the bone of the upper jaw. After teeth are lost, the part of that bone that held them shrinks, and it keeps shrinking for years. This is why someone who has worn a full denture for a long time is often told there is “not enough bone”.

A zygomatic implant is longer and is anchored in the zygomatic bone, the strong bone that forms the cheek. This bone is not the part of the jaw that shrinks after tooth loss, so it can still be there when the ridge is gone. The idea is simple: move the anchorage to bone that is still available. The prosthesis on top is fixed, and in the end it does not look different from other fixed prostheses. What differs is where it is anchored.

What “no bone” usually means

When a dentist says “no bone”, it almost always refers to the upper jaw, in height, thickness or both, in the area where conventional implants would go. It does not say anything about the zygomatic bone. Only a CT scan can show whether the cheekbone offers the support needed and what path each implant can take. I do not give an opinion on this without looking at the scan.

Who may be a candidate

• People with severe bone loss in the upper jaw;
• Long-term denture wearers who have lost bone volume;
• Cases in which a conventional bone graft would be extensive, slow, or of uncertain result;
• People who were told elsewhere that implants are not possible;
• Some patients after surgery for tumors in the region. Here the reviews show lower survival, so this is a separate and more cautious conversation [2,3].

Candidacy is only confirmed after an examination and imaging, and it also depends on your general health. I ask every surgical patient for a surgical risk report from the cardiologist and laboratory tests (glycated hemoglobin, fasting glucose, blood count and coagulation tests).

If you were told you need a bone graft first

A graft often means another surgical site, months of healing before the implants can be placed, and a result that is not certain in severely atrophic jaws. Zygomatic anchorage can avoid that step in selected cases. That does not make grafting wrong. For some patients it is the right path, and I recommend it when the tomography points that way.

Do the studies say which is better? Not clearly. A 2023 systematic review of 33 studies on severely atrophic maxillae found the studies too different to pool, and concluded that no single approach can be called the gold standard; the choice depends on the patient’s biology and on the clinician’s expertise [4]. If you want to go deeper, I compare the options in the text on zygomatic implants vs. bone graft.

What the evidence shows

Zygomatic implants are not experimental. The largest systematic review I rely on pooled 68 studies, with 4,556 zygomatic implants in 2,161 patients and 103 failures. Cumulative survival at 12 years was 95.21%, and most failures happened in the first six months. The complications reported were sinusitis in 2.4%, soft tissue infection in 2.0%, paresthesia in 1.0% and oroantral fistula in 0.4%, with the authors warning that these figures may be underestimated [2].

A 2023 meta-analysis of 18 studies, with 1,349 zygomatic implants in 623 patients followed for 75.4 months on average, found 96.2% survival at six years. Survival was higher with immediate loading (98.1%) than with delayed loading (95%), and sinusitis was reported in 14.2% of patients at five years [1]. The sinus numbers differ between reviews because the studies define and follow it differently, which is why I treat the sinus as something we watch for years, not weeks.

An older review, from 2012, reported 96.7% survival at 12 years in 42 studies. It also said something any honest page should repeat: placing zygomatic implants requires very experienced surgeons, since delicate structures are nearby [3]. None of this makes the procedure routine. It makes it predictable in trained hands, which is a different claim, and the honest one.

How treatment works

1. Imaging and planning. A CT scan maps the bone and the path of each implant. I ask for the tomography and show it on the screen, so you see what I see. Nothing is decided before this.
2. Surgery. The surgery is done in a prepared facility. When there is sedation, it is always given by the anesthesiologist, and it is not done without a companion. In some zygomatic cases general anesthesia is the better option. Some patients need four zygomatic implants and others two zygomatic and conventional ones in front. The scan decides.
3. Provisional prosthesis. In many protocols a fixed provisional prosthesis is delivered within days, so you do not spend the healing period without teeth.
4. Follow-up. I schedule your returns closer together than for a conventional case, and the sinus is followed for years.

Recovery

Swelling and discomfort in the first days are expected, as after any surgery, and are managed with the medication I prescribe. Most people move to soft foods in the first week and progress from there, following my instructions. The first weeks are when problems are easiest to catch, so the follow-up plan matters as much as the operation.

Before you book a flight

A message can tell us whether your case is worth examining and which images are needed. It cannot replace the in-person examination. And if someone shares the decision with you, a spouse or a son or daughter, I ask that they come with you to the consultation, because this is not a decision to be made by video or by message. Questions to ask any clinic, here or anywhere else:

• Who performs the surgery, and what is the professional registration?
• Will a CT scan be read before any plan is offered?
• Who gives the anesthesia or sedation?
• What happens if a complication appears after I fly home, and who sees me locally?
• Does the proposal include the prosthesis or only the implants?

A clinic that accepts every case without conditions is not being accommodating; it is skipping the diagnosis. Two related texts cover the practical side: whether Brazil is safe for dental implants and what determines the treatment plan in Brazil. For how long they last, see how long zygomatic implants last.

What the evidence allows us to say, and what it does not

It allows us to say that zygomatic implants have high survival in the studies we have (about 95% to 96% over six to twelve years), that most failures are early, and that sinusitis is the complication to plan for [1,2]. It does not allow us to say that it is right for everyone with bone loss, that grafting is wrong, or that the result is identical with every surgeon. The evidence is of low to medium quality, and I would rather say so [4].

Sources

• [1] Brennand Roper M, et al. Long-term treatment outcomes with zygomatic implants: a systematic review and meta-analysis. Int J Implant Dent. 2023;9(1):21. doi:10.1186/s40729-023-00479-x
• [2] Chrcanovic BR, Albrektsson T, Wennerberg A. Survival and complications of zygomatic implants: an updated systematic review. J Oral Maxillofac Surg. 2016;74(10):1949-1964. doi:10.1016/j.joms.2016.06.166
• [3] Chrcanovic BR, Abreu MHNG. Survival and complications of zygomatic implants: a systematic review. Oral Maxillofac Surg. 2013;17(2):81-93. doi:10.1007/s10006-012-0331-z
• [4] Alsi SA, Deshpande S, Pande N. Clinical outcomes of implant-supported prosthetic rehabilitation of severely atrophic maxilla: a systematic review. J Indian Prosthodont Soc. 2023;23(4):335-346. doi:10.4103/jips.jips_360_23

Ask about your case

Whether this applies to you is decided by imaging and an examination, not by a web page. A CT scan and a short history are enough to get a useful first answer from Dr. Daniel Coutinho (CRO-RN 2966), specialist in Implantology (FOP-UNICAMP), in Natal, Brazil, and you will be told if your case is not one for zygomatic implants. You can read my credentials and check any Brazilian dentist’s registration yourself. If you would like to send your scan, here is what to send.