Can upper zygomatic implants support upper dentures with a clip-on mechanism?

Zygomatic Implants for Upper Denture Support with Clip-On Mechanism

Yes, zygomatic implants can support upper dentures with a clip-on mechanism, providing a reliable solution for patients with severe maxillary atrophy without requiring bone grafting procedures. 1, 2

Understanding Zygomatic Implants

Zygomatic implants are specifically designed for patients with severe atrophy of the maxilla when conventional implants cannot be placed without extensive bone augmentation. These implants:

• Are anchored in the zygomatic bone, providing stability in cases of insufficient maxillary bone volume 1
• Can be used with either delayed or immediate loading protocols 1
• Were first introduced by Aparicio and collaborators in 1993 for rehabilitating edentulous premaxilla 1
• Often involve trans-sinus placement, where implants pass through the maxillary sinus cavity 1

Clinical Outcomes with Zygomatic Implants

Recent clinical evidence demonstrates favorable outcomes for prosthetic solutions supported by zygomatic implants:

• A 2024 retrospective study of 274 zygomatic implants with 7.5-year mean follow-up showed 93.8% implant survival rate 3
• Prosthetic success rate of 92.3% was reported in the same long-term study 3
• A 2018 randomized controlled trial comparing zygomatic implants to conventional implants in augmented bone showed significantly fewer prosthetic failures with zygomatic implants (1 vs 6 patients) 4
• Time to functional loading was dramatically reduced with zygomatic implants (1.3 days vs 444.3 days) compared to conventional approaches requiring bone augmentation 4

Advantages of Zygomatic Implant-Supported Dentures

Clip-on (overdenture) prostheses supported by zygomatic implants offer several benefits:

• Elimination of the need for bone grafting procedures, reducing surgical morbidity 2, 5
• Significantly shorter treatment time compared to conventional approaches requiring bone augmentation 4, 5
• Improved quality of life with better chewing ability and esthetics 2
• Long-term stability and function, as demonstrated by a 9-year follow-up case showing no peri-implant inflammation, infection, or bone resorption 5

Prosthetic Considerations for Clip-On Mechanisms

When planning for clip-on dentures supported by zygomatic implants:

• A prosthetically-driven approach is essential to achieve optimal outcomes 6
• Proper preoperative planning should aim to position implant platforms as close as possible to the central fossae and cingulum of prosthetic teeth 6
• This positioning helps minimize buccopalatal cantilevers that could lead to speech disturbances and unhygienic prosthesis contours 6

Potential Challenges and Complications

Despite high success rates, several challenges should be considered:

• Placement involves technical complexity requiring specialized training and expertise 3
• Potential complications include maxillary sinus-related issues (sinusitis, increased sinus radiopacity) 1, 3
• Limited surgical visualization during placement 1
• Risk of unfavorable emergence profile depending on anatomical features 1
• Smoking habits negatively correlate with implant survival 3

Patient Selection and Follow-up

For optimal outcomes with zygomatic implant-supported clip-on dentures:

• Strict case selection is necessary due to potential complications 3
• Regular recall visits and proper oral hygiene maintenance are essential 3
• Patients should have sufficient mouth opening (similar to requirements for pterygoid implants, which need approximately 35mm) 1
• Patients should be informed about the possibility of complications but also about the significant improvements in function and quality of life 4, 2