FIGURE 13-1 The zygoma implant is considered when only zone I bone is available in the patient’s residual maxillary alveolus.

FIGURE 13-2 The zygomatic implant has two distinct diameters: 5 mm at the crest and 4 mm at the apical half.

(Courtesy Nobel Biocare, Yorba Linda, Calif.)

FIGURE 13-3 The implant platform is 45° and the soft tissue cuff is established around this portion of the platform and its corresponding abutment body.

(Courtesy Nobel Biocare, Yorba Linda, Calif.)

FIGURE 13-4 The crestal portion of the zygomatic implant is usually in 1 to 3 mm of alveolar bone because zones II and III bone is very limited or absent in this group of patients.

(Courtesy Nobel Biocare, Yorba Linda, Calif.)

FIGURE 13-5 The majority of the mid-section of the zygomatic implant is traversing through the maxillary sinus without any bony contact.

(Courtesy Nobel Biocare, Yorba Linda, Calif.)

FIGURE 13-6 The apical portion of the implant is in approximately 4 to 10 mm of bone as it travels through the body of the os zygomaticus.

(Courtesy Nobel Biocare, Yorba Linda, Calif.)

FIGURE 13-7 The quad-cortical stabilization of the zygomatic implants are at points 1, 2, 3, and 4.

(Courtesy Nobel Biocare, Yorba Linda, Calif.)

FIGURE 13-8 The drills have long shafts to allow access through the maxillary sinus and preparation of the osteotomy within the body of the os zygomaticus. Slightly shorter versions of the drills are also available.

FIGURE 13-9 The crestal osteotomy is initiated between the first and second maxillary bicuspid region.

(Courtesy Nobel Biocare, Yorba Linda, Calif.)

FIGURE 13-10 The colored lines represent the three trajectories of the zygomatic implant. The only proper trajectory is represented by the red line, placing the apex of the implant within the body of the os zygomaticus.

FIGURE 13-11 A, Shallow palatal vault and buccal vestibule are common in moderate to severely resorbed edentulous maxillae. B, Presence of zone I bone only is evident on the panoramic radiograph.

FIGURE 13-12 A full-thickness mucoperiosteal flap is raised, exposing the lateral maxillary wall.

A modified sinus opening is made.

FIGURE 13-13 The sinus window made through the lateral wall of the maxillary sinus is established with a 90° counter-clockwise rotation as compared with the outline made for a conventional sinus lift procedure.

FIGURE 13-14 A, The path of the drills and the implant should be directly visualized during preparation of the osteotomy as well as during placement of the zygomatic implant. B, The shaft of the screwdriver used to remove the fixture carrier from the implant must be perpendicular to the edentulous ridge to ensure proper orientation of the 45° implant platform.

FIGURE 13-15 Indexing the denture with polyvinylsiloxane registration paste, allowing the transfer of the abutment positions onto the intaglio surface of the denture.

FIGURE 13-16 Luting the temporary titanium cylinders to the denture base using fast-setting acrylic.

FIGURE 13-17 Luting the intaglio surface of the denture base to the titanium cylinders.

FIGURE 13-18 The immediate-load prosthesis 1 week after surgery.

FIGURE 13-19 Postoperative panoramic radiograph of the immediate-load maxillary prosthesis supported by two premaxillary implants and two zygoma implants for posterior support.

FIGURE 13-20 Endoscopic evaluation of the mid-portion of the zygomatic implant within the maxillary sinus demonstrates no adverse reaction of the Schneiderian membrane.

FIGURE 13-21 During animation the patient’s maxillary free gingival margin is visible.