Surgical Modifications to the Brånemark Zygomaticus Protocol in the Treatment of the Severely Resorbed Maxilla: A Clinical Report

Purpose: The Zygomaticus dental implant, designed by Nobel Biocare, was developed for the treatment of the severely resorbed maxilla. Brånemark has reported an overall success rate of 97.6% with the placement of 183 implants over the last 12 years. The purpose of this article was to present a modification to the original Brånemark surgical approach to achieve better access and optimal implant placement. Materials and Methods: There are parameters within the patient's resorbed skeletal frame that guide the surgical placement of the currently used implant. However, there are shortcomings in the current surgical protocol. This report describes a simplified surgical approach in 45 patients (77 implants) using an implant with a modified head angulation of 55 degrees and a placement appliance to assist the surgeon in placing the implant as close to the crest of the edentulous ridge as possible. Results: The placement appliance identifies accurately the anatomic constraints of the resorbed skeletal frame that limit implant placement. This, together with the modified surgical protocol, has resulted in improved access and in ideal positioning of the restorative head. Discussion: The present technique allows restorative clinicians to achieve a more ideal restorative result in the posterior maxillary alveolus using the zygomatic implant, while reducing the buccal cantilever, improving tongue space, and access for maintenance. Conclusion: By placing the implant closer to the crest of the alveolar ridge using the placement appliance and an implant with a 55-degree head, the emergence of the restorative head and resultant buccal cantilever can be reduced by as much as 20%.