A New Method to Eliminate the Risk of

Maxillary Sinusitis with Zygomatic Implants

James Chow, BDS, MDS, MBBS1/Peter Wat, BDS, LDS2/Edward Hui, MBBS, BDS, MDS1/
Philip Lee, BDS, MDS1/William Li, BDS, MDS, Adv Dip OMS1

Purpose: A new approach for zygomatic implant placement was proposed to eliminate the risk of maxillary sinusitis related to the procedure. Materials and Methods: A prospective study of this new approach
was conducted, and consecutive patients treated between June 2007 and December 2008 were
included. An extended sinus lift with retained bone window was performed, such that zygomatic implants
were placed completely outside the displaced maxillary sinuses. All patients were followed up radiologically at regular intervals using cone beam computed tomography to evaluate the status of the zygomatic
implants and the condition of the maxillary sinuses. Results: Sixteen patients (9 women and 7 men with
a mean age of 60) were treated with 37 zygomatic implants. Within the period of investigation from
6 months to 24 months, there were no failed zygomatic implants, and no instances of maxillary sinusitis
were reported. Conclusions: The new approach that combined the zygomatic implant placement with the
extended sinus lift procedure was predictable and fulfilled the purpose of lowering the risk of maxillary
sinusitis. INT J ORAL MAXILLOFAC IMPLANTS 2010;25:1233-1240
Key words: bone regeneration, maxillary sinusitis, sinus elevation, sinusitis, zygomatic implants

rnemark and coworkers introduced zygomatic

implants to restore function in persons with
severely atrophic edentulous maxillae.1 Numerous
studies have shown zygomatic implants to be a predictable treatment option with very few technical
and biologic complications.113 However, it was not
uncommon to encounter maxillary sinusitis in zygomatic implant patients. The reported incidence of
maxillary sinusitis after zygomatic implants ranges
from 0% to 37.5%. In the present study, therefore, a
new method was proposed to eliminate the maxillary
sinusitis risk in zygomatic implants.

MATERIALS AND METHODS

Consecutive patients with severely atrophic maxillae
who were treated with zygomatic implants between

1Director,

Brnemark Osseointegration Center, Hong Kong, China.

Implant Prosthodontist, Brnemark Osseointegration
Center, Hong Kong, China.

2Consultant

Correspondence to: Dr James Chow, Associated Brnemark

Osseointegration Center, 1901-1905, 1912-1913, The Center,
99 Queens Road Central, Hong Kong SAR. Fax: +852-28514700.
Email: jameskfchow@hotmail.com

June 2007 and December 2008 were included in this

study. Patients who required extraction of their
remaining teeth were treated conventionally without
the use of a surgical template; patients who were
already edentulous were given the option of being
treated by computer-assisted planning and templatebased guided surgery.
All patients were free of signs and symptoms
related to acute maxillary sinus infection at the initial
consultation. All patients were assessed preoperatively for any medical contraindications that might
prevent them from undergoing general anesthesia.
Both smokers and nonsmokers were included.
Patients who had sufficient bone volume for conventional implant placement were excluded.

Cone Beam Computed Tomography Imaging

Cone beam computed tomography (CBCT ) was
employed for preoperative imaging for every patient
(Fig 1). The digital CBCT files were rendered for computer-based planning using Procera software (Nobel
Biocare). In selected patients, stereolithographic templates were produced for guided zygomatic implant
placement according to a previously published protocol.8 All patients were followed up with serial CBCT
examinations. CBCT was performed immediately after
implant placement and repeated at the 3-month,
6-month, and 12-month follow-up appointments.
The International Journal of Oral & Maxillofacial Implants 1233

2010 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Chow et al

Fig 1 CBCT for preoperative assessment.

Coronal view demonstrates the anatomy of
the zygomas and the status of the maxillary
sinuses.

Fig 2 An extended sinus lift is performed with a retained bone

window.
Fig 3 (Right) The retained bone window functions as a shield to
protect the sinus membrane from direct damage by the drills.

Zygomatic Implant Placement

All patients received general anesthesia for zygomatic implant placement. Vital signs of all patients
were monitored, and all patients were observed for
their depth of anesthesia using an electroencephalographic bispectral index. All patients received prophylactic amoxicillin clavulanate (1.2 g intravenously)
after induction of anesthesia.
Patients were divided into two groups: one group
received guided zygomatic implant placement and
the other received conventional zygomatic implant
placement. The patients who underwent guided zygomatic implant placement were treated with NobelGuide stereolithographic templates. The guided
protocol,8 previously published, made use of SimPlant
software (Materialise Dental) instead of Procera software (Nobel Biocare).

A crestal incision was made with vertical releasing

incisions in the midline and second molar regions for
patients undergoing conventional flap surgery. After
the flap was raised and retracted, an extended rectangular bone window was cut according to the level of
the sinus floor and sinus roof (Fig 2). The purpose of
this bone window was to allow adequate exposure of
the entry and exit points for zygomatic implants at
the crestal/palatal level and the zygomatic bone,
respectively. The bone window was retained on the
underlying mucosa while the sinus membrane was
slowly and carefully elevated from the sinus walls. The
retained bone window acted as a shield that could
protect the sinus membrane from direct damage by
rotary instruments, such as the round bur and twist
drills (Fig 3).

1234 Volume 25, Number 6, 2010

2010 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Chow et al

Fig 4a A NobelGuide surgical template in place for guided

implant placement. Two palatal drill sleeves are incorporated for
zygomatic implants in the posterior region.
Fig 4b (Right) With the NobelGuide surgical template, a guided
twist drill is placed through the drill sleeve and used to penetrate
the crestal bone at the entry area for the zygomatic implant.

In patients treated with conventional flap surgery,

zygomatic implant osteotomies were carried out
starting with a round bur, followed by a 2.9-mm-diameter twist drill, 3.5-mm-diameter pilot drill, and finally
a 3.5-mm-diameter twist drill. The entire osteotomy
procedure was completed under direct visual control.
In patients treated using the NobelGuide stereolithographic template, the zygomatic implant osteotomy
was performed through the palatal drill sleeve on the
surgical template 8 (Figs 4a and 4b).
In situations when more than one zygomatic
implant was placed on the same side, the posterior
zygomatic implant was placed first, followed by the
anterior one. Conventional implants (NobelReplace or
Brnemark System, Nobel Biocare) were placed in the
anterior maxillary region between the zygomatic
implants according to the standard protocols recommended by the manufacturer. All patients were given
5-day prescriptions for antibiotics, analgesics, and
mouthwash (chlorhexidine 0.2%).

Loading of the Zygomatic Implants

All patients were given a fixed provisional prosthesis
for immediate or early loading. When a fixed prosthesis was attached to the zygomatic implants for
occlusal loading within 24 hours after the surgery,

these zygomatic implants were considered immediately loaded implants. If the prosthesis was placed
after this 24-hour period, zygomatic implants were
considered to be early loaded.
When the guided surgery protocol was employed,
a provisional prosthesis was prefabricated and connected immediately or shortly after surgery. In other
patients, an impression was made immediately after
surgery. A provisional prosthesis made of a cast
cobalt-chromium framework and acrylic resin teeth
was fabricated in the laboratory and was delivered to
the patient within a few days.
Patients were seen on a regular basis for wound
care and occlusal adjustment. All patients were
advised to avoid hard or bony food during the initial
healing period of 3 months. Zygomatic implants were
examined individually for stability before the final
impression was made.

Success Criteria for Zygomatic Implants

Zygomatic implants were considered successful
when they met the following criteria: (1) asymptomatic function with a fixed prosthesis, (2) clinical stability without mobility when examined individually,
and (3) no sinus infection as detected clinically and
radiologically.
The International Journal of Oral & Maxillofacial Implants 1235

2010 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Chow et al

Table 1Patient Data

Patient no.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

Sex

Age (y)

Medical history

Smoking

NobelGuide

Extraction

F
M
F
F
F
F
M
M
M
F
M
F
F
M
M
F

59
74
68
61
80
38
65
54
50
83
47
52
70
51
56
58

Clear
Ischemic heart disease
Osteoporosis
Clear
Epilepsy
Clear
Clear
Diabetes mellitus and hepatitis B
Hepatitis B
Congestive heart failure
Hypertension
Clear
Clear
Clear
Hypertension and ischemic heart disease
Hypertension

No
No
No
No
No
No
No
No
No
No
Yes
No
No
Yes
No
No

Yes
Yes
No
No
No
No
Yes
No
No
No
No
No
No
No
No
Yes

Not required
Not required
Not required
Yes
Yes
Not required
Not required
Yes
Yes
Not required
Yes
Not required
Not required
Yes
Yes
Not required

Table 2Implant and Prosthetic Data for Patients

No. of implants placed
Patient no.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Total

Anterior

Zygomatic

Date of surgery

4
4
4
4
3
4
4
2
4
4
3
4
0
4
4
4
53

2
2
2
2
2
2
2
4
2
2
3
2
4
2
2
2
37

Jun 12, 07
Jun 25, 07
Jul 12, 07
Oct 17, 07
Oct 25, 07
Dec 12, 07
Dec 31, 07
Jan 22, 08
Jan 22, 08
Feb 18, 08
Mar 5, 08
Mar 12, 08
Jun 3, 08
Sep 2, 08
Nov 27, 08
Dec 15, 08

RESULTS
Sixteen consecutive patients were included (9
women and 7 men, ranging in age from 38 to 83
years, with a mean age of 60) and 37 zygomatic
implants were placed (Tables 1 and 2). Nine patients
were edentulous, while the others required extractions on the day of surgery. Four patients underwent
guided implant surgery, while the remaining patients
received conventional flap surgery. Two patients
received their prostheses immediately after surgery,
while the others were given their prostheses 1 to 8
days postoperatively. All zygomatic implants fulfilled

Date of loading
Jun 12, 07
Jun 26, 07
Jul 13, 07
Oct 20, 07
Oct 29, 07
Dec 14, 07
Dec 31, 07
Jan 23, 08
Jan 25, 08
Feb 26, 08
Mar 6, 08
Mar 20, 08
Jun 5, 08
Sep 3, 08
Dec 1, 08
Dec 17, 08

Delay (d)
0
1
1
3
4
2
0
1
3
8
1
8
2
1
4
2

the success criteria. None of the 16 patients developed any clinical signs or symptoms of maxillary
sinusitis during the investigation period.
CBCT examinations were employed to evaluate
the maxillary sinuses and the zygomatic implants. No
radiologic signs of maxillary sinusitis were found. Incidentally, there were radiologic signs of new bone formation around the zygomatic implants in all patients.
These radiologic signs (Fig 5) included the following:
(1) existence of a radiopaque area surrounding the
zygomatic implants and (2) thickening of the bone at
the entry and exit areas of the zygomatic implants.

1236 Volume 25, Number 6, 2010

2010 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Chow et al

Fig 5a Preoperative CBCT of a patient.

Fig 5b Postoperative CBCT at 3 months of

the same patient. Radiopaque areas
around the zygomatic implants can be
seen, in addition to thickening of the bone
palatal to the zygomatic implant at the
entry and exit locations.

DISCUSSION
Brnemark et al1 reported the 10-year results of 56
zygomatic implants in 28 patients. The authors conducted regular clinical and radiographic examinations
of this group of patients and concluded that zygomatic implants were predictable, with a long-term survival rate exceeding 94.3%. Since the zygomatic
implants were placed via a transantral approach, an
otolaryngology specialist was asked to investigate the
tissue response of the sinus membrane to the
exposed titanium surface. In the 11 cases examined by
Petruson,14 the sinus membrane was healthy and normal. Despite these favorable findings, Brnemark and
coworkers nevertheless encountered four patients
with recurrent maxillary sinusitis that required surgical intervention. Although the etiology of the maxillary sinusitis was unknown, Brnemark et al stated
that the sinus infection could be adequately treated
without causing zygomatic implant failure.
Malevez et al2 reported retrospective data on 103
zygomatic implants placed in 55 patients with severe
maxillary bone resorption. Among these 55 patients,
six developed maxillary sinusitis during the investigation period. These patients infections resolved after
they received antimicrobial treatment, and none of
them required surgical intervention. The authors
admitted that it was difficult to evaluate the status of
osseointegration in the zygomatic region; however,
they reported a 100% survival rate of these zygomatic implants based on their clinical stability.
In a multicenter study,3 Hirsch et al evaluated 66
patients with 124 zygomatic implants 1 year after treatment. The authors reported a 97.9% survival rate after
the loss of three zygomatic implants in two patients. In
addition, an additional three patients presented with
signs and symptoms related to sinus infection. In a later
report on the same group of patients,4 14 of the 60
remaining patients had experienced sinus-related

Fig 5c Postoperative CBCT at 6 months of

the same patient.

complications during the 3-year investigation period,

and one patient actually presented with maxillary
sinusitis at the 3-year follow-up. There was no loss of
zygomatic implants related to the sinus infection, however. These two studies showed that maxillary sinusitis
can be a delayed problem in zygomatic implants and
can happen at any time during follow-up.
Aparicio et al6 recently conducted a prospective
study to investigate the clinical outcome of 131 zygomatic implants in 69 consecutively treated patients.
No failures of zygomatic implants were reported, but
three patients presented with acute sinusitis at different times during the investigation period. One of
them suffered from recurrent sinusitis. These sinusitis
episodes were managed with oral antibiotics, without
surgical treatment. The authors suggested that the
lack of crestal bone contact around the zygomatic
implants was the explanation for maxillary sinusitis in
these patients.
Becktor et al5 retrospectively evaluated 31 zygomatic implants in 16 patients and reported a 90.3%
survival rate after a mean follow-up period of 46.4
months. Six patients presented with recurrent sinus
infection and three of them developed bilateral sinusitis. Despite the fact that oral antibiotics were given and
surgical interventions were performed, three zygomatic implants in three patients had to be removed as
a consequence. To explain the occurrence of maxillary
sinusitis in zygomatic implant patients, the authors
postulated that the design of the zygomatic implant,
with an internal threaded chamber perforating the
implant head, along with the thin palatal bone surrounding the long flexible zygomatic implants, might
increase the risk of oroantral communication.
In general, the maxillary sinusitis risk associated
with zygomatic implants has been reported as low to
moderate (Table 3). Except for a few instances,4,7 maxillary sinusitis seldom resulted in the loss of the zygomatic implants. Etiologic factors such as preexisting
The International Journal of Oral & Maxillofacial Implants 1237

2010 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Chow et al

Table 3Findings from Studies of Zygomatic Implants

Study
Brnemark et al (2004)1
Malevez et al (2004)2
Hirsch et al (2004)3
Kahnberg et al (2007)4
Becktor et al (2005)5
Aparicio et al (2006)6
Zwahlen et al (2006)7
Chow et al (2006)8
Duarte et al (2007)9
Bedrossian et al (2002)10
Bedrossian et al (2006)11
Dav et al (2007)12
Mozzati et al (2008)13
Pearrocha et al (2007)15
Aparicio et al (2008)17
Mal et al (2008)18

No. of
patients

No. of
implants

Smokers

Loading
protocol

28
55
66
60
16
69
18
5
12
22
14
18
7
21
20
29

56
103
145
145
31
131
34
10
48
44
28
36
14
40
36
67

Nonsmokers
18 smokers
15 smokers
15 smokers
Not known
27 smokers
Not known
Nonsmokers
Not known
Not known
Not known
Not known
Nonsmokers
3 smokers
12 smokers
3 smokers

Two-stage
Two-stage
Two-stage
Two-stage
Two-stage
Two-stage
Two-stage
Immediate
6h
Two-stage
2h
48 h
24 h
Two-stage
24 h
24 h

sinus pathology, perforation of the sinus membrane,

marginal bone loss around zygomatic implants, and
inadequate oral hygiene at zygomatic implant sites
have been suggested, without scientific proof.
The original protocol1 for zygomatic implant placement did not emphasize the importance of the
integrity of the sinus membrane. The subsequent
endoscopic study by Petruson14 strengthened the
general belief that titanium zygomatic implants were
compatible with sinus mucosal health and normal
sinus function. In the literature, there have been interesting observations about how to manipulate the
maxillary sinus membrane during zygomatic implant
placement. In many studies, the sinus membranes
were always perforated.3,9,10,15 Many other studies provided no information about the integrity of the sinus
membrane during zygomatic implant placement.
Although many clinicians attempted to preserve the
sinus membrane, others believed that it was better to
remove the sinus membrane to avoid possible trapping of soft tissue remnants between the implant and
the zygoma.3,10
Because maxillary sinusitis in zygomatic implant
patients has been a common observation, various
techniques have been proposed to prevent sinus
infection. Pearrocha et al15 employed the slot technique to place 40 zygomatic implants in 21 patients.
The advantages of this technique included the elimination of a sinus window while preparing the zygomatic implant osteotomy.16 However, in spite of this
advantage, the authors stated that sinus membrane
perforation could not be avoided. The sinus membranes in all 21 patients were invariably perforated,

Survival
rate

Incidence of
sinus
infection

Sinus
membrane
integrity

94.3%
100%
97.9%
96%
92.3%
100%
94.1%
100%
100%
100%
100%
100%
100%
100%
100%
98.5%

4 (14.3%)
6 (10.9%)
3 (4.5%)
14 (23.3%)
6 (37.5%)
3 (4.3%)
1 (5.6%)
0
0
0
0
1 (5.6%)
0
2 (9.5%)
0
4 (13.8%)

Not known
Not known
All perforated
All perforated
Intact
Not known
Intact
Not known
All perforated
All perforated
Not known
Not known
Not known
All perforated
Not known
Not known

and postoperative sinusitis was reported in two

patients. However, there was no evidence in the literature suggesting that sinus membrane perforation was
associated with postoperative sinusitis in zygomatic
implant patients.
In a recent publication, Aparicio and coworkers17
reported their experience with extrasinus placement
of zygomatic implants in 20 patients. All patients presented with pronounced buccal concavities lateral to
the maxillary sinuses. The contour of the maxillary
walls allowed the authors to perform zygomatic
implant placement without creating an opening into
the maxillary sinuses. In addition to 100% success
after a follow-up of 18 months, the authors did not
encounter a single case of maxillary sinusitis.
In another study, Mal et al18 described an original
method of using extramaxillary implants with a new
design to avoid the maxillary sinus while obtaining
direct bone anchorage in the zygomatic region. Mal
et al presented 29 patients who had received 67
extramaxillary implants and reported a 2-year survival rate of 98.4%. Four patients who had developed
postoperative maxillary sinusitis were treated successfully by medical or surgical intervention. Mal
reported that it was not possible to keep the sinus
membrane intact in some patients because of
anatomical factors. It would seem that when the maxillary sinus was per forated during the implant
surgery, the risk of maxillary sinusitis in conjunction
with extramaxillary implants could not be ignored.
Although there is no evidence in the literature confirming a cause-and-effect relationship between zygomatic implants and maxillary sinusitis, it is reasonable

1238 Volume 25, Number 6, 2010

2010 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Chow et al

to think that the passage of a long and flexible zygomatic implant through the thin crestal/ palatal bone
could increase the risk of oroantral communication.
This risk of oroantral communication could be related
to the residual bone thickness at the zygomatic
implant entry point. However, no information is available about residual bone thickness in the literature for
further analysis.
Theoretically, it is logical to try keeping the zygomatic implants outside the maxillary sinuses. The
extrasinus placement technique17 was promising, but
it only worked in patients with certain extreme
anatomic characteristics. The new use of implants for
extramaxillary anchorage by Mal et al 18 was an
interesting attempt; however, there was a concern
regarding the long-term stability of the soft tissue
seal surrounding the implant heads.
In this study, an extended sinus lift was performed
with a retained bone window. In leaving the bone
window attached to the sinus membrane, the membrane was kept intact during the zygomatic implant
osteotomy. This short-term study showed promising
results in avoiding maxillary sinusitis in zygomatic
implants. The extrasinus position of the zygomatic
implants was crucial for this success.
In addition to eliminating the risk of maxillary
sinusitis in zygomatic implant patients, the new
approach revealed the possibility of new bone formation around the zygomatic implants underneath the
elevated maxillary sinus. CBCT images obtained after 3
and 6 months suggested that new bone had been
formed around the zygomatic implants. These radiologic features included a radiopaque area surrounding
the zygomatic implant bodies and increased thickness
of bone at the palatal entry and exit areas of the zygomatic implants. These features were seen in every
patient, but they were more pronounced in some
patients. It was not possible to confirm that these radiologic features were mineralized tissues; however, several clinical and experimental studies 19,20 could
provide some insight regarding the probable bone
formation underneath the elevated maxillary sinus.
Lundgren and coworkers19 conducted a prospective
investigation of the potential of bone formation
around dental implants underneath an elevated sinus
without using any graft material in 10 patients. This
study demonstrated that new bone formation around
dental implants could be predictably achieved inside a
space created by sinus membrane elevation without
grafting. In an experimental study, Palma et al20 provided histologic evidence of de novo bone formation
underneath the elevated sinus with or without simultaneous implant placement. The study also showed that
bone formation was more pronounced around titanium implants with an oxidized surface. Although this

information could not be extrapolated directly to the

current study, it is reasonable to expect that zygomatic
implants with a similar surface may promote bone formation underneath an elevated maxillary sinus.
The potential advantages of the new method are:
(1) elimination of the risk of maxillary sinusitis in
zygomatic implants, and (2) increased zygomatic
implant stability through the promotion of spontaneous bone formation underneath the elevated maxillary sinus membrane.

CONCLUSION
The risk of maxillary sinusitis related to zygomatic
implant placement can be avoided by performing an
extended sinus lift with a retained bone window
before placing the implants. Follow-up studies are
required to evaluate long-term outcomes of this new
method. Moreover, clinical and experimental research
is needed to further investigate the probable bone
formation around zygomatic implants underneath
the elevated sinus membrane.

REFERENCES
1. Brnemark PI, Grndahl K, hrnell L-O, et al. The zygoma
option. Clinical procedure and long-term results. Scand J Plast
Reconstr Surg Hand Surg 2004;38:7085.
2. Malevez C, Abarca M, Durdu F, Daelemans P. Clinical outcome
of 103 consecutive zygomatic implants: A 648 months follow-up study. Clin Oral Implants Res 2004;15:1822.
3. Hirsch J-M, hrnell L-O, Henry PJ, et al. A clinical evaluation of
the zygoma fixture. One-year follow-up at 16 clinics. J Oral
Maxillofac Surg 2004;62:2229.
4. Kahnberg K-E, Henry PJ, Hirsch J-M, et al. Clinical evaluation of
the zygoma implant: 3-year follow-up at 16 clinics. J Oral Maxillofac Surg 2007;65:20332038.
5. Becktor JP, Isaksson S, Abrahamsson P, Sennerby L. Evaluation
of 31 zygomatic implants and 74 regular dental implants used
in 16 patients for prosthetic reconstruction of the atrophic
maxilla with cross-arch fixed bridges. Clin Implant Dent Relat
Res 2005;7:159165.
6. Aparicio C, Ouazzani W, Garcia R, Arevalo X, Muela R, Fortes V.
A prospective clinical study on titanium implants in the zygomatic arch for prosthetic rehabilitation of the atrophic edentulous maxilla with a follow-up of 6 months to 5 years. Clin
Implant Dent Relat Res 2006;8:114122.
7. Zwahlen RA, Gratz KW, Oechslin CK, Studer SP. Survival rate of
zygomatic implants in atrophic or partially resected maxillae
prior to functional loading: A retrospective clinical report. Int J
Oral Maxillofac Implants 2006;21:413420.
8. Chow J, Hui E, Lee PK, Li W. Zygomatic implantsProtocol for
immediate occlusal loading: A preliminary report. J Oral Maxillofac Surg 2006;64:804811.
9. Duarte LR, Filho HN, Francischone CE, Peredo LG, Brnemark P-I.
The establishment of a protocol for the total rehabilitation of
atrophic maxillae employing four zygomatic fixtures in an im mediate loading systemA 30-month clinical and radiographic follow-up. Clin Implant Dent Relat Res 2007;9:186196.

The International Journal of Oral & Maxillofacial Implants 1239

2010 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Chow et al

10. Bedrossian E, Stumpel L III, Beckely ML, Indresano T. The zygomatic implant: Preliminary data on treatment of severely
resorbed maxillae. A clinical report. Int J Oral Maxillofac
Implants 2002;17:861865.
11. Bedrossian E, Rangert B, Stumpel L, Indresano T. Immediate
Function with the zygomatic implant: A graftless solution for
the patient with mild to advanced atrophy of the maxilla. Int J
Oral Maxillofac Implants 2006;21:937942.
12. Dav Rodriguez R, Malevez C, Rojas J. Immediate function in
atrophic upper jaw using zygoma implants. J Prosthet Dent
2007;96(6, suppl):4451 [erratum 2008;99:167].
13. Mozzati M, Monfrin SB, Pedretti G, Schierano G, Bassi F. Immediate loading of maxillary fixed prostheses retained by zygomatic and conventional implants: 24-month preliminary data
for a series of clinical case reports. Int J Oral Maxillofac
Implants 2008;22:308314.
14. Petruson B. Sinoscopy in patients with titanium implants in
the nose and sinuses. Scand J Plast Reconstr Surg Hand Surg
2004;38:8693.
15. Pearrocha M, Garca B, Mart E, Boronat A. Rehabilitation of
severely atrophic maxillae with fixed implant-supported prostheses using zygomatic implants placed using the sinus slot
technique: Clinical report on a series of 21 patients. Int J Oral
Maxillofac Implants 2007;22:645650.

16. Stella PJ, Warner MR. Sinus slot technique for simplification
and improved orientation of zygomatic dental implants: A
technical note. Int J Oral Maxillofac Implants 2000;15:889893.
17. Aparicio C, Ouazzani W, Hatano N. The use of zygomatic
implants for prosthetic rehabilitation of the severely resorbed
maxilla. Periodontol 2000 2008;47:162171.
18. Mal P, de Araujo Nobre M, Lopes I. A new approach to rehabilitate the severely atrophic maxilla using extramaxillary
anchored implants in immediate function: A pilot study.
J Prosthet Dent 2008;100:354366.
19. Lundgren S, Andersson S, Gualini F, Sennerby L. Bone reformation with sinus membrane elevation: A new surgical technique
for maxillary sinus floor augmentation. Clin Impl Dent Relat
Res 2004;6:165173.
20. Palma VC, Magro-Filho O, de Oliveira JA, Lundgren S, Salata LA,
Sennerby L. Bone reformation and implant integration following maxillary sinus membrane elevation: An experimental
study in primates. Clin Implant Dent Relat Res 2006;8:1124.

1240 Volume 25, Number 6, 2010

2010 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Copyright of International Journal of Oral & Maxillofacial Implants is the property of Quintessence Publishing
Company Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email articles for
individual use.