Immediate Full-Arch Maxillary Rehabilitation Using Zygomatic Implants and Inferior Nasal Floor Elevation
Mohamed Eltoukhy, BDS, MDS *
*Correspondence to: Mohamed Eltoukhy, BDS, MDS. Privete Clinic, Dammam, Eastern Province,
Saudi Arabia.
Copyright.
© 2026 Mohamed Eltoukhy, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 22 August 2026
Published: 01 September 2026
DOI: https://doi.org/10.5281/zenodo.22224519
Abstract
Background: Severe maxillary atrophy may prevent conventional posterior implant placement without extensive augmentation. Zygomatic implants obtain remote anchorage in the zygomatic complex and can support a fixed cross-arch prosthesis when appropriate surgical and prosthetic conditions are achieved.
Case presentation: A 75-year-old patient with hypothyroidism and a severely atrophic, edentulous maxilla sought fixed rehabilitation. Clinical and panoramic assessment demonstrated loss of maxillary dentition, reduced facial support, and marked deficiency of the residual maxillary ridge. Cross-sectional imaging was used to evaluate the zygomatic corridors and adjacent anatomical structures.
Treatment: Two JD zygomatic implants (40 mm), placed bilaterally, were used to bypass the deficient posterior maxilla and were combined with three anterior CAMLOG CONELOG Progressive implants (11 mm). A limited inferior nasal floor elevation was performed as a case-specific adjunct to facilitate prosthetically driven positioning of the anterior implants and improve the restorative emergence profile. High primary stability, appropriate implant distribution, and rigid cross-arch splinting permitted immediate loading with a screw-retained full-arch maxillary provisional prosthesis. Implant positions were captured using a digital photogrammetric workflow, and a rigid framework was clinically verified before prosthesis delivery.
Outcome: Immediate fixed function and improved dental and facial aesthetics were achieved. At the 6-month clinical follow-up, the prosthesis remained stable, and no implant-related, prosthetic, or sinus-related complications were observed or reported. The patient remained satisfied with the functional and aesthetic outcome.
Conclusion: This single case demonstrates the feasibility of immediate fixed maxillary rehabilitation using bilateral zygomatic implants combined with three anterior conventional implants, a case-specific inferior nasal floor elevation, and a digital photogrammetric workflow. The uncomplicated 6-month clinical follow-up supports further evaluation of this coordinated surgical-prosthetic approach.
Keywords: zygomatic implant; atrophic maxilla; immediate loading; full-arch rehabilitation; graftless rehabilitation; nasal floor elevation.
Introduction
Rehabilitation of the severely atrophic edentulous maxilla is challenging because loss of alveolar volume and sinus pneumatization may leave insufficient bone for conventional posterior implants. Staged grafting can recreate implant-bearing volume, but it increases treatment time and may add donor-site morbidity, additional operations, and a prolonged removable-prosthesis phase. Zygomatic implants offer an alternative by engaging the zygomatic complex and supporting the posterior aspect of a cross-arch reconstruction [1-3].
Current consensus positions zygomatic implants as a specialist treatment for maxillary bone atrophy or deficiency. A 2023 systematic review and meta-analysis reported a mean zygomatic implant survival of 96.2% at approximately six years, while emphasizing sinusitis and other biological complications as important outcome measures rather than relying on implant survival alone [1,2]. Immediate loading is frequently used when sufficient primary stability and prosthetic rigidity can be achieved; however, it should be considered a coordinated surgical-prosthetic protocol, not merely an accelerated delivery step [1,4].
This report describes immediate maxillary rehabilitation using bilateral zygomatic anchorage, three anterior conventional implants, a limited inferior nasal floor elevation, digital implant-position capture, and a screw-retained full-arch maxillary provisional prosthesis. Immediate loading was selected because high primary stability was achieved intraoperatively and the implant distribution permitted rigid cross-arch splinting. The report is restricted to information supported by the confirmed clinical record and supplied images.
Case Presentation
A 75-year-old patient with a medical history of hypothyroidism presented with an edentulous maxilla and requested a fixed solution. Extraoral examination demonstrated diminished dental display and reduced support of the upper lip. Intraoral examination showed a fully edentulous maxillary arch with a markedly resorbed ridge. The mandibular dentition and existing mandibular restorations were retained during maxillary treatment.
Panoramic imaging confirmed advanced maxillary resorption and extensive sinus pneumatization, with inadequate posterior alveolar volume for a conventional implant distribution. Cross-sectional imaging was used to assess the zygomatic corridors, residual anterior maxilla, maxillary sinuses, and nasal floor. The clinical and radiographic findings are shown in Figure 1.
Diagnostic Assessment and Treatment Planning
Cross-sectional imaging was used to assess the residual maxilla, the zygomatic bodies, the maxillary sinuses, the nasal floor, and the proposed implant trajectories. The restorative objective was a screw-retained full-arch maxillary prosthesis with posterior support from zygomatic anchorage and anterior support from the remaining premaxillary bone. The final plan comprised two JD zygomatic implants, placed bilaterally and each 40 mm in length, and three anterior CAMLOG CONELOG Progressive implants, each 11 mm in length.
The treatment alternatives discussed for this clinical condition should include removable prosthodontic treatment, staged augmentation followed by conventional implants, and zygomatic implant rehabilitation. Zygomatic treatment may shorten the interval to fixed function, but it requires advanced surgical experience, three-dimensional planning, management of sinus-related risk, and a coordinated restorative workflow [1,3,4].
Surgical Procedure
Access and inferior nasal floor elevation
Following surgical access, the severely resorbed maxillary anatomy was exposed. A limited inferior nasal floor elevation was performed as a case-specific adjunct to facilitate prosthetically driven positioning of the anterior implants and improve the restorative emergence profile. This procedure is not presented as a routine component of zygomatic implant treatment. Because the clinical record does not provide dimensions or additional technical details, none are inferred.
Implant placement
Two JD zygomatic implants, each 40 mm in length, were placed bilaterally and directed toward the zygomatic complexes to bypass the deficient posterior maxillary alveolus. Three CAMLOG CONELOG Progressive implants, each 11 mm in length, were positioned in the anterior maxilla. High primary stability was achieved intraoperatively. Multiunit restorative components were connected to establish a common prosthetic path and permit rigid cross-arch splinting with a screw-retained restoration. The intraoperative configuration is illustrated in Figure 2. Insertion torque and implant stability quotient values are not reported because they were not documented.
Postoperative cross-sectional images demonstrated engagement of the zygomatic bone and the long extrasinus/intrasinus trajectories selected for this anatomy (Figure 3). These images document implant position; no unreported diameter, insertion torque, or implant stability quotient values are inferred.
Immediate Prosthetic Rehabilitation
Digital implant-position capture
After restorative components were connected, the implant positions were recorded using a photogrammetric workflow. A passive, accurately fitting full-arch framework is particularly important in an immediately loaded reconstruction because it splints the implants and limits non-axial micromotion across the arch. A rigid metal framework was tried in and verified before delivery of the screw-retained restoration (Figure 4).
Provisional prosthesis
A screw-retained full-arch maxillary provisional prosthesis was delivered for immediate loading. The indication for immediate loading was based on the high primary stability achieved intraoperatively, appropriate anteroposterior implant distribution, and rigid cross-arch splinting provided by the prosthetic framework. The design restored maxillary tooth display, lip support, and the maxillomandibular relationship while uniting the zygomatic and anterior implants as a single functional unit. Occlusion was adjusted to limit excessive cantilever and off-axis loading during early healing.
Immediate loading of zygomatic implants has been described in prospective and retrospective studies, including a randomized trial that reported a substantially shorter interval to fixed function than staged augmentation [4]. In the present case, however, immediate loading was not selected solely to shorten treatment time. It was undertaken because the intraoperative and prosthetic conditions supported a mechanically stable, rigidly splinted cross-arch reconstruction.
Clinical and Radiographic Outcome
The postoperative clinical photographs demonstrated restoration of the maxillary dentition, improved dental display, and enhanced support of the perioral tissues. The retracted intraoral view showed a continuous screw-retained full-arch maxillary prosthesis and a coordinated occlusal relationship with the opposing dentition (Figure 5).
Panoramic comparison documented the transition from an edentulous, severely atrophic maxilla to a reconstruction supported by bilateral zygomatic implants and three anterior conventional implants (Figure 6). At the 6-month clinical follow-up, the prosthesis remained clinically stable. No implant-related, prosthetic, or sinus-related complications were observed or reported, and the patient remained satisfied with the functional and aesthetic outcome. Because no validated patient-reported outcome instrument was used, satisfaction is reported descriptively. These findings represent a 6-month clinical outcome and should not be interpreted as evidence of long-term survival.
Discussion
This case illustrates the principal rationale for zygomatic rehabilitation: posterior support can be obtained from remote craniofacial anchorage when residual maxillary bone is insufficient for a conventional implant distribution. The bilateral zygomatic implants supplied posterior anchorage, while the three anterior implants increased the anteroposterior spread and contributed to cross-arch support. This configuration is represented in multicenter clinical series and is consistent with contemporary consensus indications for the severely atrophic maxilla [1,5].
The immediate prosthetic phase depended on the treatment team functioning as a single surgical-restorative unit. Implant positions had to permit a cleansable prosthetic emergence, restorative components had to be aligned to a common path, and the framework had to seat passively. Photogrammetry provided a digital method for recording implant positions, while framework verification remained a direct clinical safeguard against transfer error. The immediate provisional restoration then converted the individual implants into a splinted cross-arch system.
The aesthetic outcome is relevant because severe maxillary atrophy affects both tooth position and facial support. In the present case, the prosthesis restored dental display and improved perioral support without a staged grafting period. Recent patient-reported outcome data similarly indicate high satisfaction after immediately loaded zygomatic implant rehabilitation, particularly for aesthetics, chewing, speech, and social function [6]. Such evidence supports a patient-centered assessment, although the descriptive satisfaction reported in this case cannot be equated with scores from a validated questionnaire.
Zygomatic implant treatment is not free of risk. Consensus and systematic-review evidence identify sinusitis as the most common biological complication, along with soft-tissue inflammation, oroantral communication, prosthetic complications, and less frequent neurologic or orbital events [1,2,7]. Risk reduction begins with preoperative evaluation of sinus health and three-dimensional anatomy, continues with trajectory selection and careful soft-tissue management, and extends to long-term clinical and radiographic surveillance. Patients should be instructed to report nasal obstruction, facial pain or pressure, discharge, swelling, mobility, or changes in prosthetic function promptly.
The limited inferior nasal floor elevation should be interpreted as an anatomy-driven, case-specific adjunct rather than a routine component of zygomatic implant therapy. Its purpose was to facilitate prosthetically driven positioning of the anterior implants and improve the restorative emergence profile in this individual anatomy. Its independent contribution cannot be quantified because volumetric measurements and a separate postoperative analysis of the elevated region were not documented.
Maintenance and Follow-up
A structured maintenance program should include assessment of prosthesis stability, screw integrity, occlusion, peri-implant soft tissues, hygiene access, and sinus-related symptoms. The provisional prosthesis should be examined for wear or fracture and adjusted as healing and neuromuscular adaptation progress. Radiographic review should be obtained when clinically indicated and compared with the immediate postoperative baseline. Definitive prosthetic conversion should be scheduled only after the treatment team confirms clinical stability and an acceptable soft-tissue and occlusal condition.
Conclusion
This single case demonstrates the feasibility of immediate fixed maxillary rehabilitation using two bilaterally placed zygomatic implants combined with three anterior conventional implants. A case-specific inferior nasal floor elevation facilitated prosthetically driven anterior implant positioning, while the digital photogrammetric workflow supported accurate implant-position transfer and rigid cross-arch splinting. Immediate loading was based on high primary stability, appropriate implant distribution, and a rigid prosthetic framework. The prosthesis remained stable, and no implant-related, prosthetic, or sinus-related complications were observed or reported during the uncomplicated 6-month clinical follow-up. These findings should be interpreted within the limitations of a single case and do not establish long-term effectiveness.
Declarations
References