Precise implantation using zygomatic implants

Dr Paweł Aleksandrowicz

Fri. 4. April 2025

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The method of simultaneous placement of zygomatic implants combined with a Le Fort I osteotomy represents a valuable solution for patients with severe maxillary bone loss. Just as orthognathic surgery has become a standard part of orthodontic treatment for managing complex skeletal discrepancies, the prosthetic rehabilitation of edentulous patients has increasingly incorporated surgical techniques to address similar anatomical challenges for decades. Many edentulous patients exhibit a skeletal Class III pattern, for which zygomatic implants are often the most effective—if not the only—option. This technique enables the restoration of both function and aesthetics.

However, placement of zygomatic implants may result in a prosthesis that does not conform precisely to the patient’s natural anatomy, creating a gap that must be masked with pink porcelain or acrylic. This not only affects the aesthetic outcome but also influences comfort and satisfaction. To address this, comprehensive digital planning is essential. Despite this, many clinicians still perform these procedures free-hand or reduce the alveolar ridge—an invasive approach that does not always produce consistent results. Combining placement of zygomatic implants and maxillary osteotomy without using the appropriate tools can compromise both implant positioning and patient comfort.

A guided digital workflow for precision

To overcome these limitations, I have adopted a navigated, patent-pending approach that enables simultaneous placement of zygomatic implants and Le Fort I osteotomy. This technique is based on digital planning and execution using certified medical software (DDS-Pro, Polorto), improving precision while reducing procedural risks.

Planning incorporates data from CBCT scans and intra-oral scans to develop a detailed digital model of the patient’s anatomy, supporting accurate implant and maxillary positioning. A particularly important step involves an additional CBCT scan with radiopaque markers to align soft tissue data with the CBCT scan. This integration allows for the creation of customised surgical guides that reflect the patient’s true anatomical structure, ensuring safer and more precise execution.

To further optimise treatment planning, I use DDP AI software. This tool enables the rapid generation of digital diagnostic models and provides access to essential anatomical data. It creates accurate 3D occlusal models from STL, PLY and OBJ files, supporting comprehensive planning, including tooth positioning and crown-to-root alignment.

During surgery, I use two 3D-printed surgical guides: one affixed before the osteotomy to guide implant and anchor pin positioning, and the second used after repositioning the maxilla to confirm implant alignment and skeletal placement. This workflow enhances reproducibility and reduces human error, the only variable being the quality of diagnostic data.

Clinical outcomes

I recently applied this technique in the treatment of a 69-year-old patient with longstanding edentulism and advanced maxillary bone loss. The procedure, planned entirely with DDS-Pro, allowed for accurate implant placement and maxillary repositioning (Figs. 1–4). Carried out under general anaesthesia, the surgery took approximately 2 hours and was completed without complication (Figs. 5 & 6). The surgical guides functioned exactly as expected, leading to a stress-free operation.

Postoperatively, the patient reported minimal discomfort and resumed daily activities within days. The final result exceeded the patient’s expectations, restoring both confidence and aesthetics. In my practice, this approach consistently delivers precise, repeatable outcomes while enhancing patient satisfaction.

By integrating these digital technologies, I am able to provide patients with the highest level of care—both medically and aesthetically—while pushing the boundaries of what is possible in complex implant and surgical rehabilitation.

Figs. 1a & b: Surgical treatment planning: determination of the true vertical line.

Figs. 2a & b: Digital design of the Le Fort I osteotomy involving precise alignment of the maxillary intra-oral scan with the CBCT scan for creation of a digital model that accurately reflected the patient’s anatomy, ensuring correct implant and maxillary positioning.