The zygomaticus fixture: an alternative approach for implant anchorage in the posterior maxilla.

Implant rehabilitation of the edentulous maxilla continues to challenge the ingenuity and clinical skills of the surgeon and restorative dentist. Advanced posterior alveolar resorption combined with increased maxillary sinus pneumatization often leaves insufficient bone for implant anchorage. Even more challenging are conditions such as cleft deformities and maxillectomy defects which present a discontinuous maxilla and complex bony and soft tissue anatomy. Much attention has been paid to combining bone graft procedures either with immediate or delayed implant placement in the management of this type of complex defect anatomy. Various types of bone graft augmentation methods carry significant patient morbidity, require lengthy healing time and are resource demanding. Recently Brånemark introduced an alternative method of securing posterior maxillary implant anchorage using a longer titanium implant placed through the palatal aspect of the second premolar region transantrally into the os zygomaticum (zygoma). This paper describes the indications and clinical applications of the zygomaticus fixture and reviews current outcome data.