Quad Zygoma Tips

Sunday 07, 2017 | by Dr Alex Fibishenko
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This article is intended for dental professionals only, who have a high level of experience with All-On-4 dental implants treatments. It is in response to a question Dr Senichi Suzuki:

What are the most important factors for Quad Zygomas?

Quad Zygoma is an advanced treatment for patients who, through bone atrophy following tooth loss, trauma, or other causes, have lost so much maxillary bone that they do not have enough remaining jawbone to house standard implants, or even single Zygomas …so double Zygomas must be placed on each side in order to provide adequate support for an immediate set of fixed replacement teeth.

The traditional Zygoma technique ad modum Branemark has lost popularity among surgeons and clinicians around the world for various reasons, which led to the development of the ‘Zygoma-Plus‘ concept. It is a newer technique that offers simpler placement, reduced risks and improved results, and this concept can also be used as Quad-Zygoma-Plus …but there are some factors for the surgeon to consider:

  • there is sometimes not enough cheek bone height for side-by-side implants, so the surgeon needs to be careful not to start the posterior implant too far back and too vertical, and should place the double implants slightly more forward and more horizontal than what we do for single Zygomas. Usually, for a single Zygoma, I start the osteotomy from the 6 site. But for a double Zygoma I often need to start from the 5 position, and for the front implant I will typically start from the 3 position;
  • I recommend placing additional 2 small implants (like NP 8.5mm) in the 11 and 21 positions for 2 reasons: a) it helps with connecting the stent for the indexation procedure; and b) It gives some support anteriorly, which is needed because the implants are more horizontal than usual;
  • If there is no room for 2 small implants anteriorly, I would then use a wide midline fixture within the incisive foramen. You need to take extra care here as it is more prone to fracture, and must also ensure that the foramen is cleared from all of its content;
  • It is not always possible to be fully inside the sinus when placing the implants more anteriorly and more horizontally, especially for the front zygoma implants …this is ok, but I would recommend packing some BioOss Collagen between the 2 zygoma implants, and place Bioguide membrane over the top;

I will upload a video in due course …

Dr. Alex Fibishenko


Oral Implantology & Reconstructive Dento-facial Surgery
Dental Surgeon in Self-Restricted Practice
Innovator of All-On-4 Plus ® & founder of All-On-4 Clinic LTD

Dr Alex Fibishenko practices exclusively in Oral Implantology, Dento-Facial Surgery and Facial Aesthetics.

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