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Updated: Jan 15, 2026
Real-Time Dynamic Navigation System for the Precise Quad-Zygomatic Implant Placement in a Patient with a Severely Atrophic Maxilla
Published on: October 18, 2021
Comparative finite element analysis of three zygomatic implant approaches using real-life anatomic models
Carlos Aparicio1, Adi Lorean2, David Pastorino3
1Visiting Research Professor, Indiana University School of Dentistry, Indianapolis, Ind.; and Director of Zygomatic Unit, Hepler Bone Clinic, ZAGA Center Barcelona, Barcelona, Spain.
Statement Of Problem:
Because of the wide anatomic variations among individuals, the differences between procedures for placing zygomatic implants (ZIs) and between zygomatic and regular implants, the biomechanics of ZI in the restoration of an atrophic maxilla are not yet well known.
Purpose:
The purpose of this finite element analysis (FEA) study was to critically review and clarify the biomechanical principles of the ZIs based on clinical reality.
Material And Methods:
Two FEA models were created representing the most frequent anatomic situations for the posterior atrophic maxilla: zygoma anatomy-guided approach (ZAGA) type 3 (18.7%) and ZAGA type 4 (57.4%). The models were analyzed under functional loads by comparing 3 surgical approaches: the original surgical technique (OST), ZAGA, and oversized-osteotomy (OO) in a hybrid rehabilitation design.
Results:
The amount of bony support of the ZI was found to be inversely proportional to the efforts observed in the implant and components. An oversized osteotomy led to excessive stresses and displacement in the whole system. The OST provided limited bony support and led to moderate stresses and displacements in the entire system. The ZAGA concept led to the lowest stresses and displacement values.
Conclusions:
The biomechanical principles of ZIs were clarified, demonstrating that a reduction in the area resisting functional forces leads to increased stress and displacement within the system. When using the OO technique, this reduction results in an extended lever arm, raising the risk of implant fatigue fracture. With the OST technique, it causes stress concentration in the alveolar bone, increasing the risk of bone failure. In contrast, the ZAGA technique provides optimal stress distribution and minimal displacement compared with both OST and OO.
