A Novel 2-Piece Zygoma Extension System for Optimizing Prosthetic Emergence in the Atrophic Maxilla: A 3-Case...

Zygomatic and pterygoid implants are essential tools in the rehabilitation of the severely atrophic maxilla, yet they often result in prosthetic emergence in unfavorable posterior or palatal locations. This article introduces a novel 2-piece zygoma extension system, available in straight and angled (12°, 20°, 25°) configurations, designed to redirect emergence to the alveolar crest with improved biomechanics and prosthetic accessibility. Three patients with varying degrees of maxillary atrophy underwent treatment using MegaGen BLUEDIAMOND implants combined with precision-milled titanium straight or angled extensions. Standardized surgical protocols were followed, with cone beam computerized tomography (CBCT)-based planning, intraoperative guide use, cortical engagement strategies, and immediate loading protocols. Across all cases, implants achieved high primary stability (70-80 Ncm), and extensions allowed prosthetic emergence in ideal posterior or second molar positions. Postoperative CBCT confirmed accurate implant placement, stable trajectories, and favorable abutment orientation. Immediate previsualization was successful in all patients with no intraoperative or early postoperative complications. The 2-piece zygoma extension system provides a safer, simpler, and more prosthetically advantageous alternative to conventional zygomatic and pterygoid approaches. Decoupling implant trajectory from prosthetic emergence expands treatment possibilities for complex maxillary atrophy and improves restorative outcomes.