For citation purposes: Grecchi F, Busato A, Grecchi E, Carinci F. Surgically-guided zygomatic and pterygoid implants?a no-grafting rehabilitation approach in severe atrophic maxilla?A case report Annals of Oral & Maxillofacial Surgery 2013 May 01;1(2):17.

Case report


Surgically-guided zygomatic and pterygoid implants—a no-grafting rehabilitation approach in severe atrophic maxilla—A case report

F Grecchi, A Busato, E Grecchi, F Carinci

Authors affiliations

(1) Maxillo-facial Unit, IRCCS, Galeazzi Orthopedic Institute, Milano, Italy

(2) Private practice, Milano, Italy

(3) Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy

* Corresponding author Email:



This report discusses surgically-guided zygomatic and pterygoid implants.

Case report

We present a case report of a successful surgical approach in extreme maxillary atrophy without bone grafting. Six osseointegrated dental implants were positively positioned exploiting the residual atrophic bone: two in the canine region, two zygomatic implants placed using the sinus slot approach and two in the pterygomaxillary region. The procedure used to identify the correct placement of the fixtures is of particular interest. A high-definition computed tomography scan had been taken purely for diagnostic purposes and this was used to make a stereolithographic model. The surgical approach was simulated and then carried out directly on a solid acrylic resin model. An extremely precise surgical template was then developed and used to transfer the surgical approach for positioning implants to real bone. The patient was already wearing a complete upper denture, and this was modified to become a temporary denture during the period of osseointegration. No immediate loading was performed. Four months after surgery, the implants were loaded, and an excellent aesthetic and functional result was achieved with no increase in bone volume from bone grafts. The entire residual bone was used as an anchorage for the implants. The excellent results achieved demonstrate that zygomatic implants in association with other conservative and guided surgical approaches are a valid alternative to bone grafting in treating severe atrophic and edentulous maxillae.


In this case report, the accurately planned surgery made the use of local anaesthesia with intravenous sedation possible.

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