Dr. Waldemar Polido - "Indications for zygomatic implants: a systematic review"
Episode summary
In this ZAGA Centers Podcast episode, Dr. Waldemar Polido, oral and maxillofacial surgeon at Indiana University Indianapolis School of Dentistry and ZAGA Scientific Partner, discusses his 2023 systematic review "Indications for zygomatic implants," published in the International Journal of Implant Dentistry with co-authors Wei-Shao Lin and Tara Aghaloo. The review, linked to an ITI consensus conference, screened 1,266 records and retained only 10 that clearly defined their indication criteria, showing that most zygomatic-implant reports do not precisely define the atrophy treated. The literature converges on roughly four millimeters or less of posterior crest height as the threshold for severe atrophy, while ridge width and zygomatic-bone anatomy remain under-reported. Delayed and immediate loading appeared in roughly equal numbers across papers, with recent work favoring immediate loading. Clear indications include post-maxillectomy cases, failed grafts or implants, post-trauma defects, and patient preference to avoid staged grafting. Polido stresses that zygomatic implants are high-risk and require experienced, well-trained surgical and restorative teams.
Key takeaways
- The systematic review "Indications for zygomatic implants" screened 1,266 publications and reports and retained only 10 that clearly defined their indication criteria.
- Most published zygomatic-implant reports describe outcomes without precisely defining the maxillary atrophy being treated.
- The literature converges on approximately four millimeters or less of posterior crest height as the threshold for considering a zygomatic implant over a staged sinus lift.
- Ridge width and the three-dimensional anatomy of the zygomatic bone itself are rarely reported; the authors call for anatomically driven, CBCT-based assessment in future studies.
- Across the reviewed papers immediate versus delayed loading was roughly 50/50 (about 104-105 each), with more recent publications favoring immediate loading as a primary option.
- Clear indications include post-maxillectomy cases, severe posterior maxillary atrophy, failed previous grafts or implants, post-trauma defects, and patient preference to avoid staged grafting.
- Because zygomatic implants are high-risk, they should be placed only by experienced, well-educated surgical and restorative teams, and a defined indication must also consider the planned restoration type.
What you'll learn
- How to define severe maxillary atrophy for zygomatic implant selection (~4 mm or less posterior crest height)
- Why width and three-dimensional ridge/zygomatic-bone anatomy are under-reported in the literature
- Clear indications: post-maxillectomy, severe posterior atrophy, failed grafts/implants, post-trauma, and patient preference to avoid staged grafting
- The trend from delayed toward immediate loading and when delayed loading is still needed
- Weighing zygomatic implants against grafting, tilted/short implants, and reconstruction in younger patients
About the guest
Dr. Waldemar Polido
Dr. Waldemar Polido is an oral and maxillofacial surgeon and full-time professor in the Oral and Maxillofacial Surgery department at Indiana University Indianapolis School of Dentistry, where he directs the pre-doctoral surgery program. He holds MS and PhD degrees from PUCRS in Porto Alegre, Brazil, and completed his residency at the University of Texas Southwestern Medical Center in Dallas. He placed his first zygomatic implant in 1999 after training in Brussels, and is a ZAGA Scientific Partner and an active fellow and speaker with the ITI (International Team for Implantology).
