Dr. Caesar Butura: Combined Immediate Loading of Zygomatic Implants

Key takeaways

• Dr. Caesar Butura's 2014 study followed 19 patients treated with combined immediately loaded zygomatic and mandibular implants over a two-year period.
• The study placed 40 zygomatic implants and 112 conventional implants, with mandibles restored using an All-on-4 approach.
• Zygomatic implant survival was 100% at an average of two years, with no failures among the conventional implants and no early sinus issues.
• Implants were loaded within three to four hours of surgery at an insertion torque between 32 and 45 Ncm; the 45 Ncm ceiling protected the external connection of the Nobel Speedy fixtures from distortion.
• Zygomatic implants in extramaxillary positions can show micromotion up to 100 micrometers, unlike anterior conventional implants, so controlling occlusion across a roughly 40 mm arch spares the anterior implants from torsional forces.
• The implants were placed following the original Branemark protocol updated with the Stella slot technique, as the ZAGA concept was not yet fully established at the time.
• One patient, a former F-4 Vietnam fighter pilot in his late 70s, had a failed 1980s subperiosteal implant removed before placement of two zygomatic fixtures and anterior conventional implants.

What you'll learn

• Combining immediately loaded zygomatic implants with mandibular All-on-4 in one surgical intervention
• Insertion torque window of 32-45 Ncm to load implants without distorting external-connection fixtures
• Managing dissimilar implant behavior by controlling occlusion to spare anterior conventional implants from torsional forces
• Removing failed subperiosteal implants and placing zygomatic fixtures in the atrophic maxilla
• Setting occlusion de novo when both arches are restored simultaneously in mixed dentate/edentulous cases

About the guest

Dr. Caesar Butura

Dr. Caesar Butura is a board-certified oral and maxillofacial surgeon practicing in Phoenix, Arizona, where he founded Butura Oral and Maxillofacial Surgery. He has focused on immediately loaded full-arch reconstruction of the maxilla and mandible since his first immediate-load case in August 2008. His practice is the ZAGA Center Phoenix, and he trained at Columbia University College of Dental Medicine and the University of Illinois Chicago.

Related on ZAGA Centers

• The ZAGA Concept (Zygoma Anatomy-Guided Approach)
• Dr. Caesar Butura — ZAGA Network profile
• Dr. Carlos Aparicio — creator of the ZAGA Concept
• Edentulism scientific conference
• All ZAGA Centers Podcast episodes