Dr. Rubén Davó, based in Alicante, Spain, is a pioneer of zygomatic implant treatment. Here, he tells Nobel Biocare News about the evolution of this advanced approach, its advantages and his experiences with the new NobelZygoma implant.

Dr. Davó, you have been involved with zygomatic implant surgery from the very beginning. How did this approach first develop?

Dr. Rubén DavóDr. Rubén Davó:  I started implementing a zygomatic approach back in 1999, working together with Professors P-I Brånemark and Chantal Malevez. At that time, we didn’t have a predictable solution for the severely atrophic maxilla, and we were confident zygomatic implants could be the answer. The results we saw were outstanding from the start.

Five years later I began combining zygomatic implant placement with Immediate Function. This was actually the focus of my PhD dissertation, which was one of the first publications in the world on Immediate Function with zygomatic implants. A couple of years later, we started with the quad zygoma concept using four zygomatic implants, this time utilizing Immediate Function from the beginning.

What are the main patient benefits associated with zygomatic implant treatment?

Davó: It’s absolutely incredible for the patient, the benefit is tremendous. Previously, for patients with severe maxillary resorption, grafting was unavoidable. The zygomatic approach may avoid grafting and can reduce treatment times and costs, which in turn can increase treatment acceptance.

After zygomatic treatment the improvement in quality of life is dramatic. Before the treatment, these patients are orally handicapped, which can lead to a lot of psychological, social and functional problems. In my experience, after the treatment quality of life can return to normal. It’s remarkable.

Nobel Biocare is building on 25 years of success in zygomatic implants with the introduction of the NobelZygoma implants. What have your experiences been with these new options?

Davó: I have already performed many cases with the NobelZygoma implant with a high success rate. I think it is a very good implant as it offers more opportunities to adapt the position of the zygomatic implant to the needs of the patient – to the different anatomies we see in our daily practice.

With the surface of the implant I now have threads just where I need them. I have been finding that it is beneficial to have parts of the implant surface that are unthreaded. I also feel that you have a little more stability with the new tapered apex.

In a study1 my team and I presented as a poster at the 2016 EAO Congress in Paris, we followed thirteen patients who were each treated using NobelZygoma implants. Some patients required just one zygomatic implant, others up to four. In total, we assessed the clinical outcome of 33 NobelZygoma implants and the patients were followed for at least six months. During this observation period, we saw a 100% success rate, with no implants failing and all provisional prostheses remaining stable.

Overall, I think the new NobelZygoma implants are a step forward for the zygomatic approach, offering opportunities to place the implants in different positions, and, in my opinion, to help ensure primary stability.

For a clinician who is looking to start with zygomatic implant placement, what is the best way for them to start with this advanced procedure? 

Davó: It is very important to attend specialized courses. Nobel Biocare offers many such courses, I run a cadaver course with Professor Chantal Malevez, for example, but there are many more. Attending a good course is essential, even for very experienced maxillofacial surgeons. There are many very important details to consider in order to ensure a successful outcome. You have to respect the protocol and adhere to it strictly especially at the beginning. If you follow the protocol and use high-quality implants like NobelZygoma, you will be on course for delivering a successful treatment.

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  1. Davó R, Syed H, Vicente G V, Pons, O. Clinical outcome of 33 immediately loaded NobelZygoma 45º (new design). (2016), Implant Therapy Outcomes, Surgical Aspects. Clin. Oral Impl. Res., 27: 256. doi:10.1111/clr.254_12958

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