Oral cancer affects 650,000 people per year worldwide. Currently men are twice as susceptible as women, though female cases are increasing. It is calculated that more people in the UK die of oral cancer than of cervical and testicular cancer combined, and the incidence rate has risen by 49% in the last 10 years.[i] [ii]
Malignant diseases of the head and neck can require radical treatment, sometimes resulting in loss of teeth and bone, causing drastic changes in anatomy and aesthetics. The implications of this are life-changing: dental function, speech, swallowing and appearance can all be altered, deeply affecting a patient’s social and psychological wellbeing.[iii]
The goal of treating oral cancer is not just the reconstruction of affected areas, but the restoration of function and aesthetics. Dental rehabilitation after maxillary oncological resection can be demanding. There are technical difficulties once the anatomy of the region has been altered. Surgeons are tasked with re-establishing a separation between the oral cavity and the nasal/paranasal regions, as well as rehabilitating oral function with a prosthesis that can also deliver satisfactory facial aesthetics.[iv]
In the past, rehabilitation was mainly obtained with a removable obturator prosthesis. This solution is not sufficient in many cases of radical resection,[v] and patients often have difficulty wearing conventional prostheses due to mucosal irritation, dryness or ulceration.[vi] Pedicled or free muscle flaps are successful in separating the oral cavity from the nasal/paranasal region. These procedures do not restore function or aesthetics.
After maxillary oncological resection, reconstructive procedures with osteomyocutaneous composite flaps have been used to create enough bone volume for endosseous implants. However, the shape of the defect can preclude this form of treatment. As well as requiring a number of interventions and several healing periods, further complications can arise due to the effects of post-operative radiotherapy.[vii]
Zygomatic implants – a game changer for survivors of oral cancer
Zygomatic implants (ZIs) were first introduced in 1988 for the treatment of oncologic patients as an anchor for obturator prostheses. But through the years, ZIs have been used for different protocols with increasingly promising results.[viii] Successful outcomes are increasingly a reality despite the effects of radiotherapy, which in turn is significantly less likely to affect healthy adjacent tissue during treatment than in previous decades. [ix]
Zygomatic bone acts as an ideal anchor, due to its resistance to metastasis. Its anatomical features represent an alternative anchorage for implants even after major resections in the maxillary bone.[x]
ZIs are rapidly advancing in the field of dental implantology as an immediate and predictable treatment for severe maxillary atrophy. They can provide remote anchorage for a variety of oral and facial prostheses that can dramatically and rapidly improve function and quality of life for patients being treated for maxillary and mid-facial tumours.[xi]
The use of ZIs has several advantages, such as a considerable shortening of treatment time, decreased morbidity because the technique eliminates the necessity of a graft (and thus a graft donor site), a smaller number of implants to support fixed prostheses, and a decrease of the patients’ costs. ZIs have enabled the oral surgeon to overcome the local osseous deficiency by engaging hard tissue at the distant zygomatic bone, allowing increased retention and stability of an obturator or prosthesis. [xii]
Several approaches are now in use for the rehabilitation of the maxilla, with tilted implants and bilateral/single ZIs. The treatment of severe maxilla atrophic jaws with zygomatic implants is increasingly considered a safe and minimally invasive procedure, reaching a cumulative success rate of 96.1% after more than 5 years.[xiii]
It is now possible to perform immediate loading procedures in oncologic patients by the utilisation of zygomatic implants, hugely reducing the time between cancer removal and the complete rehabilitation of the patient.[xiv] Patients with head and neck cancer who receive zygomatic implant prostheses are generally found to have more favourable outcomes in terms of speech, aesthetics or facial contour and eating and drinking function without nasal leakage.[xv]
The installation of ZIs is a major surgical procedure and should be performed only by properly trained clinicians. Due to the complexity of the zygomatic structures, there is considerable risk of soft tissue complications around the abutments and of sinusitis.[xvi]
Leading global brand, W&H, has developed the Zygoma Surgical Handpiece SZ-75, as a comprehensive solution for even the most complex of 
ZI cases. The 20:1 transmission ratio gives surgeons powerful accuracy with easy action. Among many unique features, the Zygoma handpiece incorporates optimal angulation to make access to difficult surgical sites easy. Ergonomic design also takes the fatigue out of conducting intricate procedures over a long duration. W&H offers a broad surgical solution with the Zygoma handpiece used alongside the Implantmed Plus surgical motor offering a wealth of options to enhance surgical treatment.
Oral rehabilitation after maxillary oncological resection is challenging, both for dental surgeons and patients. However, it is important to consider quality of life when treating survivors of oral cancer. Loss of function and aesthetics can have a dramatic effect on patients’ lives and, for many, this represents a shorter duration due to the nature of their diagnosis. The shorter treatment period involved in zygomatic treatment is a real game-changer for patients.[xvii]
To find out more visit www.wh.com/en_uk, call 01727 874990 or email
[i] Mouth Cancer Facts and Figures. 2022. Available at: https://www.mouthcancerfoundation.org/mouth-cancer-facts-and-figures/ Accessed March 2024.
[ii] Oral Health Foundation. State of Mouth Cancer UK Report 2022 Available at: https://www.dentalhealth.org/Handlers/Download.ashx?IDMF=3d5ff14b-e667-4905-88a4-a3d0cebf05ad Accessed March 2024.
[iii] Hackett S, El-Wazani B, Butterworth C. Zygomatic implant-based rehabilitation for patients with maxillary and mid-facial oncology defects: A review. Oral Dis. 2021 Jan;27(1):27-41. doi: 10.1111/odi.13305. Epub 2020 Mar 5. PMID: 32048429.
[iv] Grecchi F, D’Ambrogio RG, Stefanelli LV, Grivetto F, Goker F, Del Fabbro M, Schreiber A, Piazza C, Salgarello S, Dosio C, Grecchi E. Guided Zygomatic Implantology for Oral Cancer Rehabilitation: A Case Report. J Clin Med. 2023 May 24;12(11):3653. doi: 10.3390/jcm12113653. PMID: 37297847; PMCID: PMC10253450.
[v] Grecchi F, D’Ambrogio RG, Stefanelli LV, Grivetto F, Goker F, Del Fabbro M, Schreiber A, Piazza C, Salgarello S, Dosio C, Grecchi E. Guided Zygomatic Implantology for Oral Cancer Rehabilitation: A Case Report. J Clin Med. 2023 May 24;12(11):3653. doi: 10.3390/jcm12113653. PMID: 37297847; PMCID: PMC10253450.
[vi] Hackett S, El-Wazani B, Butterworth C. Zygomatic implant-based rehabilitation for patients with maxillary and mid-facial oncology defects: A review. Oral Dis. 2021 Jan;27(1):27-41. doi: 10.1111/odi.13305. Epub 2020 Mar 5. PMID: 32048429.
[vii] Grecchi F, D’Ambrogio RG, Stefanelli LV, Grivetto F, Goker F, Del Fabbro M, Schreiber A, Piazza C, Salgarello S, Dosio C, Grecchi E. Guided Zygomatic Implantology for Oral Cancer Rehabilitation: A Case Report. J Clin Med. 2023 May 24;12(11):3653. doi: 10.3390/jcm12113653. PMID: 37297847; PMCID: PMC10253450.
[viii] Grecchi F, D’Ambrogio RG, Stefanelli LV, Grivetto F, Goker F, Del Fabbro M, Schreiber A, Piazza C, Salgarello S, Dosio C, Grecchi E. Guided Zygomatic Implantology for Oral Cancer Rehabilitation: A Case Report. J Clin Med. 2023 May 24;12(11):3653. doi: 10.3390/jcm12113653. PMID: 37297847; PMCID: PMC10253450.
[ix] Chen HHW, Kuo MT. Improving radiotherapy in cancer treatment: Promises and challenges. Oncotarget. 2017 Jun 8;8(37):62742-62758. doi: 10.18632/oncotarget.18409. PMID: 28977985; PMCID: PMC5617545.
[x] Grecchi F, D’Ambrogio RG, Stefanelli LV, Grivetto F, Goker F, Del Fabbro M, Schreiber A, Piazza C, Salgarello S, Dosio C, Grecchi E. Guided Zygomatic Implantology for Oral Cancer Rehabilitation: A Case Report. J Clin Med. 2023 May 24;12(11):3653. doi: 10.3390/jcm12113653. PMID: 37297847; PMCID: PMC10253450.
[xi] Hackett S, El-Wazani B, Butterworth C. Zygomatic implant-based rehabilitation for patients with maxillary and mid-facial oncology defects: A review. Oral Dis. 2021 Jan;27(1):27-41. doi: 10.1111/odi.13305. Epub 2020 Mar 5. PMID: 32048429.
[xii] Bruno Ramos Chrcanovic, DDS, MSc,* Tomas Albrektsson, MD, PhD,y and Ann Wennerberg, DDS, PhDz. Journal of Oral and Maxillofacial Surgery. Survival and Complications of Zygomatic Implants: An Updated Systematic Review Crossref DOI link: https://doi.org/10.1016/j.joms.2016.06.166 Published Print: 2016-10
[xiii] Solà Pérez A, Pastorino D, Aparicio C, Pegueroles Neyra M, Khan RS, Wright S, Ucer C. Success Rates of Zygomatic Implants for the Rehabilitation of Severely Atrophic Maxilla: A Systematic Review. Dent J (Basel). 2022 Aug 12;10(8):151. doi: 10.3390/dj10080151. PMID: 36005249; PMCID: PMC9406716.
[xiv] Grecchi F, D’Ambrogio RG, Stefanelli LV, Grivetto F, Goker F, Del Fabbro M, Schreiber A, Piazza C, Salgarello S, Dosio C, Grecchi E. Guided Zygomatic Implantology for Oral Cancer Rehabilitation: A Case Report. J Clin Med. 2023 May 24;12(11):3653. doi: 10.3390/jcm12113653. PMID: 37297847; PMCID: PMC10253450.
[xv] Hackett S, El-Wazani B, Butterworth C. Zygomatic implant-based rehabilitation for patients with maxillary and mid-facial oncology defects: A review. Oral Dis. 2021 Jan;27(1):27-41. doi: 10.1111/odi.13305. Epub 2020 Mar 5. PMID: 32048429.
[xvi] Solà Pérez A, Pastorino D, Aparicio C, Pegueroles Neyra M, Khan RS, Wright S, Ucer C. Success Rates of Zygomatic Implants for the Rehabilitation of Severely Atrophic Maxilla: A Systematic Review. Dent J (Basel). 2022 Aug 12;10(8):151. doi: 10.3390/dj10080151. PMID: 36005249; PMCID: PMC9406716.
[xvii] Grecchi F, D’Ambrogio RG, Stefanelli LV, Grivetto F, Goker F, Del Fabbro M, Schreiber A, Piazza C, Salgarello S, Dosio C, Grecchi E. Guided Zygomatic Implantology for Oral Cancer Rehabilitation: A Case Report. J Clin Med. 2023 May 24;12(11):3653. doi: 10.3390/jcm12113653. PMID: 37297847; PMCID: PMC10253450.
