05/04/2026
The Maxillary Myth: Why I’m Choosing Bicortical Over Zygomatic
Stop drilling into the cheekbones and stop waiting 6 months for a sinus lift to "maybe" work. It’s time we talk about the Bicortical Advantage.
Looking at a severely atrophic maxilla like this, the traditional "Gold Standard" usually points toward Zygomatic implants or extensive Sinus Lifts with endosseous fixtures. But are we over-complicating surgery at the expense of the patient?
The Controversial Take:
Bicortical engagement (utilizing the basal bone, nasal floor, and pterygoid plates) is often superior to the "Heroics" of Zygomatics. Here’s why:
1. Zero Grafting, Instant Loading: Why perform a sinus lift and wait for months of osteointegration when you can engage the dense, cortical bone of the nasal floor or pterygoid process for immediate stability?
2. Less Morbidity: Zygomatic implants are invasive. Engaging the cortical pillars of the midface provides the same "fixed" result with significantly less risk of sinusitis or oro-antral communications.
3. The Biomechanics of the "Hard Shell": Endosseous implants in grafted bone rely on "spongy" quality. Bicortical implants anchor into the "hard shell" of the skeleton. It’s the difference between anchoring a screw into drywall vs. a wooden stud.
4. Maintenance: Managing peri-implantitis around a zygomatic fixture is a nightmare. Cortical-supported restorations offer a cleaner, more maintainable emergence profile.
The Reality Check:
Yes, it requires a different surgical skillset. Yes, it defies the "big bone graft" industry. But if we can provide a fixed, full-arch restoration in 72 hours without touching the zygoma—shouldn't we?
Are you Team Zygomatic or Team Bicortical? Let’s argue in the comments.
