Upper Mini Dental Implants vs. Zygomatic and Pterygoid All-on-4 Implants

Mini dental implants and zygomatic implants are as opposite as they come! In this video I explain how someone with “no bone” on the upper jaw would consider mini dental implants vs. zygomatic/pterygoid dental implants. Which type of dental implant lasts longer? Which type of implant is prone to problems?

Video Transcription lightly edited for easy reading:

Hello, I’m Dr. Ramsey Amin. Today the topic is something that’s quite the opposite: mini implants versus zygomatic and pterygoid implants. Now we’re typically talking about replacing the full upper jaw (all of the teeth in the upper arch). And let’s talk about each one here for a moment.

Usually when this question arises is because somebody has been told they have no bone on their top jaw at all, and there’s nothing to anchor, so do you go really, really small and narrow or do you put something extra, larger, in different areas of the mouth?

So my own personal feelings of mini dental implants, and over the years and experiences that I’ve seen them, I call them temporary implants.

Mini Dental Implants (aka Temporary Dental Implants)

They’re very narrow. They are bendable and they break. They’re not intended to really support full teeth for a long-term basis. They could be used on a temporary basis in some situations, or when they’re really sick, who may need some denture support.

But mini dental implants (or temporary dental implants) certainly aren’t for long-term. Mini implants have never really been well accepted by the dental community. We haven’t found long-term success with them. It’s a quick fix.

Zygomatic and pterygoid implants

So if the upper jaw is typically hollow altogether and there’s no bone anywhere, the other option is putting implants in remote locations. That means that we’re going to anchor them into the bottom of the nose (or what’s called the vomer)…this thing called the piriform rim, the zygomatic arches, or zygoma it’s called. Or way in the back, called the pterygoid area. Those are areas that have bone, even in patients who have had severe bone loss.

Typically the upper jaw is hollow because the sinuses are very big. So even though you feel like you have gum there, inside there’s nothing to go into. So in my practice, patients who have hollow bone or no bone, I have utilized zygomatic and pterygoid implants for many years now, in addition to anchoring into the bottom of the nose.

It sounds a little bit strange that the implant doesn’t go through your nose at all, but it actually anchors into the base of the nose, just grabs the hard bone. And that’s what we’re looking for. Usually it’s hollow everywhere, and as we get a little deeper, there’s a hard spot almost everywhere on the upper jaw. And so that’s called remote anchorage or non-conventional implants.

All-on-4 implants or mini (temporary) dental implants – which type of implant is better?

So if I had to choose having my whole upper jaw (whole upper arch of teeth) replaced with mini implants or a combination of larger, longer implants (such as pterygoid, zygomatic or vomer nasal lifting), that would certainly be the way that I would do it. Or if my own mother or father needed to have their teeth replaced. Because all-on-4 dental implants give long-term solutions with a regular size diameter implant.

All-on-4 zygomatic (pterygoid) implants are, on average, 4.2 millimeters in diameter, versus a mini implant that’s two millimeters in diameter. That’s not very much if you look at a little ruler and check that out.

Also, with the options that I provide for patients, we typically will have teeth within 24 hours. That means I could take out the remaining teeth, I can put in the zygomatic, the pterygoid, the nasal type of implant, and have teeth attached right away. That means you’re smiling and all that is done within a day.

Of course, it takes a lot of work on the front end (some digital planning, facial scanning, which we call intraoral scan). It’s like a little wand that goes inside. We use what’s called a Trios that helps develop all the records beforehand and make sure that your jaw, called the vertical dimension, is correct…all before doing anything in your mouth at all.

• I find that with the mini dental implant solution, they’re just kind of put in there, and then it’s more of an afterthought making the teeth. Whereas with the definitive way of doing real implants or zygomatic pterygoid implants, all that is pre-planned very carefully beforehand (a full digital workup, a full facial analysis).
• All of this allows me to see and know what you’re going to look like before I ever start. There’s a lot of mental rehearsal that comes through, many times over, until we actually go to surgery and then deliver teeth that get computer milled. It’s really quite neat!
• That means that little arms come out from a computer machine and drill away a large puck of material to make the smile really nice. And I have lots of examples on my website.

But bottom line…mini dental implants would NOT be my solution anywhere in the mouth for long term. Mini dental implants can possibly be a solution for maybe 18 months at most.

And again, zygomatic pterygoid dental implants are typically provided by a dental implant specialist with a lot more skills, training and experience whereas the mini dental implants are oftentimes placed by (or let’s say sometimes) providers who have very minimal training, or they’re afraid to open the gum completely or go into those deeper bone areas. Many of the mini implants fall out unfortunately and people are just left with nothing. And then that just kind of starts the process all over again.

I’d rather do it right the first time.