QUAD ZYGOMATIC IMPLANTS FOR THE MANAGEMENT OF AN IMPROPER MAXILLARY REHABILITATION: A CASE REPORT

¹ Private practice, Via Azzurra 26, 40138 Bologna, Italy
² Private practice, Forlì, Italy
³ Private Practice, Naples, Italy
⁴ University of Ferrara 44121 Ferrara, Italy

Correspondence to:

Journal of Orthopedics 2026 September-December; 18(3): Ahead of Print
https://doi.org/10.69149/orthopedics/2026v18iss3_1

Received: 4 August 2026 Accepted: 7 September 2026

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Abstract

Zygomatic implants (ZIs) represent an advanced surgical option for the rehabilitation of patients with severely atrophic maxillae, particularly when conventional implant placement is not feasible because of insufficient bone volume. By engaging the dense cortical bone of the zygoma, these implants can provide high primary stability and support fixed prosthetic rehabilitation in challenging anatomical conditions. Pterygoid implants may provide additional posterior anchorage and further improve implant distribution in complex full-arch rehabilitations. Here, we report a case of inadequate maxillary rehabilitation treated with four zygomatic implants, placed in a quad configuration with two implants on each side, in combination with two pterygoid implants, one on each side. Intraoral welding technique (WT) was used to rigidly splint the implants and provide immediate stabilization of the prosthetic framework. We delivered a provisional maxillary fixed prosthesis on the same day as surgery. At the one-year follow-up, the patient was clinically healthy, with no reported chewing difficulties, aesthetic concerns, or postoperative complications. The combination of quad zygomatic implants, pterygoid implants, and intraoral welding may offer a useful graftless approach for rescuing complex maxillary rehabilitations, allowing immediate fixed prosthetic restoration in carefully selected patients.

Keywords: bone, fixtures, graft, implant, maxilla, quad, zygomatic