Learn More about Dental Implants




Which one is better??? Zygomatic dental implants or a sinus lift bone graft?  I would like to start by saying that both are excellent options.  Both have long-term data to support their use and I do both procedures very routinely.Often I will recommend one over the other or give you the option to choose what is right for you.  There are times where both options are not good!

Try-in for upper and lower bridge. Upper implants are zygomatic placed by Ramsey Amin DDS
x-ray taken at time of zygomatic implant placement. The left sinus is a bit cloudy because it is taken on the day of surgery. This will clear up in just a few days since sinus passages are clear.

Both of these procedures only apply to the upper jaw.  Specifically they apply to the back teeth of the upper jaw.  In the back part of the upper jaw where your molars are, that bone is remarkably soft and it is generally hollow.  It is hollow because the maxillary sinus drapes down into this area.  The combination of hollow and soft does not make for strong and secure dental implants.  Something has to be done to augment it so that back teeth implants can be placed.I often tell patient that if your sinuses are hollow on 3-D scan and we need back teeth implants than either way I need to go into your sinus somehow.  Either it has to be grafted in the sinus to rebuild bone  …then… have dental implants or we have to go *through* the sinus (or very close to it) to place zygomatic implants in the cheekbone. 

Unless there is an option to bypass/avoid the sinus with a tilted dental implant concept, then there is no way to avoid the sinus.  I routinely use pterygoid implants as well to give additional support.

Please keep in mind that the distance from the cheekbone to the sinus is very similar.  It is not that much further up.  The outer wall of the sinus is the zygomatic cheek bone of the skull.  They are connected!

3-D image of zygomatic implants placed into the cheekbones on a severe bone loss patient
Final x-ray with upper and lower solid zirconia Bridges on 12 implants. There are 24 teeth supported by these 12 implants. The sinus was avoided
surgical entry point for zygomatic implants. Please note that it is not much higher than sinus lift bone grafting through lateral window approach
entry points for lateral window sinus grafting. Please note that it is not much lower than zygomatic position.

To properly restore your mouth you must have molars.  Without back teeth, everything in the front will fail prematurely and nothing will work right.  The bite must be level and stable.

The zygomatic implant is typically only used when you are replacing a full set of upper teeth.  This allows all of the teeth to be connected in an arch form called “cross arch splinting”.  This gives strength and rigidity to the system where each implant is strengthened by another implant.

A sinus lift bone graft can be used when you are replacing just one side of your teeth and not the other.  It can also be used to replace both sides of your back upper molars and bicuspids.

Sometimes I only use one zygomatic implant per side and sometimes I will use two per side (quad zygoma).  Sometimes I will only put zygomatic implant on the left or on the right and bypass the sinus on the opposite side.  It is not necessary for implants to be placed in a symmetrical nature because our bodies are not symmetrical.

The following table describes some of the differences and similarities between the two:

Sinus liftZygomatic Dental Implant
Typically takes 8-18 months to completeCompleted in a single visit – 1 day
Requires bone graft from human, cow, self or synthetic.Requires no bone graft
Not possible to have fixed teeth on surgery dayFixed temporaries on same day of surgery
Must have clear sinuses to performMust have clear sinuses to perform
Pain and bruising –usually mildPain and bruising –usually mild
In office procedure under IV sedationIn office procedure under IV sedation
Antibiotics requiredAntibiotics required
Can be used to anchor teeth on one side or both sides, keeping some existing teethCan only be used when all upper teeth are being replaced
Implants are regular lengthImplants are extended length
Patient must wait for healingYou can leave with immediate loaded functioning fixed teeth on the same day of the surgery.
Very risky to use a temporary denture over the top while it is healing – best if no denture is worn for 1-4 weeks or not at allUpper denture is eliminated on the day of surgery for most patients. 
No option for immediate teethImmediate teeth very likely
Sinus Lift cost  – generally more than zygomatic because of numerous appointments and graft materialsZygomatic generally less costly than sinus lift
Numerous appointmentsSingle appointment
Bridge can be made thinner on insideThe final bridge on the tongue side of the molars sometimes needs to be made a bit thicker
Must be done in the sinusZygomatic implant can be placed partially in and partially out of the sinus
Multiple implants necessary per sideGenerally only one implant needed per side
3-D scan necessary for diagnosis3-D scan necessary for diagnosis
Can be used for All on 4, 5,6,7,8 etcCan be used for All on 4, 5,6,7,8 etc
Existing bone is very softZygomatic cheek bone is generally harder
Procedure dates back to 1974Procedure dates back to 1988
Can be used to replace one toothCannot be used to replace one tooth.

Both zygomatic dental implants and sinus lifts bone grafts should not be done if your sinus is not healthy or it is plugged shut.  The sinus is supposed to drain into your nose and other sinuses. If that area is blocked the procedure should be delayed until that blockage is cleared.  Sometimes clearing that blockage only requires some nasal sprays/steroids and other times and requires surgery by an ear nose and throat doctor.  Many smokers have thickened sinus membranes that are not healthy.

The zygomatic dental implant really opens the door for having immediate teeth on the upper jaw on the same day of removal of your existing teeth (PRETTAU dental implant bridge is one example)  This is a big deal for those patients that I am having to remove all of their teeth both upper and lower on the same day and provide them with new teeth and implants within 24 hours.  For a lot of people wearing a denture for a year is not an option.

Whether you are in the public eye, a stay-at-home mom, retired or a busy professional many people cannot tolerate a denture and need same day teeth.  The sinus lifts graft does not allow for this to happen.  Occasionally I have a patient that is okay wearing no teeth at all for 6-18 months and that really allows all options to be carried out.  There is no age restriction for either procedure although I would suggest you are 20 or older.

Both options are very stable long-term and neither option has a high risk for chronic sinus issues after the procedure.

Both of these procedures should be completed by a very skilled and experienced implant surgeon.  I would not consider these procedures for a novice!  They require a very in-depth knowledge of the anatomy.  Offices that do these procedures should do them under a hospital-like, aseptic surgical operatory to prevent infections.

I hope the detailed descriptions help you to make an informed decision.

Your comments are welcome.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry


    1. The iRaise is a bit of a gimmick. Its tool that allows a dentist to lift the sinus and place a regular implant. It is not for zygomatic implants. The reason why I say it is a gimmick is that it is trying to replace technical skill. A dentist that is scaled and trained in the sinus lift procedure does not need to use this.

  1. Hello doctor! I am in a bit of a bad situation. Since I was young my parents never taught me to brush and now at 20, in my lower jaw on both sides I’m missing 4-5 teeth from the back of the mouth. My bone there has become very very think-like. What are my options doctor? I feel ashamed and embarrassed. I want something done I can’t even eat properly. Can I get implants? Do I need bone graft? Will it be possible? If so how many implants? Maybe the rest with a bridge? Please give me some advice doctor. Thank you

    1. Of course without seeing you there is no way that I can give you proper guidance. My best recommendation is that you get in the hands of a very skilled dentist that can help you hopefully save the remaining teeth that you have and replace the missing ones with implants. It is all about having a good long-term treatment plan that will last as long as possible because even dental implants are not permanent.

  2. Dear Doctor,
    I am 58 and 9 months post op after 5 on 1 implants above and below; in the upper I had 3 zygoma implants and the result was superb esthetically and functionally. However, 1 zygoma implant can be felt in the upper cheeck like at some point it will pop out of my skin. It does not hurt but it is awkward and freeky to touch. Should I be scared. My doctor does not seem to be very worried. He has performed hundreds of these operations as he said and he is a well known surgeon here and abroad. Thank you for your feedback

    1. It sounds like you have very thin skin… No pun intended. Many times zygomatic implants purposely are placed just a tiny bit outside the bone. Those with thin skin can feel them on the outside but most cannot. Do not make a habit of rubbing it.

      If it really bothers you an incision can be in the skin from the outside and it can be ground down a bit. The incision can be hidden in a natural facial crease.

      Generally I would suggest just leaving it alone unless it becomes a problem which is not likely

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      1. thank you very much this does make me less anxious, although I am not sure whether I can now continue doing some facial or laser trreatments such as dry needling around the eyes or other skin improvement such as endermology to increase collagen etc.. you are right I do have think skin, I am blue eyed blonde.

  3. Hi Dr. I had major bone grafts on both sides. My nasil cavity on the left side was fully exposed. The bone on that side was like egg shells. The bone took but not enough for the regular implants so I just had mini ones placed. 2 on each side was all that could be doneand one fell out. I might have the implants that go into the cheek bone. My concern is that 4 years ago I had a brain tumor removed called an accustic nerouma . it left some nerve damage and I have vertigo and eye pain also left my right ear dead totally deaf. There are plates on that side around my ear. Would this procedure be any more risky . thank you hope you cam answer this question and maybe have had this experience with someone.

  4. Dr. Amin,
    Yesterday 3-14-19 I had a CT scan taken by my dentist of the Maxilla jaw. The CT scan revealed that I would need a sinus lift and bone grating before implants could be placed. I was told that this would take up to two years before a bridge could be placed. I am a teacher and this time table is not satisfactory for me to go without teeth. I would prefer something less invasive.
    For the past 15 years I have had a fixed porcelain bridge being held on by 4 teeth (2-10-15-16.). Due to the condition of the teeth this bridge is now failing. Would you be willing to look at my CT and tell me what my options are? I understand you have done many implants and I thank you for what you are doing for patients with needs such as I. Thank you Dr. for your time.
    Best Regards

    1. Thank you for your kind words but I would have to see you to make these determinations. Even looking at a scan alone is not enough information. That’s only about 50%

      1. Dr. Amin,
        I have scheduled an appointment with you for June 13-14. My Dentist has sent you all of my radiographs. I am looking forward to coming to California and meeting you and have you evaluate my case.
        Best to You

  5. Dr. Amin, I need full upper dental implant. But on my lower jaw, I am missing first molars on each side. Due to not having these teeth for a while, it causes my teeth to shift forward and a misaligned lower jaw. I was told I may need to do Orthodontic treatment on lower to get the teeth and jaw in proper placement. But keep in mind that I also need to do the full upper implant. Can you please advise me on which is best to do first? Do I go for orthodontic treatment first on the lower jaw and then upper implants afterwards. Or, do I go for the upper dental implants first before orthodontic? Please advise. Thank you

  6. Dr. Amin,
    I’m 3 weeks post op lateral sinus lift, upper left, 14 and 15 missing. Procedure went fine, lots of bone put in, his partner removed stitches and said he’s never seen so much bone put in and called him a rock star! I healed well. BUT Teeth 12 and 13 are numb!! Feel “tight” Thought/assumed that it’s normal and it would go away eventually, but OS said today he has no reasoning at all that this would have occurred. No nerves in the area, etc. He said he hopes it goes away, yet has zero logical reasoning as to why it’s like that. I thought because he packed a bunch of bone in there! Yet he said the bone is in the sinus area not by the teeth..CONCERNED! DO you have any insight? Would appreciate your valued opinion.
    Thank you so much!

    1. It is possible to be numb due to Graft or retraction on the flap. Most of the time these return to normal. Give it 2-3 months and will likely come back. The upper jaw is much more forgiving with nerve numbness than the lower jaw. I am assuming the skin of the side of your nose and upper lip feels normal.

      1. Yes, the skin on nose and upper lip are just fine. I am wondering why he was so surprised and said “no logical explanation?”
        They feel tight- feels odd when I brush. Hope it’s safe to have the implant put in- scheduled in 4 months if it’s like this. Seriously, he must know it’s possible for this to happen as you stated- makes me question his integrity now. Ok to proceed with the implant?? One more notation- I’ve had numerous panoramic X-rays- is it really necessary for all that radiation exposure??
        Thanks again, your feedback is much appreciated!

        1. x-rays are normal to be taken several times during the reconstruction process. It is very important to do so. The numbness comes from the infraorbital nerve. It also has branches that sometimes traverse the sinus internally.

          1. Dr. Amin,
            I know I’ve asked a lot of questions, you’ve been very helpful, patient, and kind to answer all my questions!
            You’re very much appreciated!

          2. Good to hear after all that! Could the implant cause further issues?
            Why is it a “tough call?”
            I want it done of course, yet don’t want issues. Wil the implant be by that nerve, too? gosh, I sure hope not. Thx for your info:) Maybe everyone needs to hop on a plane and fly out to you for their procedures;)

          3. Implant wont be near the nerve. Tough because you already have a problem in the area so from your perspective you may be reluctanct to move forward.

  7. Can you please explain sinus augmentation with bone or bone substitutes via a lateral open approach.

    Because I have bad allergies and constantly blow my nose, I opted not to have the sinus lift in June 2017. In March 20 I find that my dentist claims this procedure was done on January 3 – sinus augmentation with bone or bone substitutes via a lateral open approach at the same time the surgical placement of implant body: endosteal implant. Is there any way to tell if this work was actually done? I question whether this procedure was done since it cost $1500 for the sinus lift. Your help is clarifying this for me is appreciated.

      1. Wouldn’t the dentist need to inform me that I had a sinus augmentation via a lateral open approach so I wouldn’t blow my nose? If the original quote show the sinus augmentation crossed out because of my allergy issues, why would the other dentist try this procedure without my consent? Since I’m constantly blowing my nose every day, mostly during the nights and go through boxes of kleenex tissues wouldn’t I experience pain in my sinus area?. I did not have any pain in my sinus area when blowing later that day.

        When you say that I need an experienced doctor for a second opinion, you mean Dentist, right? If so, I will ask about having a 3D CBCT scan done.

  8. Thank you again! Just want it done now. Was going to get 2nd opinion on having crestal done, but probably won’t! I know the lateral is best choice with my vertigo. Thx!

    1. Dr. Amin, had the lateral sinus lift on Thurs. Glad I was sedated- woke up and done! OS said it went great. No apnea. Curious tho, no steroids, no chlorhexidine- only antibiotic. Minimal bleeding, some swelling. Sleeping upright for 4 nights as per OS. Just following up for others that it’s not too painful, it’s necessary, and you’ll get through it! Can I take a long car ride? Or should I continue to rest for a few days? Also why no mouth rinse or steroid? Curious. Also, should I also do #15 since the bone is there now? OS said most do not do it, but prepared it so I can. Small mouth.
      Thank you!

      1. excellent… Thank you for the follow-up. You may have had a steroid intravenously rather than a postoperative steroid taken by mouth. The intravenous or intramuscular forms are the best. Generally speaking chlorhexidine is prescribed for 7-10 days after this procedure. It is recommended although I would not say it is critical. Antibiotics are definitely necessary. Yes you can take a long car ride!

        Asked for replacing #15… If it is on the same side and you have a lower opposing tooth than I would definitely do this. He should strongly consider connecting to teeth together for strength since the implants are placed and grafted bone. This is an area of high bite force and low bone density even after grafting.

        1. If ever I need anything done I would want you to be my dentist . I think you know a lot and would give you all my trust. Please give me your info.

          1. that is very kind of you to say 😉

            500 E. Olive Ave, Suite 520
            Burbank, CA 91501
            Phone: 818-538-5718

  9. Dr. Amin,
    I lost #15 at least 5 yrs ago. Just last week had #14 ext. with bone preservation and collagen for dental implant. I have dry mouth due to RA-I from TC 10 years ago. Having crowns and rct too frequently now. Excellent OH. I am literally freaking out about the sinus lift due to having no vestibular system on my R side. I’ve also had a torn retina recently. So that’s what scares me, more vertigo, and the possibility of having a torn, or worse yet, detached retina from the MALLETING!! It’s 2017- that’s barbaric! Those are my 2 concerns! I literally CANNOT tolerate any more vertigo or another torn retina. Please give your advice! Thank you so much for your time and your blog, it’s very informative! Wish I wasn’t in this position yet I know I shouldn’t leave the upper left minus 2 molars! Eek. Help please.

    1. Simple solution…. Have a lateral window sinus lift bone graft rather than internal techniques. Internal or crestal approaches oftentimes require slight tapping from a mallet. There are also bone inflatable methods but they are not as predictable in raising the sinus membrane in the proper location. The lateral window bone graft does not involve any sort of tapping with a mallet and is extremely predictable. These procedures are extremely technique sensitive. Some of these gimmick-type balloon instruments are made for those that do not have a ton of experience.

      The lateral window graft is easy and they generally heal well and generate a lot of bone!

      Mallets are used in operating room’s across the world to insert prosthetic devices into knees, hips etc.!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      1. Thanks Dr. Amin,
        My oral surgeon mentioned that- if I’m concerned about the MALLETING, he’d do the lateral approach- he was talking briefly while I had a mouth full of gauze. I see him soon for follow up and will get more precise details, yet I thought the newer less invasive approach was the indirect approach. It sounds like the lateral approach is more invasive…. And his assistant said much more costly! But I’m willing to do that if I can get away from the possible problems with vertigo, and the Retinal issues. I had the extraction without incident, and I can cope with the pain afterward, just have other medical issues that preclude me from wanting to go ahead with it.
        Thanks for your reassurance that it has predictable results, and is not so invasive. Just what I needed to hear. Any further words of wisdom are always appreciated. Thank you for helping the dental community, I am a former hygienist and you are very much appreciated!!

          1. my friend has no bone and no teeth
            on top and her dentures keep falling out because she cannot find glue to hold them in and she’s tried many…is she a candidate for zygomatic implants??

          2. Yes. This is the perfect indication for zygomatic implants. She can also have a fixed bridge placed within 24 hours.

          3. Dr. Amin,
            I’ve completely healed well from procedure, and have amazing bone results, almost 6mm, yet not enough to forgo lateral sinus procedure. Shoot! Anyway, next concern, I have apnea, no c pap, from accident, neck damage, wt. gain, and the OS wants IV sedation with versed and fentanyl- I’m now concerned I will stop breathing being “out” and on my back. It happens all the time, yet I wake myself gasping, but being sedated, I don’t think i will awaken myself, and not get enough O2 to my brain/body. Can’t I just take a xanax? Don’t care about the noise/pressure etc thx!

          4. Lani…we treat patients with obstructive sleep apnea all the time. Just make sure your dentist knows this. We don’t need to be out for this but basically sedation will help tremendously. Sometimes we augment our reduce fentanyl and just use Versed. Have this discussion with your dentist and good luck!

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Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.