02 — Complex implant cases
Zygomatic and pterygoid implants, navigated.
When the upper jaw has lost the bone that ordinary implants need, the answer is not always a graft and a two-year wait. Zygomatic and pterygoid implants anchor in bone the patient still has — the cheekbone and the pterygoid plates — and can often support a fixed bridge within days.
- ZAGA Center Miami — Director
- Certified ZAGA implantologist
- Zygomatic, pterygoid and full-arch reconstruction
- Second opinions on failed treatment
Zygomatic implants
Anchorage in the cheekbone
A zygomatic implant is long enough to bypass the resorbed upper jaw entirely and engage the dense bone of the zygoma. It is the established option for a maxilla that has lost too much height for conventional implants, for patients whose sinus grafts have failed, and for those who have been told for years that nothing can be done.
Dr Nicolaievsky works to the ZAGA concept — the implant path is chosen to follow each patient’s own anatomy rather than forcing every case into one technique. Blum-Nico Oral Surgery Associates is Miami’s certified ZAGA Center for this treatment.
Pterygoid implants
Anchorage behind the sinus
A pterygoid implant is angled backwards through the tuberosity into the pterygoid plates. It restores the back of the arch — the molars — without a sinus lift, and it gives a full-arch bridge support at the far end rather than a long unsupported cantilever.
Both approaches share the same demand: a long trajectory through anatomy where a small error at the entry point becomes a large one at the tip. This is precisely the case for navigating rather than estimating.
Who this is for
The referrals we see most
“You don’t have enough bone”
Severe maxillary atrophy after years of denture wear, where conventional implants have been ruled out.
Failed grafts
Sinus lifts or block grafts that resorbed, became infected, or never produced usable bone.
Failed implants
Existing implants that are loose, painful, malpositioned or unrestorable, and need a plan for what comes next.
Post-oncologic and trauma defects
Maxillary reconstruction where the normal implant sites no longer exist.
Full-arch, one procedure
Patients who want a fixed upper bridge without staged grafting over several years.
Referring clinicians
Colleagues who want the surgical phase handled and the patient returned for the prosthetic work.
What to expect
From first scan to fixed teeth
Assessment starts with a cone beam CT and a conversation about what the final teeth should look like. That restorative goal drives the surgical plan, not the other way round. Where the case allows, a provisional fixed bridge is delivered within days of surgery, with the definitive prosthesis after healing.
Treatment is carried out under sedation or general anesthesia depending on the case. Dr Nicolaievsky’s background in dental anesthesiology, and his hospital appointment at Mount Sinai Medical Center, mean medically complex patients can be managed in the appropriate setting.
Certification
A certified ZAGA Center in Miami
Blum-Nico Oral Surgery Associates joined the ZAGA Centers network in March 2022 and is Miami’s certified center of excellence for zygomatic implant treatment. Dr Nicolaievsky is a certified ZAGA implantologist and directs the center.
ZAGA — the Zygoma Anatomy-Guided Approach — was developed by Dr Carlos Aparicio and starts from a straightforward observation: no two atrophic maxillae resorb the same way, so no single implant path suits every patient. The anterior maxillary wall is classified case by case and the implant is routed accordingly, intrasinus or extrasinus, hugging the patient’s own bone rather than imposing one technique on all of them.
Certification is not a logo. It means the protocol, the instrumentation, the prosthetic workflow and the follow-up are audited against the network’s standard, and that outcomes are recorded in a way that can be compared with other centers.
Common questions
Zygomatic and pterygoid implants, answered
Am I too old, or have I waited too long?
Neither is usually the deciding factor. Bone volume, sinus health, general medical status and what the patient wants from the result matter far more than age or how long the jaw has been edentulous.
Do I need a bone graft first?
Generally no. Avoiding the graft is the point of the technique: the implant reaches bone that has not resorbed instead of rebuilding bone that has.
How soon do I get teeth?
Many patients receive a fixed provisional bridge within a few days of surgery. Whether immediate loading is appropriate depends on the stability achieved at placement.
What does it cost?
It depends on the number of implants, the anesthesia required and the prosthesis. A written treatment plan with costs follows the consultation and the scan — there is no useful figure before that.
My implants failed elsewhere. Is that a problem?
No, and it is a large share of the practice. Previously failed treatment changes the plan; it rarely ends it.
What is a ZAGA Center?
ZAGA Centers are clinics certified in the ZAGA concept for zygomatic implant treatment, which adapts the implant path to each patient’s anatomy. Blum-Nico Oral Surgery Associates is the certified center in Miami.
Get in touch
Referral, second opinion, lecture, or a question about the book
Messages reach Dr Nicolaievsky’s office directly. Complex and previously failed cases are welcome.