Zygomatic & Remote Anchorage Implants · Bonney Lake, WA
When traditional implants aren’t possible due to severe bone loss, remote anchorage protocols, zygomatic implants, pterygoid implants, and the PATZI sequence, restore fixed teeth in patients other practices turn away. Performed personally by oral and maxillofacial surgeon Dr. Jonathan Volland.
What it is
Traditional dental implants, including the standard All-on-4 protocol, must be anchored in the jawbone itself. When years of denture wear, periodontal disease, or previous tooth loss have resorbed that bone beyond a critical threshold, conventional implants are no longer viable.
Sinus lifts, ridge augmentation, autogenous grafts harvested from the hip or chin, staged over 12 to 18 months before implants could even be placed, with no guarantee the regenerated bone would hold.
Patients who couldn’t tolerate the timeline, the additional surgeries, the cost, or the uncertainty were left with conventional dentures, which, given the underlying bone loss, often didn’t fit well either.
Rather than rebuilding bone that isn’t there, zygomatic and pterygoid implants anchor in nearby bone that is, supporting a fixed prosthesis without years of grafting and healing. This is not experimental work. Zygomatic implants have been performed since the 1990s, with published 12-year cumulative survival around 95% across thousands of cases.¹ Modern protocols like ZAGA and PATZI provide systematic, evidence-based decision-making rather than improvisation.
The anchorage sites
The maxillofacial skeleton contains several regions of dense bone that can support implants when the maxilla itself cannot. Each has specific clinical applications.
Most common
Anchored in the zygomatic bone (cheekbone). Used in pairs to support the posterior portion of a full-arch prosthesis, often combined with conventional anterior implants.
Length
30–55 mm
Anatomy used
Zygomatic process into the body of the zygoma
Placement path
Intrasinus (original) or extrasinus (ZAGA)
Loading
Immediate, when primary stability achieved
12-year survival
~95% cumulative¹
Posterior Anchorage
Anchored in the pterygoid plate at the back of the upper jaw. Often paired with anterior conventional implants in the PATZI protocol, effective when posterior maxillary bone is atrophic but pterygoid density is preserved.
Length
15–24 mm
Anatomy used
Pterygomaxillary complex, dense bone
Placement path
~70° angled through tuberosity
Loading
Immediate, with >40 Ncm insertion torque
Survival
High in published immediate-load studies³
Specialized Use
Anchored through the nasal floor. Reserved for severely atrophic anterior maxillae where conventional anterior and zygomatic placement are both inadequate.
Anatomy used
Nasal floor and nasal process of the maxilla
When used
Severely atrophic anterior maxilla
Frequency
Less common, most severe cases only
Foundation Layer
Standard implants in the front of the maxilla, sometimes tilted, placed first in the PATZI algorithm whenever bone allows, before escalating to remote anchorage.
Length
8–18 mm, conventional range
Why included
Anterior bone is often preserved even in atrophic patients
Position in PATZI
Second priority, after pterygoid
Who we see
The patient seeking remote anchorage care has typically already done significant research. Three profiles are particularly common.
Profile A
The “not a candidate” patient.
Told by one or more practices they aren’t candidates for full-arch implants, usually after long-term denture wear with significant bone resorption. Often arrives discouraged. Most patients in this category are, in fact, candidates with remote anchorage. Profile B
The previous-implant-failure patient.
Had implants placed elsewhere that failed, with bone loss at the original sites complicating re-placement. Wants a second opinion from someone with broader surgical scope. Profile C
The “no grafting” patient.
Quoted full-arch implants only after 12+ months of staged grafting. Can’t tolerate the timeline, cost, or additional surgical exposure, and wants to know if a faster path to fixed teeth exists.
Candidacy
Patients with severe upper-jaw bone loss are often dismissed as “not candidates” for full-arch implants by general dentists and even some specialists. Remote anchorage protocols change that calculation.
Long-term denture wearer with significant bone resorption
Previous implant failure with bone loss at the original sites
Told you “need extensive bone grafting” before any implants
Severe maxillary atrophy after years of tooth loss
Want to avoid 12+ months of grafting, healing, then implants
The protocol
PATZI, published in the International Journal of Oral and Maxillofacial Implants in 2023⁵, is a systematic intraoperative decision-making algorithm for full-arch maxillary reconstruction: prioritize traditional implants, escalate to remote anchorage only when needed.
P
Pterygoid implants are placed first in the PATZI sequence. The posterior anchorage they provide eliminates the cantilever forces that compromise traditional posterior placement in atrophic maxillae. If pterygoid placement achieves adequate primary stability, the posterior support of the prosthesis is established without requiring zygomatic implants.
A
Standard implants are placed in the front of the upper jaw, where bone density is typically preserved even in atrophic patients. Anterior placement uses available native bone rather than escalating to remote anchorage prematurely. The PATZI algorithm specifically prioritizes traditional implants when they are anatomically viable.
T
Tilted implants, placed at angles up to 30°-45°, extend the posterior reach of conventional placement, similar to the All-on-4 angled posterior approach. This is the third escalation step when straight anterior placement and pterygoid anchorage haven't fully addressed the prosthetic plan.
Z
Zygomatic implants are added when the previous steps haven't established adequate prosthetic support. The PATZI sequence treats zygomatics as the highest-escalation option rather than the default, a meaningful philosophical contrast to "zygomatic-first" approaches that some specialty practices use. The result: zygomatic implants are placed when truly required, not as a marketing feature.
I
The completed configuration, whichever subset of the four placement types provides adequate support for one fixed prosthesis. Determined intraoperatively, case by case.
Conventional implants are technically simpler, faster to place, less expensive, and have a longer track record than zygomatic implants. A protocol that systematically prefers conventional placement when viable, and escalates to remote anchorage only when genuinely needed, produces, on average, better outcomes than one that defaults to zygomatics.
Technique
When zygomatic implants are required, the surgical placement technique matters significantly. The Zygomatic Anatomy-Guided Approach (ZAGA), developed by Dr. Carlos Aparicio, has become the modern standard.²
Requires opening a window into the maxillary sinus and elevating the membrane, effective, but with higher complication rates.
Comparable long-term implant survival to the original technique, with significantly lower complication rates.
At Elite Oral Surgery, zygomatic placement follows the ZAGA framework, anatomy-specific surgical planning from 3D imaging, confirmed intraoperatively, under in-house IV sedation or general anesthesia.
Expected outcomes
Zygomatic implants have been studied longitudinally for over two decades. The modern systematic reviews aggregate data from thousands of implants across dozens of studies.
95.21%
Cumulative survival
12 years
96.2%
Mean survival
6 years
98.1%
Immediate-Load Survival⁴
94%
Mean Prosthesis Survival⁴
The most comprehensive systematic review, 68 studies, 4,556 implants, 2,161 patients, reports a 12-year cumulative survival rate of 95.21%. These rates are comparable to conventional dental implants. The most frequent complication is sinusitis, around 14% at five years, generally manageable with appropriate surgical technique and monitoring. Pterygoid implants show similarly favorable outcomes, 100% survival reported in one immediate-load study, with larger datasets continuing to support high survival when proper insertion torque is achieved.
Patient Reviews
“I really appreciated how attentive and detailed Dr. Volland and his team were when answering questions and sharing what the experience would be like when getting my wisdom teeth removed. I felt very at ease during and after the procedure because of their reassurance despite being uneasy initially.”
“Dr. Volland is amazing! Had a great journey getting my wisdom teeth removed and a bone graft done. All the staff are super nice and make you feel at home. Recovery was quick, and I could tell I was in expert hands.”
“I was very nervous going into the procedure. Dr. Volland was absolutely amazing. He was kind, reassuring, and took the time to make me feel comfortable every step of the way. The procedure was quick, smooth, and much easier than I expected.”
“I cannot say enough about Dr. Volland. He is so thorough and caring. He truly listens to patients, making every visit feel special. Got my all-on-x treatment done, and the results are amazing!”
“The calm atmosphere and confidence of the dr and assistant was reassuring. The extraction was painless and they were attentive to me throughout the procedure. They made the entire experience as comfortable as possible.”
“Dr. Volland was super professional during my consult. Definitely recommend him for anyone in the Sumner area looking for dental implants. Talked through everything in detail. He truly knows his stuff!”
“I really appreciated how attentive and detailed Dr. Volland and his team were when answering questions and sharing what the experience would be like when getting my wisdom teeth removed. I felt very at ease during and after the procedure because of their reassurance despite being uneasy initially.”
“Dr. Volland is amazing! Had a great journey getting my wisdom teeth removed and a bone graft done. All the staff are super nice and make you feel at home. Recovery was quick, and I could tell I was in expert hands.”
“I was very nervous going into the procedure. Dr. Volland was absolutely amazing. He was kind, reassuring, and took the time to make me feel comfortable every step of the way. The procedure was quick, smooth, and much easier than I expected.”
“I cannot say enough about Dr. Volland. He is so thorough and caring. He truly listens to patients, making every visit feel special. Got my all-on-x treatment done, and the results are amazing!”
“The calm atmosphere and confidence of the dr and assistant was reassuring. The extraction was painless and they were attentive to me throughout the procedure. They made the entire experience as comfortable as possible.”
“Dr. Volland was super professional during my consult. Definitely recommend him for anyone in the Sumner area looking for dental implants. Talked through everything in detail. He truly knows his stuff!”
“Dr. Volland did an amazing job! The procedure was quick, completely painless, and I was in and out in no time. My recovery was also very fast and pain-free. Highly recommend!”
“Dr. Volland is as professional as he is kind. His extractions are quick and easy, implants are successful and look great, and IV sedation makes the whole process go off without a hitch.”
“Dr. Volland was so gentle and made sure I was comfortable during my implant surgery. He's the only Dr I'll trust with my oral surgery needs!”
“I went in for a dental implant under sedation and it was absolutely painless! It was so easy and smooth. I can't thank him enough!”
“Our family had an excellent experience with Dr. Volland and his team. Dr. Volland personally took a call from me when we got home and answered my questions. His commitment to patient care is outstanding.”
“Dr. Volland did an amazing job! The procedure was quick, completely painless, and I was in and out in no time. My recovery was also very fast and pain-free. Highly recommend!”
“Dr. Volland is as professional as he is kind. His extractions are quick and easy, implants are successful and look great, and IV sedation makes the whole process go off without a hitch.”
“Dr. Volland was so gentle and made sure I was comfortable during my implant surgery. He's the only Dr I'll trust with my oral surgery needs!”
“I went in for a dental implant under sedation and it was absolutely painless! It was so easy and smooth. I can't thank him enough!”
“Our family had an excellent experience with Dr. Volland and his team. Dr. Volland personally took a call from me when we got home and answered my questions. His commitment to patient care is outstanding.”
Risks
Remote anchorage protocols, particularly zygomatic implants, carry a meaningfully higher complication risk profile than conventional implants. Intelligent decision-making requires understanding what those risks are.
ZAGA-based placement planning, pre-op sinus evaluation, post-op monitoring, prompt management of symptoms.
Confirmed high primary stability (>40 Ncm), careful 3D-guided trajectory planning, zygomatic-specific post-op protocols.
Anatomy-guided emergence point selection, hygiene instruction specific to zygomatic implants, regular follow-up.
Pre-surgical 3D imaging to identify nerve location; technique that maintains safety margins from neurovascular structures.
ZAGA-based extrasinus placement when appropriate, careful sinus membrane management, post-op imaging when warranted.
Comprehensive pre-op medical clearance, hospital-trained anesthesia administration, full monitoring, on-site resuscitation protocols.
All risks are reviewed at consultation and again as part of formal informed consent before surgery is scheduled.
Pricing
Remote anchorage cases are quoted individually at consultation rather than priced from the standard $15,000 per-arch structure used for All-on-4 and All-on-6. Surgical complexity, implant count, and configuration vary substantially case by case.
Typical Range
$25,000–$60,000+
Typical Washington State range · per arch, by configuration
Every patient receives an itemized written treatment plan before any surgical date is scheduled, covering implant configuration, surgical fee, anesthesia, prosthetic fabrication, and follow-up care.
If intraoperative findings require a meaningfully different approach, we stop and discuss before proceeding. There is never a change in price after surgery is underway.
All five financing partners are available. HSA/FSA eligible. Most patients spread the cost across 60–84 months.
Common Questions
Probably yes. Most patients told they aren't candidates were assessed against criteria for conventional or All-on-4 implants, both of which require adequate bone in the maxilla itself. Zygomatic and pterygoid implants change that calculation by anchoring in different bone. The honest answer comes from 3D Cone Beam CT imaging at consultation, not any prior verbal assessment.
Different anchorage sites in different bone. Zygomatic implants (30–55mm) anchor in the cheekbone, providing posterior support when the upper jaw lacks bone for conventional posterior implants. Pterygoid implants (15–24mm) anchor in the dense pterygoid plate at the back of the upper jaw. The two are often used together, the PATZI protocol determines which combination is right for each case.
The surgery is more involved, longer surgical time (typically 3.5+ hours), a larger surgical field, and typically general anesthesia or deep IV sedation. Recovery is somewhat more complex, but most patients report it’s meaningfully easier than the alternative: extensive bone grafting followed by 6–12 months of healing, then a separate implant surgery.
The largest published systematic review reports a 12-year cumulative survival rate of approximately 95%, comparable to conventional implants. Most failures occur within the first six months. Implants that integrate successfully tend to remain stable long-term with appropriate maintenance.
PATZI: Pterygoid, Anterior, Tilted, Zygomatic Implants, is a systematic algorithm published in 2023 that prioritizes traditional implant placement, escalating to remote anchorage only when conventional approaches are inadequate. It matters because it produces, on average, better outcomes than approaches that default to zygomatics for all atrophic cases.
ZAGA: Zygomatic Anatomy-Guided Approach, was developed by Dr. Carlos Aparicio in 2010. It classifies each patient’s anatomy (ZAGA 0–4) to determine the surgical placement path. Compared to the original technique, ZAGA produces comparable survival with significantly lower complication rates, and is the modern standard of care.
The surgical phase is typically completed in a single visit, with same-day provisional teeth. Final zirconia follows the same 10–12 week timeline as conventional full-arch protocols, meaningfully faster than staged grafting, which commonly extends total treatment to 12–18 months.
Two differences. First, we follow the PATZI algorithm: conventional implants are placed when viable, and remote anchorage is used only when actually needed, rather than defaulting to zygomatics. Second, Elite is independently owned, and Dr. Volland plans, performs, and follows up on every case personally.
Dental insurance typically provides limited coverage, usually a small portion attributed to extractions or the prosthesis, capped at $1,000–$3,000 lifetime in most plans. Medical insurance occasionally covers a portion when bone loss results from trauma, cancer treatment, or certain congenital conditions. We help document exactly what your plan covers.
Opening January 2027
Leave your details and we'll reach out as soon as consultations are available. No obligation, no marketing. Just a note when the door opens.
9907 205th Ave E · Bonney Lake, WA 98391
(206) 738-2503
