09 November 2026
Zygomatic Implants vs All-on-4: Which Is Right for Severe Bone Loss?
Written and clinically reviewed by Dr Shi Karim, Principal Dentist, GDC No. 82155. Last reviewed 9 November 2026.
If you’ve lost a lot of bone in your upper jaw, the choice between zygomatic implants and All-on-4 usually comes down to one thing: is there still enough bone at the front and sides of the jaw to hold angled implants securely? If there is, All-on-4 is normally the simpler route. If there isn’t, and you’d rather not go through bone grafting, zygomatic implants anchor into the cheekbone instead. Your CBCT scan, not a brochure, decides which one is realistic for you.
That’s the short version. The rest of this post is the conversation I have with patients who come to us having already been told “you haven’t got enough bone”.
Two different answers to the same problem
When teeth are lost, the bone that held them slowly shrinks. Years of wearing a loose upper denture can speed that up. In the upper jaw there’s a second problem: the sinus sits just above the back teeth, and as bone thins, the space for a normal implant there can disappear altogether.
All-on-4 works around this by placing four implants in the jaw, with the two back ones tilted so they avoid the sinus and use the denser bone further forward. A full arch of fixed teeth is then screwed onto them. It can be done in the upper or lower jaw.
Zygomatic implants are much longer implants that pass from the back of the mouth up into the zygomatic bone (the cheekbone). That bone stays dense even when the jaw beneath it has worn away. They’re usually combined with one or two standard implants at the front, or, where the front bone is also very thin, two zygomatic implants are used on each side. They’re only ever used in the upper jaw.
So this isn’t really a contest. All-on-4 is the first thing we look at for a full upper arch. Zygomatic implants are what we look at when the scan shows All-on-4 can’t be anchored well enough without grafting first.
How they compare
|
All-on-4 |
Zygomatic implants |
| Where the implants anchor |
Your jawbone, back implants angled |
Your cheekbone, often with standard implants at the front |
| Upper or lower jaw |
Either |
Upper only |
| Bone needed |
A reasonable amount at the front of the jaw |
Very little in the jaw itself |
| Bone grafting |
Usually avoided |
Usually avoided, even with severe bone loss |
| Fixed teeth on the day |
Often possible, if the implants are stable enough |
Often possible, for the same reason |
| Surgical complexity |
Lower |
Higher; it’s a more demanding operation with different risks |
What the evidence says about zygomatic implants
I’d rather you heard the trade-offs from me than found them later. The most recent Cochrane review on cheekbone implants compared them with standard implants placed into grafted bone, in people with severe upper-jaw bone loss. Zygomatic implants probably failed less often and got people into fixed teeth far sooner, because there was no long wait for a graft to heal. But they also probably came with more complications, such as sinus problems and irritation of the gum around the implant.
The review is honest that the evidence base is still small. That matches my own view. Zygomatic implants are a very good option for the right person. They’re not something to choose just because they sound more advanced.
When All-on-4 makes more sense
- The scan shows enough bone at the front and sides of the upper jaw to anchor four implants firmly.
- You need a full arch in the lower jaw. Zygomatic implants don’t apply there.
- You’d prefer the smaller operation, with fewer things that can go wrong, where it’s a genuine option.
Most people who ask me about zygomatic implants turn out to be suitable for All-on-4 once we’ve looked properly. Bone loss on a flat X-ray often looks worse than it is in three dimensions.
When zygomatic implants are worth considering
- You’ve been told elsewhere you need a sinus lift or a large bone graft before any implants can go in.
- You’ve worn an upper denture for many years and the ridge it sits on has largely flattened.
- Previous implants or grafts in the upper jaw have failed.
- You don’t want to wait many months, often over a year, for grafting to heal before you get fixed teeth.
They’re not for everyone. Uncontrolled diabetes, heavy smoking, active sinus disease and some medications all change the picture, and sometimes a graft followed by standard implants, or a well-made implant-retained denture, is the better plan. Doing nothing is also a legitimate choice, and we’ll talk through what that means for your bone and your current denture.
How we decide here
Everyone starts with a free consultation with one of our treatment coordinators. It’s a chance to talk about what’s bothering you, how your current teeth or denture are working, and what you’d like to end up with. Nobody expects you to know which technique you need.
If implants look possible, the next step is a CBCT scan, a 3D X-ray that shows the height, width and density of bone, plus exactly where the sinus and nerves sit. We pair it with a digital scan of your mouth from our 3D scanner. With both, we can plan where each implant would go and see straight away whether All-on-4 positions are workable or whether we’d need the cheekbone.
We make our surgical guides on site, so the plan on screen is transferred to the operation precisely. We also place zygomatic implants in-house, which means you aren’t referred elsewhere halfway through and your planning, surgery and follow-up all happen with the same team. Sedation is available, and most people having full-arch surgery choose it. You can read more about that on our sedation page.
The question I ask myself at the planning stage is simple: what’s the least complicated treatment that will give this person a stable, fixed set of teeth that lasts? Sometimes that’s All-on-4. Sometimes it’s zygomatic implants. Occasionally it’s grafting first. I’d rather explain why than just hand you a plan.
Questions patients ask me
Will I leave with teeth on the same day?
Often, yes, with either approach. It depends on how firmly the implants hold when they go in. If they’re stable enough, we fit a fixed temporary bridge on the day and the final bridge once everything has healed. If they aren’t, we’d rather wait than risk the implants.
Is zygomatic surgery a bigger recovery?
Usually there’s more swelling and bruising around the cheeks for the first week or so, because the implants reach further. We’ll go through aftercare, diet and what’s normal before your surgery date, not after.
I was told I’m not suitable for implants at all. Is it worth getting another opinion?
It’s worth having a 3D scan if your previous assessment was based only on a standard X-ray. That isn’t a promise the answer will change. Sometimes the scan confirms the original advice.
Is there a guarantee?
We offer a 5-year guarantee on implant placement. We’ll explain what it covers at your consultation.
Next step
If you’re weighing this up, start with our pages on zygomatic implant treatment and All-on-4 full-arch implants, or our post on whether you’ll need a bone graft. Interest-free finance is available on implant treatment, and we hold monthly Implant Open Days, where you can save £680.
When you come in, bring any X-rays or scans you’ve had from other dentists, and a list of the medications you take. They make that first planning conversation far more useful. We’re right next to Cheadle Hulme station, about 15 minutes by train from Manchester city centre.
Cheadle Hulme Dental is a wholly private dental practice at 20A Station Road, Cheadle Hulme, SK8 7AB, with over 1,500 reviews from our patients. Principal Dentist: Dr Shi Karim, GDC 82155. All treatment depends on a clinical assessment, and results vary between patients. To book: contact us or call 0161 486 0743.
