For patients told they’re not candidates for dental implants.
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 board-certified oral and maxillofacial surgeon Dr. Jonathan Volland.
What happens when there isn’t enough bone.
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.
The old answer: grafting.
The result: “not a candidate.”
The new answer: remote anchorage.
Where remote anchorage implants are placed.
The maxillofacial skeleton contains several regions of dense bone that can support implants when the maxilla itself cannot. Each has specific clinical applications.
Zygomatic Implants
Pterygoid Implants
Trans-Nasal Implants
Anterior & Tilted Conventional
Who arrives at our consultation room.
The patient seeking remote anchorage care has typically already done significant research. Three profiles are particularly common.
The “not a candidate” patient.
The previous-implant-failure patient.
The “no grafting” patient.
You may be a candidate, even if you’ve been told you aren’t.
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.
Common reasons patients reach this page
The algorithm for severely atrophic maxillae.
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.
Pterygoid
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.
Anterior
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.
Tilted
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.
Zygomatic
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.
Implants
The completed configuration, whichever subset of the four placement types provides adequate support for one fixed prosthesis. Determined intraoperatively, case by case.
Zygomatic placement, guided by your anatomy.
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
Original Technique
Requires opening a window into the maxillary sinus and elevating the membrane, effective, but with higher complication rates.
ZAGA Approach
Comparable long-term implant survival to the original technique, with significantly lower complication rates.
What the peer-reviewed research shows.
Zygomatic implants have been studied longitudinally for over two decades. The modern systematic reviews aggregate data from thousands of implants across dozens of studies.
Calm, careful, and clear, every time.
The complication profile, honestly disclosed.
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.
How remote anchorage cases are priced.
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.
Written quote at consultation.
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.
The quote is final.
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.
Financing options apply.
All five financing partners are available. HSA/FSA eligible. Most patients spread the cost across 60–84 months.
Answers, before you ask.
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.
Your complimentary remote anchorage consultation.
3D Cone Beam imaging. A direct conversation with Dr. Volland about whether remote anchorage is the right answer for your case. A written treatment plan with itemized pricing. No obligation, no referral required.