The use of modified zygomatic implants (Fig. 1) allows improved hygiene by the patient of the implants within the maxillary defect. The threaded portion of the implants is fully engaged into the bone with only the smooth portion protruding into the defect. Clearly this ongoing hygiene by the patient is of utmost importance in preventing peri-implant soft and hard tissue changes, but the implant design here has facilitated that extremely well in this young patient, and no additional professionally directed hygiene measures to maintain excellent peri-implant health have been required to date.

The evidence for loading zygomatic implants immediately is very clear in the literature [11] in a cross-arch manner but not in a unilateral situation as has been utilised in this case. Whilst the stability of the implants achieved at surgery was excellent, it was decided to adopt a delayed loading approach which also gave time for the maxillectomy defect to stabilise prior to the construction of the definitive prosthesis.