Immediate/early loading of zygomatic [8] and dental implants [9] have been well demonstrated already within the literature with very high implant survival rates. In the oncology setting, Boyes-Varley et al. [4] lost no zygomatic/oncology implants in their series of 20 patients restored with implant-retained obturators, 6 of whom received radiotherapy post-operatively. The case reported has been followed up for 18 months so far without evidence of zygomatic implant failure despite the use of radiotherapy. A recent review of conventional zygomatic implant surgery demonstrated that the incidence of failure after the 6-month stage was extremely low [8] although for zygomatic oncology implants, this data is not yet fully reported in the literature with the only data available on zygomatic oncology implants being limited to the work of Boyes-Valey [4], Pellegrino [10] and the authors themselves [6]. The removal of teeth at primary cancer surgery to facilitate placement of implants on the non-defect side requires careful consideration; where teeth are of poor prognosis with poor bone support, it is easier to extract, perform localised osteoplasty prior to the insertion of a conventional zygomatic implant with its inherent excellent stability and ability to be loaded early in the post-operative period. Where teeth have excellent bone support but additional implants are required to facilitate the construction of a fixed prosthesis, then careful extraction of selected teeth with the immediate installation of a root form implant can be utilised with good success as long as high primary stability is achieved at these sites.

Whilst technically, it would be possible to construct and fit the prosthesis on the same day or even a week later, the need for microvascular flap monitoring in the immediate post-operative period, together with the significant recovery period required by the patient following surgery has lead the authors to delay the fitting of the prosthesis at the 4 to 6-week period post-operatively. In terms of ongoing clinical implant follow-up, no attempt was made at peri-implant probing for the oncology zygomatic implants perforating the soft-tissue flap as it was deemed important not to disturb the soft tissue seal of the skin flap around the implant abutments. No discharge or suppuration was noted during follow-up in this case. Periodontal probing around the conventionally placed zygomatic implants was undertaken periodically during follow up and remained within normal limits.

The use of a soft tissue rather than composite reconstruction may also facilitate a shorter hospital stay and allow adjuvant radiotherapy to be delivered in a more rapid timescale with possible impact on overall cure rates of this very debilitating tumour. The initial experiences with this procedure in over ten cases have been extremely positive with excellent appreciation by patients who value being provided with a fixed dental prosthesis so quickly after major surgery.