The zygoma anatomy-guided approach (ZAGA) for rehabilitation of the atrophic maxilla

Abstract

A protocol to perform a prosthetically driven minimally invasive zygomatic osteotomy, named zygoma anatomy-guided approach (ZAGA) is introduced. The ZAGA method aims at promoting a patient-specific therapy by adapting the osteotomy type to the patient's anatomy. In most cases, this method avoids the opening of a window or slot into the lateral wall of the maxillary sinus before implant placement. Instead, a mucoperiosteal flap, including the posterior maxillary wall and the superior zygomatic rim, is raised to allow visual control of the complete surgical field. The surgical management of the implant site is guided by the anatomy of the patient according to specific prosthetic, bio-mechanic, and anatomic criteria. The ZAGA Concept represents the logical evolution of the extra-sinus technique and ZAGA classification previously described by Aparicio. The results of using the combination of the ZAGA Concept together with the new ZAGA implant designs consistently show less traumatic osteotomy; better implant stability; improved bone to implant contact, and bone sealing around the implant neck. Additionally, the rate of late complications such as oral–sinus communication or soft tissue recession dramatically decreases when compared to the original technique.

Stress Distribution Pattern in Zygomatic Implants Supporting Different Superstructure Materials

“…The rehabilitation of the severe atrophic maxillary could include different techniques that have shown different success and survival rates [ 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. In the present simulation, the modelling considered the zygoma anatomy-guided approach, considering a ZAGA type II with a combined extra- and intra-sinus path with most of the implant body being located extra-sinusally [ 45 ]. However, other conditions could modify the results presented and should be evaluated further [ 45 , 46 , 47 , 48 , 49 ].…”

“…In the present simulation, the modelling considered the zygoma anatomy-guided approach, considering a ZAGA type II with a combined extra- and intra-sinus path with most of the implant body being located extra-sinusally [ 45 ]. However, other conditions could modify the results presented and should be evaluated further [ 45 , 46 , 47 , 48 , 49 ].…”

Survival and complications of zygomatic implants compared to conventional implants reported in longitudinal studies with a follow‐up period of at least 5 years: A systematic review and meta‐analysis

“…Recently, a decision‐making method for the type of osteotomy based on the anatomy of the zygomatic bone called zygoma anatomy‐guided approach (ZAGA) was proposed 63 . This method represents an evolution of the EZI technique.…”

“…Recently, a decision-making method for the type of osteotomy based on the anatomy of the zygomatic bone called zygoma anatomy-guided approach (ZAGA) was proposed. 63 This method represents an evolution of the EZI technique. The surgical management of the implant site is guided by the anatomy of the patient according to specific prosthetic, bio-mechanic, and anatomic criteria.…”

Evaluation of surgical techniques in survival rate and complications of zygomatic implants for the rehabilitation of the atrophic edentulous maxilla: a systematic review

“…When the crestal bone height or thickness is inadequate, the alveolar entrance point should be shifted to the buccal, regardless of the maxillary wall curvature. Based on the maxillary wall concavity and the height of the new bone, the osteotomy is shaped like a tunnel or canal [ 16 , 22 ] …”