Dr. Safa Tahmasebi - “To Zygoma or Not to Zygoma? A Modern Approach to Severe Atrophy”

Episode summary

In this ZAGA Centers Podcast episode, surgical prosthodontist Dr. Safa Tahmasebi previews his Edentulism 2025 session, “To Zygoma or Not to Zygoma? A Modern Approach to Severe Atrophy.” Though experienced in advanced surgery, Tahmasebi warns that clinicians increasingly rush into zygomatic implant fixation when conservative, reversible options remain viable. He notes that the maxilla and mandible resorb continuously after tooth loss, so reserving zygomatic fixation for when patients truly need it preserves options for younger patients. He describes preparing soft tissue by edentulating terminal dentitions before zygomatic surgery, and details an atrophic-mandible case treated with two short buccal-shelf implants and four intraforaminal implants rather than a subperiosteal frame. He champions repeatable, teachable protocols like the ZAGA Concept and disciplined treatment planning, and closes reflecting on the psychological transformation of rehabilitated patients.

Key takeaways

Dr. Safa Tahmasebi is a surgical prosthodontist in Jacksonville, Florida whose practice is roughly 70% surgical and 30% prosthetic, concentrated on the atrophic maxilla.
The maxilla and mandible resorb continuously after tooth loss because the body removes bone once the periodontal ligaments are gone, so cases can look different 10 to 30 years after completion.
Tahmasebi advocates reserving zygomatic implant fixation, which he calls a 'grand surgery,' for patients who truly need it, especially younger patients who can be managed conservatively first.
Good soft tissue around the head of the zygoma is a key criterion for zygomatic implant success, so edentulating terminal dentitions and letting tissue heal before surgery can improve outcomes.
The ZAGA Concept fixtures designed by Dr. Carlos Aparicio help avoid the two common zygomatic complications: sinusitis/recurrent sinusitis and soft-tissue dehiscence.
Tahmasebi treated a severely atrophic mandible (about 7 mm vertical, 8.5 mm horizontal in the premolar-molar area) with two 3.5 x 4 mm short implants tilted palatally at the buccal shelf plus four 2.9 mm intraforaminal implants, avoiding a subperiosteal frame.
He defines a protocol as something repeatable, reproducible, and teachable, and considers the ZAGA Concept a protocol that yields repeatable results.

What you'll learn

When to defer zygomatic implant fixation in favor of conservative, reversible treatment
Why continued bone resorption over decades reshapes cases years after completion
Preparing soft tissue before zygomatic surgery by edentulating and healing terminal dentitions
Treating an atrophic mandible with short buccal-shelf and intraforaminal implants instead of a subperiosteal frame
Building a repeatable, reproducible, teachable protocol and rigorous pre-surgical planning

About the guest