Dr. Rafal Zielinski - "The Zygomatic Anatomy-Guided Approach, Zygomatic Orbital Floor Classification, and ORIS Criteria-A 10-Year Follow-Up"
Episode summary
In this ZAGA Centers Podcast episode, Dr. Rafal Zielinski, a Polish clinician-researcher and CEO of Welldent (a Central and Eastern European manufacturer of subperiosteal implants), discusses his 2023 Journal of Clinical Medicine (MDPI) publication 'The Zygomatic Anatomy-Guided Approach, Zygomatic Orbital Floor Classification, and ORIS Criteria - A 10-Year Follow-Up.' The study evaluated 81 patients treated with zygomatic implant variations (hybrids, quads, pre-ZYGOMA) and linked the ZAGA classification, a newly proposed Zygomatic Orbital Floor classification, and the ORIS success criteria to patient anatomy and outcomes. Zielinski found ZAGA classification was not significantly affected by gender, side, or age. His central message is that surgeons must classify the orbital floor depth during CBCT planning to avoid orbital floor perforation, one of the most severe complications of zygomatic implant surgery.
Key takeaways
- Dr. Rafal Zielinski's 2023 study, published in the Journal of Clinical Medicine (MDPI), evaluated 81 patients who underwent zygomatic implant procedures across variations including hybrids, quads, and pre-ZYGOMA configurations.
- The study introduced a new Zygomatic Orbital Floor classification with four levels, ranging from class one (flat orbital floor) to class four (extremely deep, more than 10 millimeters), to help surgeons avoid orbital floor perforation.
- The study linked three frameworks - the ZAGA classification, the new Zygomatic Orbital Floor classification, and the ORIS success criteria - to patient anatomy and to whether implants were placed intra- or extra-sinusly and intra- or extra-maxillary.
- ZAGA classification showed no significant differences by gender, by right versus left side, or by age across the 81 patients, indicating maxillary wall concavity does not depend on these factors.
- The ORIS criteria assess zygomatic implant follow-up across prosthodontic offset, rhinosinusitis, peri-implantitis, and implant stability, and every implant in every patient was individually examined and tabulated.
- Orbital floor perforation is a major risk: Zielinski recounted a quad zygoma osteotomy where the drill felt loose too early and returned with orbital fat, though no symptoms followed.
- Zielinski recommends surgeons place implants using the Stella (slot/window) method to preserve the alveolar crest, and warns against palatal emergence of the implant head, which can cause speech impediments and poorly designed prostheses.
What you'll learn
- The ZAGA anatomy-guided approach in long-term practice
- Zygomatic Orbital Floor (ZOF) classification
- ORIS success criteria for zygomatic implants
- 10-year clinical outcomes and survival
- Evidence for individualised, anatomy-driven placement
About the guest
Dr. Rafal Zielinski
Dr. Rafal Zielinski is a Polish clinician-researcher in maxillofacial surgery affiliated with the Department of Maxillofacial Surgery at the Medical University of Lodz and the Stomatologia na Ksiezym Mlynie clinic in Lodz, Poland. His research focuses on zygomatic implants, the ZAGA classification, and success criteria for treating severe maxillary atrophy.
