Dr. Carlos Aparicio, President and Founder ZAGA Centers Network
Episode summary
Dr. Carlos Aparicio, founder and President of the ZAGA Centers Network and originator of the ZAGA (Zygoma Anatomy-Guided Approach) concept, explains the origins and rationale of zygomatic implant rehabilitation for the atrophic maxilla. Aparicio clarifies that ZAGA is a patient-specific classification and holistic concept rather than a single technique: because every patient's anatomy differs, the implant trajectory and surgical approach must be individualized. He describes the ZAGA 0 to 4 classification based on remaining alveolar bone, arguing that surgeons should preserve residual bone before performing irreversible drilling to protect the soft tissue and prevent long-term oral-antral communication. He introduces the zygomatic implant critical zone, the value of threaded and flat Straumann ZAGA implants, channel osteotomy, and separating the anthrostomy from the critical zone. Aparicio recounts his 1980s training under Per-Ingvar Branemark and increasingly favors the quad zygoma in doubtful cases.
Key takeaways
- ZAGA (Zygoma Anatomy-Guided Approach) is a classification and holistic concept, not a single surgical technique; because every patient's anatomy is different, the implant path must be adapted to each patient's individual anatomy.
- The ZAGA classification runs from ZAGA 0 (adequate residual alveolar bone allowing an intrasinus osteotomy through the bone) through ZAGA 4 (only 1-2 mm of bone, requiring the osteotomy to shift to the buccal side).
- Before performing an irreversible act such as drilling or cutting, the surgeon should study the specific anatomy at each site; preserving even a small triangular remnant of alveolar bone (as in ZAGA 3) provides attachment for soft tissue fibers and helps prevent oral-antral communication.
- The zygomatic implant critical zone is the assembly of bone, implant, and soft tissue where the implant first meets the alveolar bone; in ZAGA 4 cases the anthrostomy (entry into the antrum) should be separated as far as possible from the critical zone to reduce contamination risk.
- Aparicio prioritizes preventing oral-antral communication over soft tissue complications because more resources exist to manage soft tissue, including the flat Straumann ZAGA implant surface, channel osteotomy that sinks the implant, the ZAGA roll flap, and connective tissue grafts.
- Threaded, fully stabilized implants induce secondary stability and osseointegration, allowing preservation of even minimal critical-zone bone rather than relying only on a soft tissue seal.
- When in doubt about whether a regular implant can be placed anteriorly (less than about 5 mm of bone), Aparicio increasingly favors the quad zygoma, having experienced more failures with regular implants than with zygomatic implants in hybrid configurations.
What you'll learn
- The history and evolution of zygomatic implants
- How the ZAGA (Zygoma Anatomy-Guided Approach) concept was born
- The ZAGA classification of maxillary anatomy
- Attaining long-term success and longevity
- The ZAGA Centers network and the future of implantology
About the guest
Dr. Carlos Aparicio
Dr. Carlos Aparicio is the founder and President of the Zygoma ZAGA Centers Network and the originator of the ZAGA (Zygoma Anatomy-Guided Approach) concept, which individualizes zygomatic implant placement to each patient's anatomy and underpins the ZAGA classification of maxillary anatomy. Based in Barcelona, Spain, he holds an MD (University of Navarra) and DDS (University of Barcelona) with a PhD in Medicine (Summa Cum Laude) and postgraduate diplomas in implant dentistry and periodontics from the University of Gothenburg. He authored the textbook 'Zygomatic Implants: The Anatomy-Guided Approach (ZAGA)' (2012), edited 'Advanced Zygomatic Implants: The ZAGA Concept' (2023), and co-developed the Straumann ZAGA implant system. He is a Fellow of the Royal Society of Medicine (England) and a past President of the Osseointegration Foundation.
Credentials: MD (University of Navarra, Summa Cum Laude); DDS (University of Barcelona); MSc Materials Science; MSc Biomedical Research; PhD in Medicine (Summa Cum Laude, International Mention); Diploma in Implant Dentistry and Diploma in Periodontics (University of Gothenburg); Fellow, Royal Society of Medicine
apariciozygomatic.com · LinkedIn · ResearchGate · ZAGA profile
