Dr. Eduardo Nicolaievsky, ZAGA Center Miami, FL, USA
Episode summary
In this ZAGA Centers Podcast interview, Dr. Eduardo Nicolaievsky, an oral and maxillofacial surgeon and lead surgeon at ZAGA Center Miami, explains how the ZAGA concept reshaped his approach to severe maxillary atrophy. He had abandoned zygomatic implants for years after early prosthetic disappointments, then returned after meeting Dr. Carlos Aparicio. He treats the ZAGA concept as a diagnostic philosophy rather than a placement technique: every full-arch patient receives a cephalometric CBCT from the first consultation to assess the zygomas and paranasal sinuses. His prosthetically driven digital workflow combines facial and intraoral scans, navigation, a printed 3D model for surgical rehearsal, and STL-based tooth design so patients approve the aesthetic result before surgery. He details sedation and same-day or next-day loading protocols, stresses the need for surgical training and an ENT partner, and reports that essentially all his patients leave with teeth.
Key takeaways
- The ZAGA concept is a diagnostic philosophy and case approach, not merely a method of placing zygomatic implants.
- Dr. Nicolaievsky orders a cephalometric CBCT from the first consultation to visualize the zygomas and the health of the paranasal sinuses.
- The choice between grafting and a graftless zygomatic approach depends on the patient's medical condition, predictability, prosthetic needs, and willingness to spend years in treatment.
- His workflow prints a 3D model (from the ZAGA Center) to rehearse the surgery in vitro and superimposes the STL tooth design onto the CBCT so the patient approves the final aesthetics before surgery; he does not operate before six weeks of planning.
- A single-arch maxillary zygomatic case typically takes about two to three hours under local anesthesia and IV sedation with a nurse anesthetist, using sterile technique and a full armamentarium of retractors, dissectors, and multiple implant sizes.
- Loading is done same-day or next-day using PICC/photogrammetry digital impressions or an STL-guided provisional.
- Safe zygomatic practice requires surgical training, knowledge of the anatomy and complications, mentoring, and an ENT partner to manage the paranasal sinuses; surgeons should refer cases beyond their competence.
What you'll learn
- How to decide between bone/block grafting and a graftless zygomatic approach in severe maxillary atrophy
- Why the ZAGA concept is a diagnostic philosophy, not just an implant-placement technique
- A full digital workflow: CBCT, facial scan superimposition, intraoral scan, navigation, and a printed 3D model for in-vitro surgery rehearsal
- Prosthetically driven planning: superimposing the STL tooth design onto the CBCT so the patient approves the aesthetic result before surgery
- Sedation, loading protocols (same-day or next-day PICC/photogrammetry), and the armamentarium required for safe zygomatic surgery
- Building trust with previously failed, distrustful patients and why an ENT partner is essential for managing the paranasal sinuses
About the guest
Dr. Eduardo Nicolaievsky
Dr. Eduardo Nicolaievsky is a board-certified oral and maxillofacial surgeon who limits his practice to surgery, including implant reconstruction, orthognathic surgery, pathology, and trauma, in Miami, Florida. He is the lead surgeon at ZAGA Center Miami (Blum-Nico Oral Surgery Associates), a member of the ZAGA Network since March 2022. His work with zygomatic implants spans more than 20 years; after an early disappointment with the palate-emerging prosthetics of the only system then available, he returned to the field after meeting Dr. Carlos Aparicio and adopting the ZAGA concept.
Credentials: Oral & Maxillofacial Surgeon; Fellow of the American Association of Oral & Maxillofacial Surgery; Diplomate of the American Board of Oral & Maxillofacial Surgery; Visiting Professor, University of Miami School of Medicine; Chief of the Oral and Maxillofacial division, Mt. Sinai Hospital, Miami Beach; lead surgeon, ZAGA Center Miami
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