The first-ever consensus on Zygomatic Implant Protocol published by the Network of ZAGA Centers

The result of months of collaborative work was published in the International Journal of Oral Implantology (Aparicio C, Pastorino D. A modified Delphi consensus for rehabilitations anchored to zygomatic implants. Int J Oral Implantol (Berl). 2023 Sep 28;16(3):225-242. PMID: 37767617), the first consensus on Zygomatic Implants, marking a significant milestone for the ZAGA Centers Network and the clinical community around zygomatic implant rehabilitation.

The consensus was created using a modified Delphi method, where a series of open and close-ended questions are shared with a group of experts. In this case, 63 experts took part in this collaborative process and answered a total of 94 questions in 6 different categories: Diagnostic and Indications, Planning, Medication, Surgery, Prosthesis, and Follow-up.

All members were part of the international network of ZAGA Centers, and shared their expertise to create this first-ever consensus to share the outcome with the clinical community.

group of doctors from the zaga centers network
Forty eigth surgeons from the ZAGA Network participate in this protocol

The Genesis of the First Protocol for Zygomatic Implants

While various studies have reported high success rates with zygomatic implants (Solà Pérez A, Pastorino D, Aparicio C, Pegueroles Neyra M, Khan RS, Wright S, Ucer C. Success Rates of Zygomatic Implants for the Rehabilitation of Severely Atrophic Maxilla: A Systematic Review. Dent J (Basel). 2022 Aug 12;10(8):151. doi: 10.3390/dj10080151. PMID: 36005249; PMCID: PMC9406716.), findings still outline complications that can appear over time. The need for a harmonized protocol was detected to allow further research to be more productive and international.

Recognizing the absence of a universally accepted protocol for zygomatic implant procedures, the members of the ZAGA Centers Network decided to create a consensus protocol. This would serve as a guideline for both practitioners and researchers focusing on zygomatic implant-anchored restorations, as well as a basis for further progress in this field.

The Delphi Method and its modification

The Delphi method, an expert consensus technique, has been widely used in various medical disciplines to establish best practices and treatment guidelines. By gathering a panel of experts and conducting several rounds of questioning, the process aims to reach an agreement on a specific subject. The modified Delphi technique referenced in the study integrates iterative rounds with controlled feedback and statistical analysis of group response, which ensures a more refined and accurate consensus.

chart delphi agreement
Percentage of agreement per section, calculated as the percentage of topics on
which a consensus was reached versus the total number of topics per section.
Following the modified Delphi process, participants remained anonymous to avoid any influence from “professionally established” participants. Additionally, experts could leave comments anonymously in the dedicated space; this helped to reformulate questions in the second round.

Study outcomes

Utilizing the modified Delphi method, this study successfully established the first consensus protocol for oral restorations using zygomatic implants.

Of the 63 experts approached, 48 actively participated in both survey rounds. To achieve consensus, an agreement rate of at least 70% was required. The study reached a consensus on 71% of the presented topics.

This protocol marks a landmark in implant dentistry. Synthesizing expert opinions and the latest research provides a clear pathway for dental professionals to offer their patients the best possible care. As dentistry continues to advance, studies like these ensure we are moving towards safer, more effective, and more patient-centered care.

chart about the zygomatic implant planning
The outcome of the modified Delphi process regarding the planning
tools and processes for zygomatic implant rehabilitations.

Why is this study important?

Zygomatic implants represent a significant breakthrough for patients who are not candidates for traditional implants due to severe maxillary atrophy. By establishing a consensus on best practices, this study enhances patient safety by advocating for evidence-based practices and safety checklists, ensuring that patients receive the safest and most effective care. Additionally, the presence of a consensus allows dental professionals to embrace a more standardized method for zygomatic implant treatments, resulting in more consistent outcomes. Notably, the study underscores patient-centered risk assessment, ensuring that individual patient requirements are always prioritized in the care process.

Download the study here.