A Milestone in Dental Implantology: Extrasinusal Approach
This year marks the 20th anniversary of a groundbreaking milestone in the field of implantology: the first global presentation of the results obtained from placing zygomatic implants with an externalized trajectory along the maxillary wall. This innovative technique was introduced in 2005 by the team of Clínica Aparicio, led by Drs. Wafaa Ouazzani, Stefan Lundgren, Lars Sennerby and Carlos Aparicio, at the biannual EuroPerio conference in Madrid. The results, based on one year of clinical experience, were later published in 2006 in the International Journal of Clinical Periodontology (1).
This advancement signified a major shift from the original surgical technique (OST) pioneered by Professor P.I. Brånemark. After years of strict adherence to OST, it became evident that modifications were necessary to overcome common challenges such as sinus infections and bulky prosthetics. The introduction of the externalized placement of zygomatic implants represented the first step in adapting the surgical approach to better align with the patient’s individual anatomy, setting the foundation for the future of the ZAGA Concept.
A Global Breakthrough
Interestingly, similar findings were independently observed by Dr. Migliorança’s team in Brazil. This simultaneous recognition of the need to tailor treatment to the patient’s anatomy to improve outcomes in zygomatic rehabilitation reinforced the technique’s universal applicability and necessity.
The externalized pathway technique played a crucial role in reducing the possible complications and expanding the horizon of treatment options for patients with severe maxillary atrophy. Before this innovation, zygomatic implants were already a solution for patients who lacked sufficient bone volume for traditional implants, but the modification of the trajectory significantly improved outcomes and reduced sinus and prosthetic-related complications.
The Foundation of the ZAGA Concept
The three-year extra-maxillary placement prospective study, e-published in 2008 in Clinical Implant Dentistry and Related Research (2), marked the inception of what we now recognize as the Zygoma Anatomy-Guided Approach (ZAGA). This approach classifies patients into five categories (ZAGA 0 to ZAGA 4) based on the anatomy of the zygomatic buttress–alveolar crest complex. This classification allows for a personalized surgical approach, minimizing potential complications such as:
- Soft tissue dehiscence
- Sinusitis
- Bulky prosthesis
By tailoring implant placement techniques to the specific anatomical features of each patient, the ZAGA Concept has helped refine best practices in zygomatic implantology, ensuring higher long-term success rates and improved patient comfort.
The Significance of the ZAGA Approach
Unlike traditional techniques that apply a standardized method to all cases, the ZAGA approach prioritizes patient-specific solutions. This means:
- Enhanced predictability: By adapting the technique to each patient’s anatomy, the risk of post-surgical complications is significantly reduced.
- Increased comfort and aesthetics: Since soft tissue adaptation is taken into account, patients experience better healing and more natural-looking prosthetic results.
- Long-term success: The ZAGA methodology helps preserve surrounding structures, ensuring durability and stability over time.
Two Decades of Transforming Lives
Over the past 20 years, the ZAGA Concept has continued to evolve, playing a pivotal role in modern zygomatic implantology. Its widespread adoption has allowed patients who were previously considered untreatable to regain full dental function and aesthetics through a minimally invasive approach.
As part of the ongoing evolution of the ZAGA Concept, the introduction of ZAGA™ Round and ZAGA™ Flat implants—developed in collaboration with Straumann—has further refined the personalization of zygomatic implant placement. These two designs offer surgeons the flexibility to adapt the implant body to the specific anatomical class of each patient, according to the ZAGA classification (from ZAGA 0 to ZAGA 4). This differentiation helps minimize complications such as sinusitis or soft tissue dehiscence by tailoring the implant shape and trajectory to the patient’s maxillary structure.
Expanding the Reach of ZAGA Centers Network
The success of the ZAGA methodology has led to the development of a global network of specialized clinics known as ZAGA Centers. These centers ensure that patients worldwide can benefit from:
- Highly trained professionals specializing in zygomatic implants worldwide
- State-of-the-art surgical techniques and technology
- A patient-centered approach focused on long-term results
By fostering collaboration among implantologists, researchers, and specialists, ZAGA Centers continue to drive innovation in the field of implant dentistry, ensuring that cutting-edge solutions are accessible to patients everywhere.
Looking Ahead: The Future of Zygomatic Implantology
As we celebrate this 20-year milestone, we also look to the future of zygomatic rehabilitation. The continued advancement of digital planning, guided surgery, and 3D printing promises to further enhance precision and patient outcomes.
The ZAGA Concept has set a new gold standard in zygomatic implant placement, and ongoing research will continue to refine the approach, pushing the boundaries of what’s possible in full-arch rehabilitation. It marked the transition from a rigid, one-size-fits-all technique to a personalized, anatomy-guided approach.
At ZAGA Centers, we are proud to honor this legacy and remain committed to advancing patient-centered solutions that transform lives, reaffirming our dedication to innovation, education, and excellence in zygomatic implantology.
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Together, we continue to shape the future of dental implantology!
June 5th– 7th, 2025
In line with the ongoing scientific development of the ZAGA Concept and its clinical applications, the next major international milestone will be Edentulism 2025, held from June 5th to 7th, 2025, in Barcelona, Spain. Recognized as the world’s foremost conference dedicated to full-arch rehabilitation and the treatment of edentulous patients, this event will bring together renowned experts in the field of implantology, including Prof. Tomas Albrektsson, Dr. Carlos Aparicio, Dr. Taras Yurov, and many others.
Preceded by a special edition of the ZAGA Course (June 2–4)—including both theoretical sessions and hands-on training—this unique week-long event provides a comprehensive update on current surgical protocols, evidence-based advancements, and real-world applications of zygomatic, pterygoid, and transnasal implants.
Beyond its scientific depth, Edentulism 2025 offers an exceptional opportunity for networking with leading clinicians, researchers, and pioneers in the field, fostering collaboration and idea exchange at the highest level of contemporary implant dentistry.
