The Straumann ZAGA Flat and ZAGA Round zygomatic implants: The story of a breakthrough

For any oral surgeon actively placing zygomatic implants, the recent launch of the Straumann zygomatic implant system is well-known. This article dives into the genesis of this innovation, from design to manufacturing, up until reaching the patients. With two different implant designs: ZAGA Flat and ZAGA Round and many unique features, this system clearly stands as a breakthrough for the growing field of zygomatic implant rehabilitation. The invention, design, industrial technology transfer, and in fine commercialization is a text-book story from start to finish.

The clinical pain points to solve

Born from the clinical requirements of the end-user in mind, this zygomatic implant systems aims at solving specific pain points of the oral surgeons:

  • The eventual lack of volume in the zygomatic bone, especially when performing quad surgeries
  • The steric problem of implant transporters usually breaking the bony crest, so valuable for soft tissue maintenance.
  • The interference of wide implant transporters with anterior hard bone or another implant in a compromised maxilla.
  • The lack of strong primary stability in the zygoma area
  • The difficulty for soft tissue anchoring at the crest level
  • The high tension of the soft tissue when placing the implant extra-maxillary in ZAGA Types 2 and 4
  • The bacterial adhesion to implant rough surfaces
Dr. Aparicio at the ZAGA Course 2020, Barcelona

ZAGA and Implant Design

ZAGA, the acronym for Zygoma Anatomy-Guided Approach, described by Dr. Carlos Aparicio, is the concept used to place zygomatic implants in a prosthetically driven manner and according to the anatomy of the patient. Clearly, the zygomatic implant systems back in the ending of the last century and in the first decade of the current one needed to further adapt to the patient’s anatomy and to the current surgical requirements. Adapting the implant design to the anatomy of each patient is critical to reaching clinical success and patient satisfaction, or should we say happiness with a new smile, free of complications. Indeed, if we were to summarize all aforementioned late pitfalls, they would fall into one of the two following categories: soft tissue complications and rhinosinusitis complications. The use of the ZAGA technique, as well as the design of the ZAGA Flat and ZAGA Round zygomatic implants, aim, since day 1, at preventing these complications.

A design becoming a reality

A thorough global professional journey around the world led Dr. Aparicio from his drawing on a desk to the industrial technology transfer of the ZAGA designs by the hand of Graham Blackbeard CEO at  Southern Implants. Originally as five different models, a set of two were selected to best solve the clinical limitations of zygomatic implants and adapt to all ZAGA classifications; but also to connect to the industrial reality. Creating and enjoying a tight, professional relationship with Southern Implants around this innovative initiative, the ZAGA Zygomatic implants came to light.

Dr. Aparicio during the process of implant design validation
Patent figures of the ZAGA Zygomatic Implant

Along with patent protection (https://uspto.report/patent/app/20190254781) for the most innovative features of the implants, the portfolio also includes aspects already proven to be appreciated by the oral surgeons. The final design then includes:

  • A narrower 3,4 mm apex diameter. This is possible as implants are fabricated with special cold-worked Grade 4 titanium, shown in bench experiments to increase fatigue strength.
  • A rough tapered apex portion to enhance primary stability and match the minimally invasive ZAGA osteotomies
  • A turned machined implant body and head to prevent bacterial adhesion
  • A 55º angle correction on the implant platform optimizing prosthetic versatility
  • A model with a flat mid-portion section to reduce soft tissue tension when placed extra maxillary
  • A model with a round mid-portion section to fit a tunnel type osteotomy when placed intra-sinus
  • A transporter with the same outer diameter as the implant to ease implant placement and preserve the bone crest.
Tapered apex evolution
Apex design iterations

Validation and Peer-reviewed scientific publications

The technical, scientific, and clinical validation of both designs is positioning them as reference tools for the treatment of severe maxillary atrophy. Thin, resistant, adapted to the anatomy of the patients, the two ZAGA zygomatic implants made their way to the market stopping by a round table meeting with Southern Implants, ZAGA Centers, and Straumann. All interested in providing this next-generation implant to the dental universe, this extraordinary encounter led to the beginning of a fruitful, impactful collaboration between three stakeholders of the dental industry. Focusing on providing a safe and predictable way to help patients with severe maxillary atrophy recover a fixed denture without complications, after an extended period of pre-clinical and clinical trials, the collaboration led to the official launch of the new Straumann zygomatic implant system in October 2020.

Straumann ZAGA Round (Top) and ZAGA Flat (Bottom) zygomatic implants with mounted transporter
Dr Carlos Aparicio Overview of The Straumann ZAGA Flat and Round Implants

Already published and mentioned in several peer-reviewed scientific publications, the Straumann zygomatic implant system composed of the ZAGA Flat and ZAGA Round models represents a breakthrough in product design and a definite answer for the product-need fit in the field of zygomatic implant rehabilitation:

  • Aparicio C, Polido W D, Chow J, David L, Davó R, De Moraes E J, Fibishenko A, Ando M, Mclellan G, Nicolopoulos C, Pikos M A, Zarrinkelk H, Balshi T, Peñarrocha M. Identification of the pathway and appropriate use of four zygomatic implants in the atrophic maxilla: a cross-sectional study Int J Oral Maxillofac Implants 2021 (Accepted)
  • Aparicio C, López-Piriz R, Albrektsson T. ORIS criteria of success for the zygoma related rehabilitation: the (revisited) zygoma success code. Int J Oral Maxillofac Implants 2020;35:366-378.
  • Aparicio C, López-Piriz R, Peñarrocha M. Preoperative evaluation and treatment planning. Zygomatic implant critical zone (ZICZ) location. In: Atlas of the Oral and Maxillofacial Surgery Clinics on Zygomatic Implants. Salman S, and Quimby A Eds. Elsevier 2021 (in press).
  • Aparicio C, Polido W D, Zarrinkelk H M. The ZAGA Concept for placement of zygomatic implants. In: Atlas of the Oral and Maxillofacial Surgery Clinics on Zygomatic Implants. Salam  Salman and Anastasiya Quimby  Eds. Elsevier 2021 (in press).
  • Aparicio C, Dawood A, Ucer C.  Zygomatic implants The ZAGA Concept. In: Implants and Oral Rehabilitation of the Atrophic Maxilla Advanced Techniques and Technologies. Marco Rinaldi Ed. Springer Nature 2021 (in preparation)
  • Case Report: https://www.straumann.com/en/discover/youtooth/article/edentulous/2020/aparicio-carlos-zaga-concept-minimally-invasive-canal-osteotomy-combined-use-straumann-zygomatic-zaga-flat-implant.html
Fixture mount with identical outside diameter as the implant head

Backed by its scientific approach and building on its legacy of innovation, Straumann now takes immediacy to the next level of reliability and efficiency.  With the ZAGA Round and ZAGA Flat zygomatic implants, Straumann completes a full portfolio of solutions that are designed to enable dental professionals to face immediate solutions for even the most challenging maxillary atrophy with scientific support and validation. Aiming for a comprehensive partnership, Straumann is progressively launching the ZAGA Round and ZAGA Flat zygomatic implants, providing the health professionals with a sophisticated engineered design and a full educative calendar. Continuing on a fruitful collaboration, Straumann and ZAGA Centers work hand in hand to keep providing education, training, and knowledge focusing on zygomatic implants. Precisely, the correct use and indication for zygomatic implant rehabilitation along with several ways to prevent long-term complications represent the main objectives. Zygomatic implants are often used in combination with regular implants when bone is available anteriorly. The ZAGA-Straumann collaboration has an even broader synergy when evaluating the high quality of the recently released BLT and BLT portfolio of implants by Straumann.

ZAGA Centers aims at enhancing, even more, the safety, reliability, and predictability of zygomatic implant rehabilitation by centralizing the experience in the hands of selected, audited certified centers, the ZAGA Centers. ZAGA Centers is a network of experienced professionals in the field of zygomatic implant rehabilitations. The members work in a patient-centric way surgically personalizing the treatment to each patient and selecting implants according to the patient´s anatomic characteristics and necessities.  Providing patients with best-in-class treatments is the reason why all professionals wake up every morning and the fuel to the hard work invested in zygomatic implant rehabilitations.

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