Dr. Jan Peter Ilg & Dr. André Sakima - "Dealing with the Smile Line in Full Mouth Reconstructions"
Episode summary
In this ZAGA Centers Podcast episode, ZAGA Center Sao Paulo surgeons Dr. Jan Peter Ilg and Dr. Andre Sakima Serrano preview their Edentulism 2025 session on managing the smile line in full-mouth reconstructions. They address severely atrophic maxillae in which a large sinus sits on the ridge and the transition between prosthetics and gum becomes visible posteriorly, a form of combination syndrome first described by Kelly in the 1970s. Sakima developed a sub-sinus technique that elevates the sinus membrane without grafting by approaching from the ridge, leaving a closed box-shaped defect and positioning the zygomatic implant platform vertically upward. A trapped blood clot then regenerates bone, confirmed by six-month CT scans and a six-year follow-up. They estimate 30 to 40 percent of zygomatic patients benefit, and the method extends across ZAGA 1 to 4 cases.
Key takeaways
- Dr. Jan Peter Ilg and Dr. Andre Sakima Serrano are oral and maxillofacial surgeons at ZAGA Center Sao Paulo, part of the ZAGA network since 2020.
- A visible posterior smile line in atrophic maxillae with a large sinus on the ridge reflects combination syndrome, first described by Kelly in the 1970s.
- The sub-sinus technique elevates the sinus membrane without grafting material and lets a blood clot in a closed box-shaped compartment regenerate bone.
- Approaching the sinus from the ridge rather than laterally preserves a closed box-shaped defect and allows better membrane elevation.
- Unlike earlier ZAGA modifications that address bucco-lingual platform position, this technique introduces vertical positioning of the platform to bury it and hide the transition.
- Post-operative CT scans at six months show bone formation, with a six-year follow-up reporting good results.
- Ilg and Sakima estimate 30 to 40 percent of zygomatic patients need this approach, which is applicable across ZAGA 1 to 4 cases and prevents soft-tissue recession.
What you'll learn
- How to hide the posterior smile line and prosthetic transition in severely atrophic maxillae
- The sub-sinus technique: sinus membrane elevation without grafting material
- Approaching the sinus from the ridge to leave a closed box-shaped defect for clot-driven bone formation
- Vertical positioning of the zygomatic implant platform (a dimension earlier ZAGA modifications did not address)
- Applying the sub-sinus approach across ZAGA 1-4 cases, especially ZAGA 4, to avoid soft-tissue recession
About the guests
Dr. Jan Peter Ilg
Dr. Jan Peter Ilg is an oral and maxillofacial surgeon and one of the leading surgeons at ZAGA Center Sao Paulo, Brazil, with almost 40 years in practice. His main interests are dental and zygomatic implants, orthognathic surgery, and rehabilitation of the atrophic maxilla. He co-developed the extra-sinus (extra-maxillary) zygoma approach and lectures internationally, and he mentored Dr. Andre Sakima in orthognathic and zygomatic surgery.
Dr. Andre Sakima Serrano
Dr. Andre Sakima Serrano is an oral and maxillofacial surgeon in Sao Paulo with 25 years in practice, working in near-fully private practice while also serving on a trauma and emergency team at a main Sao Paulo hospital. Trained by Dr. Jan Peter Ilg in orthognathic and zygomatic surgery, he specializes in zygomatic implant training and surgery at ZAGA Center Sao Paulo and developed the sub-sinus technique for managing the posterior smile line.
