The Science behind the ZAGA Concept

Discover the origins of the ZAGA Concept, as well as all peer-reviewed publications supporting it. From the first book by Dr. Carlos Aparicio to collaborative studies with the network of ZAGA Centers.

ZAGA is more than just a method, it is a philosophy of how we work with patient well-being as one of its core principles. Each patient’s individual characteristics and needs are the main elements considered when designing a treatment plan and deciding what materials or implants will be used.

By anchoring the dental prosthesis to zygomatic implants, the ZAGA philosophy aims to achieve long-term success in treating severe maxillary atrophy. In addition to maximizing success, the ZAGA philosophy seeks to prevent complications instead of treating them. To obtain these objectives through a standardized process, the ZAGA philosophy develops and uses individual, contrasted, and systemized action protocols.

  • <a href=https://drive.google.com/file/d/1c8_wqU9RjjDzg3rqct10sVJduI-0KAfm/view?usp=sharing>INCISION AND FLAP DESIGN IN ZYGOMATIC IMPLANT SURGERY: A ZAGA-BASED DECISION TREE</a>

    October 2025

    In the International Journal of Periodontics & Restorative Dentistry

    Carlos Aparicio, MD, DDS, MSc, MSc, DLT, PhD

  • <a href=https://drive.google.com/file/d/1LnnPtGKgSd8LqAw5Zuav_7nAwCg7ZV5o/view?usp=sharing>COMPARATIVE FINITE ELEMENT ANALYSIS OF THREE ZYGOMATIC IMPLANT APPROACHES USING REAL-LIFE ANATOMIC MODELS</a>

    October 2025

    In Journal of Prosthetic Dentistry

    Carlos Aparicio, MD, DDS, MSc, MSc, DLT, PhD, Adi Lorean, OMFS, DMD, and David Pastorino, Mat.Sci.Eng., MEng, MASt, PhD

  • <a href=https://www.quintessence-publishing.com/usa/en/product/managing-fully-edentulous-patients >IMPLANT DESIGNS AND THE EDENTULOUS PATIENT</a>

    September 2025

    In Managing Fully Edentulous Patients

    Bilal Al-Nawas, Prof, Dr, Dr, Carlos Aparicio, MD, DDS, MSc, MSc, DLT, PhD

  • <a href=https://drive.google.com/file/d/1yVFp7t8YonKEfgZY6h7heAZgYnrwEdh-/view>ZAGA PROTOCOL FOR QUADRUPLE ZYGOMA IMPLANT INSTALLATION</a>

    July 2025

    Carlos Aparicio, MD, DDS, MSc, MSc, DLT, PhD, Antoine Chehade, BSc, MS, David Wei-Kai Hsu, DDS , Guy McLellan, DDS, MS

  • <a href=https://pubmed.ncbi.nlm.nih.gov/38856876/>ROUND AND FLAT ZYGOMATIC IMPLANTS: EFFECTIVENESS AFTER A 3‑YEAR FOLLOW‑UP NON‑INTERVENTIONAL STUDY</a>

    June 2024

    Carlos Aparicio, Waldemar D Polido, Antoine Chehade, Marc Shenouda, Madalina Simon, Peter Simon, Bilal Al-Nawas

  • <a href=https://pubmed.ncbi.nlm.nih.gov/38363183/t>ZAGA DOUBLE PEDICLE PALATAL FLAP FOR SOFT TISSUE MANAGEMENT IN ZYGOMATIC SURGERY</a>

    February 2024

    Carlos Aparicio, Arnau Aparicio

  • <a href=https://drive.google.com/file/d/1xjkZGr_9uzwJRGB493zA9oiMuzyq_1ub/view?usp=sharing#infotext>SURGICAL–ANATOMICAL AND PROSTHETIC–BIOMECHANICAL ZAGA CRITERIA TO DETERMINE THE ZYGOMATIC IMPLANT TRAJECTORY</a>

    July 2023

    Carlos Aparicio, Arnau Aparicio and John Brunski

  • <a href=https://drive.google.com/file/d/1tR0OBZ9fozEWL9NZ-Fjvhns4qEZf1irb/view?usp=sharing>THE ZYGOMA ANATOMY-GUIDED APPROACH (ZAGA) FOR PREVENTING COMPLICATIONS USING ZYGOMATIC IMPLANTS</a>

    July 2023

    Carlos Aparicio

  • <a href=https://zagacenters.com/zaga-science/advanced-zygomatic-implant-book/>ADVANCED ZYGOMATIC IMPLANTS: THE ZAGA CONCEPT</a>

    July 2023

    A Book by Dr. Carlos Aparicio

  • <a href=https://pubmed.ncbi.nlm.nih.gov/37767617/>A MODIFIED DELPHI CONSENSUS FOR REHABILITATIONS ANCHORED TO ZYGOMATIC IMPLANTS</a>

    September 2023

    Carlos Aparicio, David Pastorino

  • <a href=https://bit.ly/zygomaticimplantschapter>ZYGOMATIC IMPLANTS. THE ZAGA CONCEPT</a>

    March 2023

    C. Aparicio, A. Dawood and C. Ucer

  • <a href=https://www.quintessence-publishing.com/deu/en/product/zygoma-implants#infotext>THE ZAGA CONCEPT: A MULTIFACETED APPROACH TO ZYGOMA IMPLANT REHABILITATION</a>

    March 2023

    In Zygoma Implants. Step by Step by Arun K. Garg
    Co-authors: Carlos Aparicio

  • <a href=https://bit.ly/zaga-sp-august-22>SUCCESS RATES OF ZYGOMATIC IMPLANTS FOR THE REHABILITATION OF SEVERELY ATROPHIC MAXILLA: A SYSTEMATIC REVIEW</a>

    August 2022

    Aleix Solà Pérez, David Pastorino, Carlos Aparicio, Marta Pegueroles Neyra, Rabia Sannam Khan, Simon Wright and Cemal Ucer

  • <a href="https://journalimplantdent.springeropen.com/articles/10.1186/s40729-022-00412-8">ROUND AND FLAT ZYGOMATIC IMPLANTS: EFFECTIVENESS AFTER A 1-YEAR FOLLOW-UP NON-INTERVENTIONAL STUDY</a>

    April 2022

    Aparicio C, Polido WD, Chow J, Davó R, Al-Nawas B. Int J Implant Dent. 2022 Apr 1;8(1):13. doi: 10.1186/s40729-022-00412-8.

  • <a href="https://link.springer.com/article/10.1007/s41894-022-00116-7">THE ZYGOMA ANATOMY-GUIDED APPROACH (ZAGA) FOR REHABILITATION OF THE ATROPHIC MAXILLA. </a>

    February 2022

    Carlos Aparicio, Antonio Olivo, Victor de Paz, Daniel Kraus, Manuel Martin Luque, Eduardo Crooke, Peter Simon, Madalina Simon, Jose Ferreira, Andre Sakima Serrano, Jan Peter Ilg, Arturo Bilbao, Alberto Fernandez, Pedro Guitián, Jay Neugarten

  • <a href=https://pubmed.ncbi.nlm.nih.gov/34325808/>PREOPERATIVE EVALUATION AND TREATMENT PLANNING. ZYGOMATIC IMPLANT CRITICAL ZONE (ZICZ) LOCATION</a>

    September 2021

    Carlos Aparicio, Roberto López-Píriz, Miguel Peñarrocha

  • <a href=https://bit.ly/zaga-sp-september-21>THE ZYGOMA ANATOMY-GUIDED APPROACH FOR PLACEMENT OF ZYGOMATIC IMPLANTS</a>

    September 2021

    Carlos Aparicio, Waldemar D. Polido, Hooman M. Zarrinkelk, Atlas of the Oral and Maxillofacial Surgery Clinics

  • <a href=https://pubmed.ncbi.nlm.nih.gov/34411224/>IDENTIFICATION OF THE PATHWAY AND APPROPRIATE USE OF FOUR ZYGOMATIC IMPLANTS IN THE ATROPHIC MAXILLA: A CROSS-SECTIONAL STUDY</a>

    August 2021

    Carlos Aparicio, Waldemar D Polido, James Chow, Lesley David, Rubén Davo, Eduardo Jose De Moraes, Alex Fibishenko, Masami Ando, Guy Mclellan, Costa Nicolopoulos, Michael A Pikos, Hooman Zarrinkelk, Thomas J Balshi, Miguel Peñarrocha

  • <a href=https://bit.ly/zaga-may-21>PREVALENCE OF MAXILLARY SINUS ALTERATIONS AFTER ZYGOMATIC SURGERY. A COMPARATIVE STUDY BETWEEN INTRA-SINUS AND ZAGA APPROACHES</a>

    May 2021

    Carlos Aparicio, Pedro Clarós, Natalia Końska, P. Clarós-Pujol, D. Clarós-Pujol, M. Peñarrocha-Diago

  • <a href=https://pubmed.ncbi.nlm.nih.gov/32142574/>ORIS CRITERIA OF SUCCESS FOR THE ZYGOMA-RELATED REHABILITATION: THE (REVISITED) ZYGOMA SUCCESS CODE</a>

    April 2020

    Carlos Aparicio, MD, DDS, MsC, MsC, DLT, PhD/Roberto López-Piriz, MD, DDS, PhD/Tomas Albrektsson, MD, PhD, RCPSG

  • <a href=https://pubmed.ncbi.nlm.nih.gov/32142581/>ZYGOMA ANATOMY-GUIDED APPROACH "SCARF GRAFT" FOR PREVENTION OF SOFT TISSUE DEHISCENCE AROUND ZYGOMATIC IMPLANTS: TECHNICAL NOTE</a>

    April 2020

    Carlos Aparicio, Sanz Antonio

  • <a href=https://bit.ly/zaga-sp-march-20>BONE REGENERATION AND SOFT TISSUE ENHANCEMENT AROUND ZYGOMATIC IMPLANTS: RETROSPECTIVE CASE SERIES</a>

    March 2020

    Miguel Peñarrocha-Diago , Juan Carlos Bernabeu-Mira, Alberto Fernández-Ruíz, Carlos Aparicio and David Peñarrocha-Oltra

  • <a href=https://link.springer.com/chapter/10.1007/978-3-030-29264-5_5>THE ZYGOMA ANATOMY-GUIDED APPROACH (ZAGA) — A PATIENT-SPECIFIC THERAPY CONCEPT FOR THE REHABILITATION OF THE ATROPHIC MAXILLA</a>

    2020

    In: James Chow (Ed.), Zygomatic Implants: Optimization and Innovation, March 2020, pp. 63–85
    Carlos Aparicio

  • <a href=https://www.abebooks.com/9780323278034/Computer-Guided-Applications-Dental-Implants-Bone-0323278035/plp#infotext>COMPUTER-GUIDED APPLICATIONS FOR DENTAL IMPLANTS, BONE GRAFTING, AND RECONSTRUCTIVE SURGERY</a>

    by Marco Rinaldi, Scott Ganz, and Angelo Mottola

    2015

    Featured chapter: Carlos Aparicio

  • <a href=https://pubmed.ncbi.nlm.nih.gov/25123760/>ZYGOMATIC IMPLANTS: INDICATIONS, TECHNIQUES AND OUTCOMES, AND THE ZYGOMATIC SUCCESS CODE</a>

    October 2014

    Carlos Aparicio, Carolina Manresa, Karen Francisco, Pedro Claros

  • <a href=https://pubmed.ncbi.nlm.nih.gov/23464749/>ZYGOMATIC IMPLANTS PLACED USING THE ZYGOMATIC ANATOMY-GUIDED APPROACH VERSUS THE CLASSICAL TECHNIQUE: A PROPOSED SYSTEM TO REPORT RHINOSINUSITIS DIAGNOSIS</a>

    October 2014

    Carlos Aparicio, Carolina Manresa, Karen Francisco, Arnau Aparicio, Jonas Nunes, Pedro Claros, Josep M Potau.

    Clin Implant Dent Relat Res. 2014 Oct;16(5):627-42. doi: 10.1111/cid.12047. Epub 2013 Mar 6. PMID: 23464749.

  • <a href=https://pubmed.ncbi.nlm.nih.gov/23078128/>THE LONG-TERM USE OF ZYGOMATIC IMPLANTS: A 10-YEAR CLINICAL AND RADIOGRAPHIC REPORT.</a>

    October 2012

    Carlos Aparicio, Carolina Manresa, Karen Francisco, Wafaa Ouazzani, Pedro Claros, Josep M Potau, Arnau Aparicio

  • <a href=https://www.amazon.com/Zygomatic-Implants-Anatomy-Guided-Carlos-Aparicio/dp/1850972257>ZYGOMATIC IMPLANTS. THE ANATOMY-GUIDED APPROACH</a>

    August 2012

    Carlos Aparicio

  • <a href=https://bit.ly/zaga-sp-september-11>A PROPOSED CLASSIFICATION FOR ZYGOMATIC IMPLANT PATIENT BASED ON THE ZYGOMA ANATOMY GUIDED APPROACH (ZAGA): A CROSS-SECTIONAL SURVEY</a>

    September 2011

    Carlos Aparicio

  • <a href=https://pubmed.ncbi.nlm.nih.gov/19076177/>IMMEDIATE/EARLY LOADING OF ZYGOMATIC IMPLANTS: CLINICAL EXPERIENCES AFTER 2 TO 5 YEARS OF FOLLOW-UP</a>

    May 2010

    Carlos Aparicio, Wafaa Ouazzani, Arnau Aparicio, Vanessa Fortes, Rosa Muela, Andres Pascual, Maria Codesal, Natalia Barluenga, Monica Franch

  • <a href=https://drive.google.com/file/d/1VsVC7qZ7kdrzTrZYJpFnw5hdn7unSJSP/view?usp=sharing>EXTRASINUS ZYGOMATIC IMPLANTS: THREE YEAR EXPERIENCE FROM A NEW SURGICAL APPROACH FOR PATIENTS WITH PRONOUNCED BUCCAL CONCAVITIES IN THE EDENTULOUS MAXILLA</a>

    Clin Implant Dent Relat Res 2010;12:55-61. E-Pub 2008.

    Aparicio C, Ouazzani W, Aparicio A, Fortes V, Muela R, Pascual A et al.

  • <a href=https://pubmed.ncbi.nlm.nih.gov/18412580/>THE USE OF ZYGOMATIC IMPLANTS FOR PROSTHETIC REHABILITATION OF THE SEVERELY RESORBED MAXILLA.</a>

    April 2008

    Carlos Aparicio, Wafaa Ouazzani, Naoki Hatano

  • <a href=https://pesquisa.bvsalud.org/portal/resource/pt/ibc-65744>¿QUÉ INDICACIONES TIENEN Y QUÉ RESULTADOS NOS OFRECEN LOS IMPLANTES CIGOMÁTICOS?</a>

    April 2008

    Aparicio, C., & Soto-Yarritu Quintana, R.

  • <a href=https://pubmed.ncbi.nlm.nih.gov/12831730/>IMMEDIATE/EARLY LOADING OF DENTAL IMPLANTS: A REPORT FROM THE SOCIEDAD ESPANOLA DE IMPLANTES WORLD CONGRESS CONSENSUS MEETING IN BARCELONA, SPAIN, 2002</a>

    October 2006

    Carlos Aparicio, Bo Rangert, Lars Sennerby

  • <a href=https://pubmed.ncbi.nlm.nih.gov/16968377/>VALIDITY AND CLINICAL SIGNIFICANCE OF BIOMECHANICAL TESTING OF IMPLANT/BONE INTERFACE</a>

    September 2006

    Carlos Aparicio, Niklaus P Lang, Bo Rangert

  • <a href=https://pubmed.ncbi.nlm.nih.gov/16919019/>A PROSPECTIVE CLINICAL STUDY ON TITANIUM IMPLANTS IN THE ZYGOMATIC ARCH FOR PROSTHETIC REHABILITATION OF THE ATROPHIC EDENTULOUS MAXILLA WITH A FOLLOW-UP OF 6 MONTHS TO 5 YEARS</a>

    August 2006

    Carlos Aparicio, Wafaa Ouazzani, Roberto Garcia, Xabier Arevalo, Rosa Muela, Vanessa Fortes

  • <a href=https://drive.google.com/file/d/1gXlb89IIMzTBF7c5sd68-8Hi6mFUawV2/view?usp=sharing>ZYGOMATIC IMPLANTS. A NEW SURGICAL APPROACH.</a>

    J Clin Perio 2006: 33: supplement (second part) 128

    Ouazzani W, Arevalo J, Sennerby L, Lundgren S, Aparicio C.

  • <a href=https://drive.google.com/file/d/1gXlb89IIMzTBF7c5sd68-8Hi6mFUawV2/view?usp=sharing>ZYGOMATIC IMPLANTS. A NEW SURGICAL APPROACH.</a>

    2006-2010

    The group led by Dr. Carlos Aparicio published in 2006 a first report summarizing their initial one-year experience with the extra-maxillary technique (Ouazzani W, Arevalo J, Sennerby L, Lundgren S, Aparicio C. Zygomatic implants. A new surgical approach. J Clin Perio. 2006;33: supplement [second part]:128). Subsequently, in 2008, as a continuation of that prospective study, the same group reported the three-year follow-up (Aparicio C, Ouazzani W, Aparicio A, Fortes V, Muela R, Pascual A, Codesal M, Barluenga N, Manresa C, Franch M. Extra sinus zygomatic implants: three-year experience from a new surgical approach for patients with pronounced buccal concavities in the edentulous maxilla. Clin Implant Dent Relat Res. 2010;12(1):55-61. doi:10.1111/j.1708-8208.2008.00130.x. Epub 2008 Dec 3. PMID: 19076181).

    It is also noteworthy that, in 2006, the group of Dr. Reginaldo Migliorança published in Portuguese, in a non-indexed Brazilian journal, their experience placing zygomatic implants using an exteriorized technique (Migliorança et al. Exteriorização de fixações zigomáticas em relação ao seio maxilar: uma nova abordagem cirúrgica. Implant News. 2006;3(1):30).

  • <a href=https://dialnet.unirioja.es/servlet/articulo?codigo=4539175>EL IMPLANTE TRANS-ZIGOMÁTICO</a>

    1999

    C Aparicio

  • <a href=https://pubmed.ncbi.nlm.nih.gov/7591008/>A NEW METHOD FOR ACHIEVING PASSIVE FIT OF AN INTERIM RESTORATION SUPPORTED BY BRÅNEMARK IMPLANTS: A TECHNICAL NOTE</a>

    September-October 1995

    C Aparicio

  • <a href=https://www.quintessence-publishing.com/gbr/en/article/843851/the-international-journal-of-oral-maxillofacial-implants/1993/01/reconstruction-of-the-premaxilla-with-autogenous-lliac-bone-in-combination-with-osseointegrated-implants>RECONSTRUCTION OF THE PREMAXILLA WITH AUTOGENOUS LLIAC BONE IN COMBINATION WITH OSSEOINTEGRATED IMPLANTS</a>

    February 1993

    Carlos Aparicio, Per-lngvar Brånemark, Eugene E. Keller, Jordi Olivé

  • <a href=https://pubmed.ncbi.nlm.nih.gov/1398830/>COMPARATIVE SURFACE MICROANALYSIS OF FAILED BRÅNEMARK IMPLANTS</a>

    1992

    Aparicio C, Olivé J.

  • <a href=https://pubmed.ncbi.nlm.nih.gov/2094658/>PERIOTEST METHOD AS A MEASURE OF OSSEOINTEGRATED ORAL IMPLANT STABILITY</a>

    1990

    Olivé J, Aparicio C.

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