ZAGA Science

ZAGA is an acronym that stands for Zygoma Anatomy-Guided Approach. This means that instead of basing treatment on an established surgical technique, the patient’s anatomy is used to help guide it. Therefore, instead of forcing the patient’s anatomy to adapt to our tools and processes, we adapt our own tools and processes to the patient’s anatomy.

THE ZAGA PHILOSOPHY

ZAGA is much more than just a method, it is a philosophy of how we work with patient well-being as one of its core principles. The individual characteristics and needs of each patient 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.

THE ORIGINAL TECHNIQUE

The person that invented the zygomatic implant was professor and physician Per-Ingvar (P-I) Brånemark. The original surgical technique for placing implants in the zygomatic bone involved entering through the palate and passing through the maxillary sinus, a process that required a visual inspection by opening a “window” in the anterior maxillary sinus wall.

After inserting the implant, the gum was completely sealed, and a removable denture was attached. After a period of 6 months, the gum was opened again and the process for building a fixed prosthesis began. The total treatment time for this original technique took about 8 months. In 1993, Dr Aparicio − along with his mentor Dr P-I Brånemark, Professor Eugene Keller (Mayo Clinic, Rochester, USA) and Dr Jordi Olivé − published the first international article explaining how the major maxillary bone loss could be repaired with zygomatic implants. The article was published in the scientific journal International Journal of Oral & Maxillofacial Implants.

In 1998, Dr. Malevez gave the first surgical course on zygomatic implants, explaining the traditional technique described by Prof. P-I Brånemark. In the years that followed, many authors also published about the original technique, some of which include: Agliardi E.L., Al-Nawas B., Aparicio C., Bedrossian E., Bothur S., Boyes-Varley J.G., Chow J., Corvello P.C., Davo R., Duarte L.R., Espósito M., Fazard P., Higuchi K.W., Jensen O., Malevez C., Malo P., Migliorança R.M., Nkenke E., Parel S.M., Peñarrocha M., Pi Urgell J., Stella J.P., and Vrielinck L.. The overall conclusion of the results established in these publications is that zygomatic implants are generally stable, which is helpful to the longevity of the implant. However, an undetermined number of patients experienced late-onset infections, such as oro-antral communication problems.

Another common problem that occurred during the initial phases of the surgical procedure was a bulky prosthesis, as they encroached upon the space of the tongue area and made it difficult to maintain oral hygiene.

  • Dr. Michael A. Pikos
    Dr. Pikos founded Coastal Jaw Surgery in 1983 and is the senior member of a four surgeon practice. He has extensive experience in implant surgery, having…
  • Dr. Costa Nicolopoulos
    Dr. Costa Nicolopoulos (BDS cum laude, FFD (SA) MFOS, Specialist Oral & Maxillofacial Surgeon) along with Dr. Petros Yuvanoglu (D.M.D. summa cum…
  • ZAGA Center Dubai – Zygomatic Implant Expert
    ZAGA Center Dubai – Same Day Dental Implants Firstly, SameDay Dental Implants Clinic is an expert in zygomatic implants in Dubai. ZAGA Centers are renowned places of excellence where patients with severe bone loss can receive implant-supported fixed teeth again. Consequently, it bears the certification by the global network of ZAGA …

    ZAGA Center Dubai – Zygomatic Implant Expert Read More »

  • ZAGA Center Tampa Bay – Zygomatic Implant Expert
    ZAGA Center Tampa Bay – Coastal Jaw Surgery About Coastal Jaw Surgery and the Pikos Institute A Name and 36 Years of Experience Discover more ZAGA centers!
  • ZAGA Center Frankfurt Mainz – Zygomatic Implant Expert
    ZAGA CENTER FRANKFURT MAINZ, Dr. Kraus Zahnärzte + Implantatklinik Undeniably, Dr Kraus Zahnärzte & Implantatklinik becomes one of the first ZAGA Centers in Germany. In light of an excellent group of professionals, the Center meets all criteria to be a ZAGA center. They are experts in zygomatic implants in Frankfurt …

    ZAGA Center Frankfurt Mainz – Zygomatic Implant Expert Read More »

  • Dr. Daniel Kraus
    Dr. Daniel Kraus can now look back on 20 years of experience in the field of implantology with several thousand implants. Numerous advanced training…
  • ZAGA Center South Florida
    ZAGA Center South Florida Sultan Center for Oral Surgery, located in South Florida, becomes the second ZAGA Center in the USA. As a group of excellent professionals, the center meets all criteria to be a reference center for the treatment of the severe maxillary atrophy with zygomatic implants following the ZAGA …

    ZAGA Center South Florida Read More »

  • Dr. Leslie Sultan
    Dr. Leslie Sultan graduated in the top 5 percent of his class at the University of Maryland Dental School, and completed an internship at Jackson Memorial…
  • Dr. Johann Styger
    Dr Johann Styger is in charge of the zygomatic implant treatment in the Centre. From the patient care to the anatomical position of the implant…
  • ZAGA Center Surrey
    ZAGA Center Surrey, The first ZAGA Center in the UK The patient care, experience and training of the whole team make Portmore Dental an ideal centre to centralize the treatment of the severe maxillary atrophy with zygomatic implants following the ZAGA philosophy in Surrey County. As a ZAGA Center, Portmore …

    ZAGA Center Surrey Read More »

  • Dr. Cemal Ucer
    Dr. Cemal Ucer graduated from Manchester Dental School in 1982. After postgraduate training as an oral surgeon, he established a private hospital referral…
  • ZAGA Center Manchester – Zygomatic Implant Expert
    ZAGA Center Manchester, UK : ICE HOSPITAL The Centre for Oral-Maxillofacial and Dental Implant Reconstruction at ICE Hospital becomes the second ZAGA Center in the UK. Therefore, they are the only certified zygomatic implants experts in Manchester. The Center meets the strict certification criteria. Consequently, they are a reference center …

    ZAGA Center Manchester – Zygomatic Implant Expert Read More »

  • Dr. Manuel Martín Luque
    With a trained team, Dr. Manuel Martín Luque is the surgeon and coordinator of zygomatic implant treatments in IOC Clínica. The patient’s well-being from…
  • Zygomatic Case Report CASE 20-01
    ZAGA Case Report: Management of a surgical complication. CASE 20-01. Overview The following pictures correspond to a patient with an extremely atrophied maxilla, treated during the January 2020 edition of the ZAGA course in Barcelona. The objective is to illustrate the management of an intra-operatory complication. Zygomatic fracturing was experienced …

    Zygomatic Case Report CASE 20-01 Read More »

  • ZAGA Center Canarias
    ZAGA Center Canarias, IOC Clínica Dental Dr. Manuel Marín Luque : Clinical Director of IOC Dental Clinic in Gran Canaria and Lanzarote Discover more ZAGA centers !
  • Dr. Chantal Malevez
    Prof. Malevez is a specialist in Maxillo-facial Surgery and Honorary Professor at the Faculty of Medicine (ULB) teaching the management of edentulous…
  • ZAGA Center Brussels
    ZAGA Center Brussels, Clinique Saint-Jean Under the leading of Prof. Dr. Chantal Malevez, the Clinique Saint-Jean located in Brussels becomes one of the first ZAGA Centers in Belgium. As a group of excellent professionals, covering from diagnosis to surgical treatment, anesthesia, and dental prostheses, the centre meets all criteria to be …

    ZAGA Center Brussels Read More »

  • Dr. Carlos Aparicio
    Dr. Aparicio is an expert in the complex technique of zygomatic implants, which consists of oral rehabilitation in the face of dental loss by means of…
  • ZAGA Center Barcelona – Zygomatic Implant Expert
    ZAGA Center Barcelona – Clinica Hepler Bone Unquestionably, clínica Heplerbone is the certified zygomatic implant expert in Barcelona. ZAGA centers are renowned places of excellence. Hence, patients with severe bone loss come to find a solution to edentulism. With this in mind, certified centers like Clinica Hepler Bone in Barcelona provide implant-supported …

    ZAGA Center Barcelona – Zygomatic Implant Expert Read More »

  • ZAGA Center Los Angeles – Zygomatic Implant Expert
    ZAGA Center Los Angeles, Greater Ventura Oral Surgery Greater Ventura Oral Surgery​, located in Los Angele​s, becomes one of the first  ZAGA Centers in the USA. As a group of excellent professionals, the centre meets all criteria to be a reference centre for the treatment of the severe maxillary atrophy with …

    ZAGA Center Los Angeles – Zygomatic Implant Expert Read More »

  • Dr. Ludovic Denglos
    Dr Ludovic Denglos located in the north of France becomes the first ZAGA Center in France. As a group of excellent professionals, the centre meets all…
  • ZAGA Center Nord France
    ZAGA Center Nord France, Dr Ludovic Denglos Dr Ludovic DENGLOS is the first ZAGA Center in France. The clinic has a team of highly qualified professionals and uses the latest techniques and technologies. Above all, Dr Ludovic Denglos clinic meets all the criteria to become a reference center for the treatment …

    ZAGA Center Nord France Read More »

  • Dr. Antonio Olivo
    Dr. Antonio Olivo graduated in Medicine and Surgery at the University of Padua, in 1994 he obtained the specialization in Maxillo Facial Surgery at the…
  • ZAGA Center Triveneto, Medical Center Padova
    ZAGA Center Triveneto, Medical Center Padova To begin with, Medical Center Padova, located in Padua, becomes the first zygomatic implant center in Italy. As a group of excellent professionals, the center meets all criteria to be a reference center for the treatment of the severe maxillary atrophy with zygomatic implants …

    ZAGA Center Triveneto, Medical Center Padova Read More »

  • ZAGA Center I-Dent, Zygomatic Implant Expert in Novosibirsk
    ZAGA Center I-Dent, Zygomatic Implant Expert in Novosibirsk I-Dent, in Novosibirsk, is the first zygomatic implant expert center in Russia. Above all, their main goal is to bring back beautiful and healthy smiles all over the country. Furthermore, the I-Dent center is one of Russia’s first centers to introduce the …

    ZAGA Center I-Dent, Zygomatic Implant Expert in Novosibirsk Read More »

  • Dr. Mikhael Toder
    Dr. Mikhael Toder was trained in new methods of implantology and advanced technologies of tooth microsurgery with recognized specialists of international…
  • Dr. Eduardo Crooke
    With more than 15 years of exclusive oral rehabilitation experience, Dr. Eduardo Crooke González de Aguilar is an expert in implantology and oral surgery…
  • ZAGA Center Costa Del Sol
    ZAGA Center Costa Del Sol, Crooke and Laguna clinic group Dr. Eduardo Crooke González de Aguilar Discover more ZAGA centers!
  • Dr. Leonard F. Anglis
    Dr. Leonard F. Anglis coordinates the treatment of severe maxillary atrophy with zygomatic implants following the ZAGA philosophy in Dr. Leonard F. Anglis…
  • ZAGA Center Northwest Indiana
    ZAGA Center Northwest Indiana, Dr. Leonard F. Anglis Dentistry Dr Leonard F Anglis Dentistry, located in Northwest Indiana, becomes one of the first Zygomatic Implant Experts in the US. Furthermore, the center provides comprehensive dental care, in addition to offering several types of treatments. In brief, the aim of the …

    ZAGA Center Northwest Indiana Read More »

  • Dr. Guillermo Rehberger Olivera
    Dr. Guillermo Rehberger Olivera, is a dental doctor since 1982, associate professor of dental prosthesis at the School of Medicine of the University…
  • ZAGA Center Asturias
    ZAGA Center Asturias, Clínica Rehberger López-Fanjul The Center has the infrastructure and experience to safely carry out this type of advanced treatment. For information regarding the Clinic and treatments for severe maxillary atrophy with zygomatic implants following the ZAGA philosophy contact us using the form. You can also call the …

    ZAGA Center Asturias Read More »

  • ZAGA Center Stuttgart
    ZAGA Center Stuttgart, Zahnarztpraxis Dres. Simon Zahnarztpraxis Dres Simon, located in Stuttgart, is part of the ZAGA Centers network and one of the first zygomatic implant experts in Germany. In brief, they believe that functional and aesthetic procedures are an essential part of the patient’s well-being. Zahnarztpraxis Dres Simon brings …

    ZAGA Center Stuttgart Read More »

  • Dr. Richard Peter Simon
    Dr. Peter Simon is the founder of the dental practice Dres. Simon. He has been working as a dentist in Stuttgart for many years and has been particularly…
  • ZAGA Center Athens
    Welcome to ZAGA Center Athens! About the Office in Athens, Greece Dr. Costa Nicolopoulos About our Worldwide Network The term ZAGA is an acronym for Zygoma Anatomy-Guided Approach. Instead of carrying out implant-based restorations based upon an established surgical protocol, this technique is guided more by the patient’s anatomy. In …

    ZAGA Center Athens Read More »

  • Zygomatic Case Report CASE 20-02
    ZAGA Case: Treatment of the severely atrophic maxilla. Overview The following pictures correspond to a heavy smoker patient with multiple failed implant procedures in her maxilla, treated in the ZAGA Center Barcelona, Hepler Bone Clinic. The surgery was performed by Dr Calos Aparicio with Dr Ophir Fromovich and Dr Guy …

    Zygomatic Case Report CASE 20-02 Read More »

  • Dr. João Carlos Ramos
    Professor Dr. Ramos is the professional responsible for the certification of the clinic as ZAGA Center in the district of Aveiro. With a professional career…
  • ZAGA Center Aveiro – Zygomatic Implant Expert
    ZAGA Center Aveiro – Instituto Português de Medicina Dentária IPMD Above all, IPMD is the zygomatic implant expert in Aveiro, Portugal. In the first place, ZAGA Centers like the Instituto Português de Medicina Dentária – IPMD in Aveiro are centers of excellence for advanced dental treatments. Consequently, patients with severe maxillary bone …

    ZAGA Center Aveiro – Zygomatic Implant Expert Read More »

  • Dr. Sergio Duarte
    Under the supervision of Dr. Sergio Duarte, patients suffering from severe maxillary atrophy can receive safe treatment with zygomatic implants following…
  • ZAGA Center Braga Guimaraes
    ZAGA Center Braga, Diagnóstico Integrado em Medicina Dentária We are glad to introduce DIMD- Diagnóstico Integrado em Medicina Dentária. This is one of the first ZAGA Center in Portugal. Located in the region of Braga and Guimarães the clinic has one of the best zygomatic implant experts. Above all, the …

    ZAGA Center Braga Guimaraes Read More »

  • Dr. Miguel Moura Goncalves
    Professor Dr. Miguel Moura Gonçalves is the professional responsible for the certification of the clinic as ZAGA Center in the district of Viseu…
  • ZAGA Center Viseu
    ZAGA Center Viseu, VISAGES VISAGES is a zygomatic implant expert in Viseu and one of the first ZAGA Centers in Portugal. In particular, VISAGES is a reference center for advanced dental surgery. Thanks to its skilled dental team, ZAGA Center VISAGES is relevant for the treatment of severe maxillary atrophy …

    ZAGA Center Viseu Read More »

  • Dr. Roberto López Píriz
    Dr. López Píriz is specialized in zygomatic implants, oral surgery and aesthetic medicine. He combines his position as Medical Director of the Institute of…
  • ZAGA Center Madrid
    ZAGA Center Madrid, Instituto Cirugía Oral Avanzada Instituto Cirugía Oral Avanzada was founded in 2011 by a team of highly qualified professionals specialized in different areas of dentistry. ICOA is a reference center for ceramic implantology and complex cases of lack of bone. As a result, the center is the …

    ZAGA Center Madrid Read More »

  • Dr. Hooman Zarrinkelk
    Dr. Zarrinkelk earned his undergraduate degree and dental degree from Loma Linda University. He began his surgical residency at the University of Texas…
  • ZAGA Center A Coruña y Lugo
    ZAGA Center A Coruña y Lugo, AB Cirugía Oral y Maxilofacial Dr. Arturo Bilbao Alonso Discover more ZAGA centers!
  • Dr. Arturo Bilbao Alonso
    Dr. Arturo Bilbao Alonso coordinates the treatment of severe maxillary atrophy with zygomatic implants following the ZAGA philosophy in AB Maxillofacial…
  • ZAGA Center Ibiza
    ZAGA Center Ibiza, Clínica Fernández Dr. Alberto Fernández Discover more ZAGA centers!
  • Dr. Alberto Fernández
    With a trained team, Dr Alberto Fernández is in charge of the clinic, main surgeon and coordinator of the treatments. From the first diagnostic visit to…
  • Prof. Dr. James Chow
    Prof Dr James Chow belongs to the first group of locally trained specialists in Oral and Maxillofacial Surgery (OMFS) in Hong Kong. Dr. Chow is one…

EXTRA-SINUS/EXTRA-MAXILLARY TECHNIQUES

After 10 years of experience with the original technique following their initial publication, for the first time, Dr. Aparicio and his group released and published several papers in top international academic journals in 2005 and 2006. These papers explained their new extra-sinus (or extra-maxillary) technique for placing zygomatic implants through the exterior maxillary lateral wall, avoiding the opening through the palate, as proposed by the original technique. The objective of the extra-sinus technique was to avoid two disadvantages of the original method: sinus complications and bulky prostheses. Furthermore, during this time, the concept of “immediate loading” was introduced, a concept that was taken from regular implants and applied to zygomatic implants. The first prosthesis could now be fixed and placed on the implant within 24 hours after the procedure. The protocols for the immediate loading of regular implants were established in 2002, after the first International Consensus of Immediate Loading, organized by Drs. Lars Sennerby, Bo Rangert and Carlos Aparicio.
In 2008 and 2009, Dr. Aparicio and his group published further results three years after their new extra-maxillary technique was introduced, noting that this method of placing zygomatic implants effectively reduced oro-antral communication-related sinus infections. They also noted that this technique improved the prostheses, a result that would later be confirmed by other authors such as Migliorança R.M., Malo P. and Corvello P.C. on the external immediate loading technique. However, Aparicio and his group also observed a new complication derived from the systematic application of the same technique on all patients: gum recession and the exposure of the zygomatic implant, creating a potential for bacterial infections.


HOW DID THE ZAGA METHOD BEGIN?

The ZAGA method originated from a need to offer patients with severe maxillary atrophy reliable, long-term solutions without the adverse effects of the original technique (sinus complications and bulky prostheses) and without the typical complications of exterior or extra-sinus techniques (gingival dehiscence and exposure of the zygomatic implant).
The ZAGA method was explained by Dr. Aparicio in his book “Zygomatic Implants. The Anatomy-Guided Approach” (ZAGA). After a series of surgical and anatomical studies with actual patients, Dr. Carlos Aparicio further developed the extra-maxillary technique for placing implants proposed by his own group in 2005. These contributions helped prevent gum recession and the presence of gaps in the gums surrounding the zygomatic implant. In 2011, based on a systematic classification of maxillary anatomy, he proposed a system for providing individualized treatment plans for each patient, known as ZAGA. The objective of these plans was to prevent the complications of previous techniques, which used similar surgical procedures for all patients.

ZAGA: A MINIMALLY-INVASIVE PROCEDURE?

The ZAGA method simplifies the procedures used by conventional zygomatic implant techniques: it preserves more bone, is faster and is more precise. Compared to traditional procedures or hip grafts, the ZAGA method allows for treatment to be minimally invasive.

This conservative approach preserves the integrity of the maxillary wall, a critical area where the zygomatic implant first enters. This prevents frequent sinus complications, common to other methods. Unlike traditional zygomatic implant techniques, the dental prosthesis used in the ZAGA method takes up a natural space in the mouth, as its dimensions are very similar to those of original teeth, which helps improve aesthetic aspects, maintenance, and hygiene.


THE ZAGA METHOD

The ZAGA method consists of a series of techniques, materials and action protocols used by the various professionals involved in treating severe maxillary bone atrophy. It takes a systematic approach to optimizing results by anchoring a fixed dental prosthesis to zygomatic implants. The ZAGA method is based on a systematic classification of the patients’ different anatomies.

This classification helps identify the anatomy of each patient and therefore allows for treatment, its protocols and materials to adapt to it. This makes surgery less invasive and problematic, and more successful, drastically increasing the success rates of the treatment compared to traditional techniques.

In contrast to these traditional zygomatic implants techniques, the ZAGA method reduces the chances of sinus infections almost to zero. One of this method’s main objectives is to avoid problems or complications that derive from gum recession and implant exposure, common in extra-maxillary (or extra-sinus) methods. The dental prosthesis used with the ZAGA method occupies a space that is very similar to where a patient’s original teeth would normally be, which helps attain a more aesthetic and lasting structure. With the ZAGA method, fixed teeth can be placed in patients with severe maxillary atrophy in just one day, without the use of grafts or donor sites.


HOW IS THE PROCEDURE PERFORMED WITH THE ZAGA APPROACH?

The procedure for placing zygomatic implants using the ZAGA approach minimizes the need for a maxillary osteotomy by not having to open a “window” in the maxillary bone, as other techniques propose. This maximizes the area of contact the implant has with the zygomatic bone without having to make an unnecessary opening in the bone. Such a procedure not only involves greater precision in making such a perforation, but also allows for a solid seal of the sinus osteotomy and for enhanced implant stability.

With the ZAGA approach, the patient receives individualized treatment. The implant is placed through a minimally-invasive osteotomy, always preserving the palate. The zygomatic implant can be both inserted from the outside through the alveolar bone, which protects the sinus, as well as through a more intra-alveolar approach, depending on the patient’s maxillary anatomy. With this approach, more bone is conserved in the critical area near the alveolar ridge, the integrity of the Schneider membrane is maintained and the soft tissue around the implant head is healthier. The better the sealing is, the less chance there is of bacteria getting through.

In subsequent publications, the ZAGA method shows it has long-term, proven benefits over the original technique. The ZAGA approach offers a methodology that can systematize zygomatic implant placement and has proven to show successful results without long-term complications and with the added benefit of having more aesthetic and functional fixed teeth within 24 hours following the procedure.