Zygoma Integrated Solutions
ZAGA is a method that can guarantee the long-term success of treating cases of maxillary atrophy with zygomatic implants. The method drastically improves upon the results of other techniques and above all, its approach focuses on applying the advances in medicine to improve patient well-being.
Zygoma Integrated Solutions is an organizational platform consisting of patients, professionals, protocols, experiences, research and scientific developments that are related to the ZAGA method. Its objective is to safely extend the use of zygomatic implants by coordinating the relationships between patients, dentists (ZAGA Partners) and professionals who are highly-trained in the field of zygomatic implants (ZAGA Centers).
ZAGA: Zygoma Anatomy Guided Approach
WHAT DOES ZAGA MEAN?
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 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 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 1991, 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.
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 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.
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.
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.
ZAGA ZYGOMATIC IMPLANTS
ZAGA zygomatic implants were developed from over 25 years of experience using zygomatic implants and in collaboration with a renowned team of engineers. The adaptability of their dimensions is far superior to what the market used to offer. Their placement requires a less invasive procedure and their composition is much more compatible with the body as it does not contain potentially harmful foreign chemical elements such as aluminium or vanadium. The shape of the implant is different as it adapts to the patient’s anatomy, preventing complications with its placement. Their texture and design also take the biology and function of the mouth’s structure into account. ZZCs use new ZAGA zygomatic implants.
Reconstruction of the premaxilla with autogenous iliac bone in combination with osseointegrated implants. Ver1993
El implante trans-zigomático. Ver1999
Implantes zigomáticos en la rehabilitación del maxilar superior atrófico. Resultados preliminares de un estudio prospectivo. Ver2001
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. Ver2006
Zygomatic implant: New surgery approach2006
Extrasinus Zygomatic Implants. Three year experience from a new surgical approach for patients with pronounced buccal concavities in the edentulous maxilla.2008
The use of zygomatic implants for prosthetic rehabilitation of the severely resorbed maxilla. Ver2008
Extrasinus zygomatic implants: three year experience from a new surgical approach for patients with pronounced buccal concavities in the edentulous maxilla. Ver2010
Immediate/Early loading of zygomatic implants: clinical experiences after 2 to 5 years of follow-up. Ver2010
A proposed classification for zygomatic implant patient based on the zygoma anatomy guided approach (ZAGA): a cross-sectional survey. Ver2011
Zygomatic implants: the anatomy-guided approach. Ver2013
The long-term use of zygomatic implants: a 10-year clinical and radiographic report. Ver2014
Zygomatic implants placed using the zygomatic anatomy-guided approach versus the classical technique: a proposed system to report rhinosinusitis diagnosis. Ver2014
Zygomatic implants: indications, techniques and outcomes, and the zygomatic success code. Ver2014
Zygomatic implant based oral rehabilitation: State of the art and proposed criteria for success. Ver2015
ZYGOMA INTEGRATED SOLUTIONS
What is a ZAGA Partner?
ZAGA Partners are a network of general dental practitioners and family dentists led by highly-trained professionals that have a global profile in patient treatment. They are characterized by the quality of their service and the compassion they have for patients.
The objective of a ZAGA Partner is to become a “point of reference” for each individual patient. A ZAGA Partner is a professional who walks the patient through the ENTIRE treatment. This includes connecting with the ZAGA Platform as part of the diagnosis phase; being in constant contact with the Platform as part of follow-up after the procedure and the immediate placement of the prosthesis; implementing the final prosthesis in the respective Partner Center; and providing follow-up treatment throughout the rest of the patient’s life, sharing experiences, and applying any new technologies – all through the ZAGA Platform.
Why should I be seen by a ZAGA Partner?
For ZAGA Partners, patients come first. ZAGA Partners are familiar with and can analyze the challenges of treatment, especially in its surgical phase. These healthcare professionals value that the ZAGA method has proven to be the most conservative and predictable method for placing zygomatic implants.
ZAGA Partners place a priority on diagnosing the need to treat maxillary bone loss with zygomatic implants, performing the rehabilitation treatment in their health centers, and providing the subsequent patient follow-up. To successfully achieve the rehabilitation of their patients, ZAGA Partners make sure that their procedures are performed according to the ZAGA method.
ZAGA Partners are part of the global ZAGA network and therefore have access to the ZAGA Platform. As part of this network, ZAGA Partners, as with ZAGA Centers, share the same objective of establishing protocol and promoting the ZAGA philosophy among professionals and patients.
What is a ZAGA Center?
ZAGA Centers are an international network of professionals that are highly-specialized in treating maxillary bone loss through zygomatic implants. Certified in the ZAGA philosophy, ZAGA Centers provide surgical treatments to patients in their region or city that need zygomatic implants, making them the experts in treating maxillary atrophy and bone loss. The main role of a ZAGA Center is to perform procedures on people with maxillary bone loss by placing zygomatic implants with the ZAGA method and by attaching an immediate fixed prosthesis within 24 hours following the procedure.
Why ZAGA Centers?
Especially from the surgical point of view, zygomatic implants are much more complex than regular tooth implants. Severe maxillary atrophy is the main indicator that zygomatic implants should be used.
Statistics show that the number of people with severe maxillary atrophy detected in a regular-sized clinic each year is very low. Considering the natural rate of learning curves, it is understandable how difficult it is for a dentist who runs a clinic to become an expert surgeon with this specific treatment.
In most cases, patients with tooth loss and severe upper maxillary atrophy only get one chance at rehabilitating their tooth loss with fixed teeth. It is our belief that the treatment of maxillary atrophy with zygomatic implants must be performed by an expert professional such as those provided by ZAGA Centers, as it is crucial to be successful on the first try.
In addition to being connected to the Zygoma Integrated Solutions platform and sharing their experience, ZAGA Centers have access to state-of-the-art technology. Also known as ZAGA Designs, this technology can adapt to the specific anatomy of each individual patient, such as with ZAGA zygomatic implants.
How do ZAGA Centers work?
ZAGA Centers are part of the Zygoma Integrated Solutions platform, whose objective is to establish protocol and promote the ZAGA philosophy among professionals and patients.ZAGA Centers are connected to ZAGA Partners through the ZAGA platform. They consist of local general practitioners that have a high global profile in specialized patient treatment, including the use of zygomatic implants when they are necessary. ZAGA Partner clinics also have access to the ZAGA Platform. ZAGA Partners are qualified to place the final prosthesis and can perform the rehabilitation treatment and ensuring patient follow-up at their respective health centers. Cases are therefore handled between the patient and a team consisting of the following professionals:
- ZAGA Partners: Walk patients through the entire process. They are responsible for making the diagnosis, placing the final prosthesis and for patient follow-up.
- ZAGA Centers: They are responsible for performing the procedure and for the immediate placement of the provisional prosthesis.
- ZAGA Integrated Solutions: They help facilitate a successful treatment as well as follow-up treatment by providing support in selecting patients, making a diagnosis and referrals, logistics and for communications between the different agents involved.
What is Zygoma Integrated Solutions?
Zygoma Integrated Solutions is an organizational platform designed to support ZAGA method zygomatic implant treatments. Through this platform, professionals share all medical, logistical and management aspects in order for the rehabilitation process to be successful. The team involved in treating patients consists of ZAGA Partners and ZAGA Centers, all certified by our team of ZAGA Experts. The experience that comes out of this platform allows for the continual improvement of protocols, techniques and instruments.
How does the ZIS platform work?
With the support of the team of ZAGA Experts, and through the platform, general dental practitioners or your family dentists (ZAGA Partner) will determine whether zygomatic implants are needed and will design the respective treatment plan. After this, patients are referred to their closest ZAGA Center for the procedure and immediate placement of the fixed provisional prosthesis. Criteria for this referral are based on geographic proximity, specific aspects of the diagnosis and on the complexity of the case. A ZAGA Center is made up of many different ZAGA Partners. Through this platform, ZAGA Centers continually gain experience as they treat more patients, which is why rehabilitation with zygomatic implants has the best success rates.
ZAGA Experts is the team that operates the Zygoma Integrated Solutions platform. It is made up of internationally-renowned surgeons and scientists known for their professional track record and for practicing a philosophy that is focused on applying the advances of medicine to put patient well-being first.
The objective of the ZAGA Experts team is to continuously improve the treatment of severe maxillary atrophy by conducting clinical trials and by fostering collaborations between different fields of medicine and technology. Through indexed publications and by participating in specialized international congresses, ZAGA experts contribute to all of the method’s new developments and breakthroughs and share this information with certified members.
ZAGA Experts are committed to clinical research and to the development of technology. They create and guide research protocols for later publication in scientific journals that adhere to the foundations of ZAGA Partners and ZAGA Centers.
MAXILLARY ATROPHY AND ZYGOMATIC IMPLANTS
What is severe maxillary atrophy and how is it treated today?
In certain situations, the bone of the upper jaw can “shrink” and become significantly smaller to the point that sometimes, it can literally disappear. This is what is known as “bone loss”.
The result of this is an upper maxillary bone made up of a very pneumatized sinus that contains a lot of air and is separated from the mouth by a thin bone septum, only a few millimeters thick. Colloquially, this is also known as “jawbone loss,” a situation where there is not enough bone material for conventional implants to be placed. Currently, our process involves using the cheekbone, or zygomatic bone, to anchor implants and place fixed teeth in 24 hours.
What are the cause of maxillary atrophy?
Maxillary atrophy usually occurs after tooth extractions, either due to dental infections and tooth decay, fractures or periodontal infections around the teeth, such as periodontitis or pyorrhea. Shrinkage of the maxillary bone can also be caused by losing dental implants or by bone graft failure. When sinus grafts fail, it is normal for maxillary atrophy to manifest more severely in the posterior areas of the mouth. Hormonal factors can also influence maxillary bone loss and is therefore common in middle-aged women. Finally, maxillary bone loss can be the result of resective neoplasm treatment, which affects the craniofacial bones.
What are zygomatic implants?
Zygomatic implants are longer than conventional implants. Starting at the residual maxillary bone, they are anchored to the zygomatic bone, malar bone or cheekbone. One of the distinguishing characteristics of the zygomatic bone is that, unlike the maxillary bone, tooth loss does not cause it to atrophy.
Zygomatic implants are used to secure fixed teeth in atrophic maxillary bones and help prevent complications that derive from the use of bone grafts in the maxillary sinus, nose or the alveolar ridge. Zygomatic implants are therefore the preferred option for treating tooth loss in patients who cannot have regular implants because of a lack of sufficient maxillary bone.
Advantages of zygomatic implants over bone grafts
The first advantage is that they help prevent the complications that derive from bone grafts, minimizing the risks of the intervention. In accordance with the ZAGA philosophy for zygomatic implant placement, a bone donor site (such as the hip) is not required. If bone grafts are not used, they do not need to be successful, and patients do not have to wait for months with missing teeth or with a removable denture for the graft to take place.
The success rate of bone graft procedures is approximately 80%. In other words, bone grafts fail in 20% of cases. Zygomatic implant treatments have a yearly 97% success rate. In other words, these treatments only fail in 3% of cases.
The treatment of bone loss or maxillary atrophy with bone grafts requires approximately 12 months until fixed teeth can finally be placed. Using zygomatic implants to treat bone loss or maxillary atrophy with the ZAGA method, however, requires less than 24 hours until a fixed prosthesis can be placed in the maxilla.
FREQUENTLY ASKED QUESTIONS
What type of cases are zygomatic implants recommended for?
Zygomatic implants are used as a last resource for people with bone loss in order to avoid the use of bone grafts, which are more aggressive and less predictable. When your ZZC surgeon uses the ZAGA method to place your zygomatic implants, you will benefit from having fixed teeth in just one day that are more aesthetic and similar in appearance to your original teeth. In addition to providing a better long-term prognosis, this procedure is less invasive, is specifically designed to adjust to your personal anatomical characteristics and the method makes patients less likely to encounter the complications of other zygomatic implants.
Are all zygomatic implants the same?
There are differences among the zygomatic implants that are currently available on the market. It is worth pointing out that, in addition to the surgical procedure, the design and composition of the implant to be used is also important in order to maximize the long-term success of the treatment. For this reason, results and potential complications vary widely depending on the materials and methodology used.
The ZAGA platform not only advocates for adapting the technique to each individual patient, but for adapting the implant’s design to the patient. Some of the benefits to ZAGA zygomatic implants are that their dimensions can adapt to the very complex cases of people who have severe atrophy, such as with female patients, and that placing these implants requires a less invasive procedure. ZAGA Centers give preferential access to implant procedures and other ZAGA designs.
Are there different ways of placing zygomatic implants?
There are various techniques that can be used to place zygomatic implants, as well as different types of zygomatic implants. Not all techniques for placing implants in the cheekbone nor all types of zygomatic implants will achieve the same results.
Unlike other methods, the ZAGA method for placing zygomatic implants uses a minimally-invasive osteotomy and an individualized pathway for each patient that usually includes part of the maxillary sinus and reaches towards the zygomatic malar bone, where it is anchored.
What is the ZAGA method for zygomatic implants?
The placement of zygomatic implants with the ZAGA method uses a minimally invasive osteotomy by following an individualized route for each patient that often passes through part of the maxillary sinus until it is anchored in the zygomatic (malar) bone. Zygomatic implants are used to attach fixed teeth to atrophic maxillary bones by avoiding the need for and the complications of bone grafts in the maxillary sinus, nose or alveolar ridge. Zygomatic implants are therefore the preferred option for restoring the missing teeth of people who cannot receive regular implants due to maxillary bone loss.
How long does it take to complete the treatment?
After the zygomatic implants are placed, and generally within 24 hours of the procedure, patients will receive a fixed denture called an “immediate prosthesis.” The final prosthesis is created after a 4-month period of using the provisional fixed teeth, during which time a soft diet is recommended. Throughout these first few months, it is normal for the inflammation in the gums to reduce; this creates gaps between the prosthesis and the gums that get bigger over time. The final prosthesis will fill these gaps and correct other technical and aesthetic aspects.
What is the success rate of this procedure?
At 92%, treating tooth loss with fixed prosthesis anchored on zygomatic implants has a very high 10-year success rate. With new developments such as the ZAGA method, these implants now improve patients’ prognosis by reducing the number of related complications.
What diagnostic testing is needed?
In addition to an intraoral examination, a panoramic X-ray is generally needed as well as an X-ray computed tomography, such as a Cone Beam CT. These tests do not eliminate the need for other medical tests.
Can there be complications?
As with all surgeries, there is always a potential for complications, so you should ask about your specific case in order to be informed of these in detail. Generally, however, the ZAGA method prevents oro-antral communication-related complications, which are common with other methods. Compared to 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.
What can be done if an implant is not successful?
There are few options to deal with the unsuccessful placement of a zygomatic implant. It is our firm belief that in the great majority of cases, patients who lose their teeth and have severe atrophy in their maxilla have only ONE opportunity to treat this tooth loss with fixed teeth, so the process has to be performed right on the first try. This is why it is best to rely on a center that is highly specialized in the restoration of extreme maxillary atrophy with zygomatic implants.
What type of teeth will I have after the procedure?
After the zygomatic implants are placed, and generally within 24 hours of the procedure, patients will receive a fixed denture called an “immediate prosthesis.” The process of permanently screwing-on teeth to the implants immediately after the operation for implant placement is called “immediate loading.” With this process, patients must have an understanding of the biological process of bone tissue repair, along with the technical aspects that must be considered for this immediate prosthesis. The general recommendation is for patients to maintain a soft diet and not smoke for approximately four months.
Why should I choose the ZAGA method for my zygomatic implant treatment?
The specialized professional that follows the ZAGA method understands and empathizes with the patient’s pain, however it manifests. Patient satisfaction is the main objective of all members of Zygoma Integrated Solutions.
With the ZAGA platform, ZAGA Centers are places where regional or local patients with severe maxillary atrophy can receive treatment when they are referred by a ZAGA Partner. This makes them the quintessential experts in the treatment of maxillary atrophy or bone loss. ZAGA Centers are in constant contact with affiliated general practitioners (ZAGA Partners) through the ZAGA platform, and therefore both will always have the information they need to provide individualized treatment.
ZAGA Centers are unique in that they use protocols that guarantee optimal long-term results. Moreover, they have access to state-of-the-art technology, such as ZAGA-design zygomatic implants, specially made to fit each individual anatomy.
Desde luego fue una decisión acertada ya que hoy puedo decir (como tantos otros imagino) que me ha cambiado la vida. Es por eso que agradezco sinceramente el trato recibido, tanto a nivel personal como por la profesionalidad mostrada en todo momento por todos ellos.
Cuando me colocaron la prótesis, ¡me parecía un sueño! Solo tengo palabras de agradecimiento al Doctor, por haberme dado la oportunidad de este sueño que me cambió la vida, y por todo el seguimiento y atenciones.