Title: The zygoma anatomy-guided approach (ZAGA) for rehabilitation of the atrophic maxilla

Abstract

A protocol to perform a prosthetically driven minimally invasive zygomatic osteotomy, named zygoma anatomy-guided approach (ZAGA) is introduced. The ZAGA method aims at promoting a patient-specific therapy by adapting the osteotomy type to the patient’s anatomy. In most cases, this method avoids the opening of a window or slot into the lateral wall of the maxillary sinus before implant placement. Instead, a mucoperiosteal flap, including the posterior maxillary wall and the superior zygomatic rim, is raised to allow visual control of the complete surgical field. The surgical management of the implant site is guided by the anatomy of the patient according to specific prosthetic, biomechanic, and anatomic criteria. The ZAGA Concept represents the logical evolution of the extra-sinus technique and ZAGA classification previously described. The results of using the combination of the ZAGA Concept together with the new ZAGA implant designs consistently show less traumatic osteotomy; better implant stability; improved bone to implant contact, and bone sealing around the implant neck. Additionally, the rate of late complications such as oral–sinus communication or soft tissue recession dramatically decreases when compared to the original technique.