Key points
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The essence of the ZAGA Concept is to provide the patient with a zygomatic anchored rehabilitation according to their specific anatomy.
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ZAGA Concept includes the choice of the adequate implant design able to adapt to the performed osteotomy.
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The ZAGA concept recommends aiming for a tunnel osteotomy, whenever possible, regardless of the maxillary wall curvature.
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A channel osteotomy is a groove made on the coronal-alveolar bone and sometimes also in the lateral maxillary wall and zygomatic buttress.
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It is critical to preserve the sinus membrane integrity and as much bone thickness as possible at the zygomatic implant critical zone crest level.
The zygomatic anatomy-guided approach concept
The zygomatic anatomy-guided approach (ZAGA) was described as a refinement of the extrasinus technique for placement of zygomatic implants (ZI). The concept seeks a patient-specific therapy and applies to all the atrophic maxillary anatomies. According to the ZAGA concept, placement of the ZI is guided by the anatomic and prosthetic requirements. The osteotomy goals ( Box 1 ) are to achieve maximum primary stability, optimal anteroposterior (AP) distribution, and implant trajectory and position that prevent potential long-term complications, such as oral-antral fistula formation or soft tissue dehiscence ( Figs. 1–113 ).
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Accomplish a prosthetically driven implant trajectory, placing the implant head at the optimal dental position.
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Achieve optimal AP distribution of the implants.
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Achieve maximal implant primary stability.
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Preserve as much bone as possible at the maxillary wall and alveolar bone.
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Maximize the BIC along the length of the whole implant. This includes alveolar, maxillary wall, and zygomatic bone.
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Complete sealing of the osteotomy by the implant body.
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Protect the sinus integrity at the implant head/neck level to prevent late sinus-oral communication.
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Prevent soft tissue dehiscence.
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