Smart Zygoma protocol

I remember 20 years ago leaving a Nobel Biocare Zygoma Implant training course thinking to myself, Not a chance; I am ever going to do that! Most patients faced with complete tooth loss at that time would be treated in my practice with conventional sinus augmentation, ridge augmentation, and root form implants. It seemed too invasive at the time without a real value proposition when compared to the systems and protocols that already worked in my hands. A big complaint among restorative dentists was that the surgical technique employed at that time resulted in excessive palatal emergence of the implant platform. This meant that the prostheses created were extremely thick and bulky on the palatal aspect, often interfering with speech and optimal hygiene. Our entire team didn’t see the real value in zygoma implants 20 years ago, particularly when immediate load wasn’t commonplace in the maxilla. We would just wait 6 to 9 months for grafts to consolidate before restoring ideally positioned implants.

What is the Smart Zygoma method?

The original zygomatic implant surgical techniques have been modified to a more extrasinus path for zygomatic implants using the ZAGA method. The anatomy-guided approach is a methodology that focuses on individual anatomic presentation to immediately rehabilitate the severely atrophic maxilla while minimizing the risk of maxillary sinus-associated complications and pathology. The relationship between the zygomatic buttress and the intraoral starting point of the implant will guide the zygoma implant to be positioned fully intrasinus or even completely extrasinus. The ZAGA approach promotes the placement of implants according to the individual anatomy of the patient.

The Smart Zygoma method combines a detailed presurgical planning and prototyping with the ZAGA approach to facilitate a predictable surgical and restorative procedure. To carry out the Smart Zygoma protocol, we start with a large field-of-view CBCT scan to enable complete assessment of the region. Careful planning is then carried out to position the zygomatic implant fixtures in ideal anatomic and prosthetic position. We ensure that the implants are optimized for maximum bone anchorage while avoiding critical anatomical structures. The plan is exported to a 3D-modeling software for model preparation and then sent to our 3D printer where a medical-grade resin prototype is created. In about 30 minutes, we have a replica of the surgical plan. The prototype is cured, cleaned, and brought to the surgical field for use. The Smart Zygoma prototype is then used during surgery to triangulate visual reference points (such as the infraorbital foramen, pyriform aperture, zygomaticomaxillary suture, and zygomatic buttress) with the drill trajectory. When using this Smart Zygoma method, we can ensure a safer and more predictable outcome.

To those of you who perform a significant amount of full-arch or full-mouth implant surgery and have not incorporated zygoma implants yet, I encourage you to do so now. New technology and the Smart Zygoma process doesn’t make the procedure any easier or less daunting, but it certainly can now be performed with a higher degree of safety with more precision and control.

If you restore full-arch or full-mouth cases, it’s time to consider referring these patients for a zygomatic implant workup in lieu of complex bone augmentation, knowing that your patients can have teeth immediately, and in most cases, with beautiful, functional smiles.

What a great time to be in dentistry. All the blessings, prosperity, and health in 2021 and for years to come.

Dr. Brian Young