ZAGA Center’s David Pastorino: “The development and potential of zygomatic implants”
With his background in material science and bone regeneration research, dental implantology was a logical move for David Pastorino. Now the Director of ZAGA Centers – a global network of expert clinics dedicated to the provision of complex treatments using zygomatic implants – he shares his perspectives on the growth and development of this niche area.
It has taken some time to develop the right techniques and materials for zygomatic implants, for which the main benefit is the immediacy they provide in cases where no other solution would work in severely atrophic maxilla.
Traditionally such cases had been treated with major block bone grafting, a complex procedure which sometimes involved a second surgery and was only successful in 80% of cases. Patients were also left a long time without dentures, which had a significant social impact.
Zygomatic implants address and help eliminate these issues. Immediate loading means no time without teeth and patients can usually eat and speak normally within a few short months. The cost is equivalent to conventional treatments; quality of life is substantially improved, and success rates are higher, which makes zygomatic procedures a very attractive investment for patients.
The field has undergone slow but significant change over the past 25 years. When they were first introduced zygomatic implants were considered a treatment breakthrough, but there were complications, particularly rhinosinusitis and extensive soft tissue recession. Even when the surgical technique was adapted and an extra maxillary approach possible, this often solved the sinusitis problem only to worsen the soft tissue recession.
Today the zygomatic option has been refined, both in terms of surgical technique and implant design. For example, the ZAGA concept, an evidence-based protocol developed by Carlos Aparicio in Spain, helps clinicians select the most appropriate surgical approach according to the patient’s anatomy, significantly reducing the risk of complications.
The design of zygomatic implants has also been developed. Once just longer versions of normal implants, they are now designed for the specific forces they must withstand, and the recent advent of purely titanium implants has meant zygomatic solutions could be made narrower without compromising stability or safety.
New adapted designs have been developed to meet clinical requirements, such as the Straumann ZAGA Flat and ZAGA Round zygomatic implants. Now on-going research suggests that sinusitis rarely occurs, compared to 75% in the past. We accept that there is always room for improvement, but zygomatic implant techniques have reached a level of maturity that makes treatment safe when used correctly.
Zygomatic implants no longer need to result in chronic complications, and you don’t have to have “golden hands” to place them. Clinicians do need experience and specific training, but they do not need to be Picasso. With the right education, support, protocols and tools, zygomatic implants can be successfully and predictably placed.
Yes, there are valid reasons why some clinicians may not be willing or able to commit to, and invest in, the extensive training needed for the safe placement of zygomatic implants. Demand is relatively low – although it is rapidly increasing with the growth of awareness and training.
Even so, if every dental practice were to offer zygomatic implants, they would only treat a few patients per year, so it may make more sense to refer. Whether you are referring patients or interested in training in the field, international ZAGA Centers offer support.
ZAGA zygomatic experts
We have an extensive network of over 48 locations globally, including the Centre for Oral-Maxillofacial and Dental Implant Reconstruction in Manchester, led by professor Cemal Ucer. All Centres share a mission to educate oral surgeons interested in zygomatic implants and to provide treatment to patients with few other options available to them.
We both promote Dr Aparicio’s ZAGA (Zygoma Anatomy-Guided Approach) and build on Professor Branemark’s classification and treatment protocol based on the patient’s anatomy for dramatically improved success rates. ZAGA Centers provide a concentration of oral surgeons placing zygomatic implants, allowing them to share accumulated knowledge, experiences and expertise.
We focus on advancing the science and minimising complications for successful, stable outcomes. We believe transparency and honesty are the only ways to maintain the very highest standards of treatment, meaning there are strict requirements for any clinicians interested in certifying as a ZAGA Center.
To be accepted, professionals must be taught and mentored by some of the most experienced professionals in their field, and attend our programme in Barcelona. Our dedicated panel of professionals will also review cases submitted by those interested in joining the ZAGA community – always focusing on the science and clinical development, rather than individual achievement.
Although just a few years old we are growing and our formula is working very well. Techniques and materials exist today that facilitate highly successful treatment of severely atrophic patients with zygomatic implants, patients who are then educated to understand the treatment and encourage the retention of their safe, and predictable, fixed upper denture.
For more information regarding the Centre for Oral-Maxillofacial and Dental Implant Reconstruction, contact Professor Ucer at
For details about the global ZAGA Centers, visit https://zagacenters.com/
