Dentaltown March 2018 - 56

Zone 1:
Premaxilla

Zone 2:
Premolars

Zone 3:
Molars

Zone 4:
Zygomatic bone

Fig. 4: Bedrossian zone classification

Bone Availability

Surgical Approach

Zones 1, 2, 3
(Lack of composite defect)

4-8 axial/traditional implants

Zones 1, 2
(Composite defect)

All-on-4 concept (4-6 implants)

Zones 1, 4
(Composite defect)

Anterior maxilla: 2-4 implants
Posterior maxilla: 2 zygomatic implants

Zone 4
(Composite defect)

Quad zygomatic implants

Fig. 5: Maxillary treatment algorithm for graftless or immediate load approach
based on available bone, using the Bedrossian zone classification.

Fig. 6: Ad modum Brånemark technique, which sometimes
necessitated a palatal emergence of the restorative platform

dimension of occlusion. The need for
bone-reduction or alveolectomy is also
predetermined to provide for the necessary
prosthetic component space, hiding the
transition-zone and creation of a hygienic
and cleansable prosthesis (Fig. 5).

Zygomatic implant therapy
Brånemark developed zygomatic
implants in the mid-1980s for treatment

56

MARCH 2018 // dentaltown.com

of maxillofacial oncologic patients who
had undergone maxillectomy procedures.
Later, zygomatic implants found use
as alternative or last-resort options in
full-arch maxillary rehabilitations-first
in delayed or staged manner, and later as
an immediate function/load approach to
salvage cases while avoiding extensive
bone-grafting procedures. Today, zygomatic implants are no longer considered
alternative or last-resort options, but
rather a routine, reliable and predictable
primary treatment by many surgeons and
prosthodontists.
The original Brånemark protocol
dictated that the zygomatic implant
would have quad-cortical stabilization
based on a trajectory that proceeded from
the palatal side of the residual alveolar
process through the maxillary sinus,
with subsequent entry into the zygomatic
bone, ultimately exiting through the
superior/lateral cortex of the zygoma. The
main drawback from this approach was
often a significant palatal emergence of
the implant restorative platform, which
then resulted in bulky prostheses, made
hygiene more difficult and sometimes
created difficulty with speech (Fig. 6).
Modifications of the ad modum
Brånemark technique were developed by
several clinicians such as Drs. John Stella,
Carlos Aparicio and Paulo Malo in an
effort to overcome some of the challenges,
limitations and complications faced by
using the original protocols.
Aparicio devised a classification system called the zygoma anatomy-guided
approach, or ZAGA concept, which
focused on an individual's anatomy rather


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Table of Contents for the Digital Edition of Dentaltown March 2018

Dentaltown March 2018 - Intro
Dentaltown March 2018 - Cover1
Dentaltown March 2018 - Cover2
Dentaltown March 2018 - 1
Dentaltown March 2018 - 2
Dentaltown March 2018 - 3
Dentaltown March 2018 - 4
Dentaltown March 2018 - 5
Dentaltown March 2018 - 6
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Dentaltown March 2018 - Cover3
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