My first step into the zygomatic implants started around 4 years ago. I went to Brazil and did live patient hands-on training. During a one-week immersive experience with other surgeons from the UK I placed 9 zygomatic fixtures in 5 patients. I have been carrying out this procedure ever since.
I recently attended a 3-day Zygoma course with Carlos Aparicio in Manchester and I would like to share my takeaways from this course. Learning from an expert in Zygomatic implants was an opportunity I could not miss. Carlos has multiple published articles in journals around zygomatic implants, developed the ZAGA concept, written a textbook on zygomatic implants and designed the latest Straumann zygomatic implant.
Here are my five takeaways from the course:
1 / the most important instrument is the pencil!
2 / the importance of meticulous planning and 3D printed models
3 / learn about complications to avoid them
4 / the right patient, surgeon and technique is the true key to success
5 / creating an osteotomy
During hands-on training on models, Carlos instructed us to mark the entry point on the alveolar crest and the entry point into the zygomatic bone. He did not let us drill until we showed him the markings! My take away from this was if someone as experienced as Carlos with over 40 years of clinical experience uses a pencil in EVERY case, then I need to get into the habit of using a pencil in every operation, not just in full arch surgery.
Over the 3 days the importance of planning was repeatedly mentioned. This involved placing implants on planning software to guide placement into the most appropriate sites. Step 2 involved mock surgery on a 3D printed model. Again, I reflected on this and decided to advise all my mentees to have models 3D printed prior to surgery and carry out a run thro the surgery.
Whenever we learn about surgical procedures we must understand associated potential complications. The best way to manage these is prevention. The two most common complications associated with zygomatic implants is buccal soft tissue dehiscence and rhino-sinusitis. It is important to understand the aetiology of these complications, to allow adequate steps to be preformed to reduce the risk of them developing. The risk of developing can be reduced by adapting your zygomatic implant technique, preserving buccal bone around the head of the zygomatic implant and soft tissue enhancement procedures such as the SCARF technique. (described by C Aparicio)
Carlos also focused on achieving success. He said the key to success is the dependant on multiple factors aligning. The right patient, a competent/trained surgeon and the correct technique.
Finally, he emphasised the preparation of the osteotomy. I have also talked about this before in a previous blog where I mention “know your implant, know your drill and know your bone.” This is vital, but Carlos also talked about using both hands to support the drill during osteotomy preparation and keeping your drills perpendicular to the path of the osteotomy. Your assistant should retract the tissues to allow adequate exposure of the surgical field. The importance of this is magnified when working with longer drills and creating a longer osteotomy.
What a wonderful 3 days of learning with like-minded colleagues. A highly recommended educational programme for anyone looking to advance into zygomatic implants.
Dr Ferhan Ahmed