Zygoma Anatomy-Guided Approach "Scarf Graft" for Prevention of Soft Tissue Dehiscence Around Zygomatic Implants: Technical Note

Different surgical approaches including the slot and the extrasinus techniques have been described to overcome disadvantages of the original Brånemark technique for the placement of zygomatic implants. A new concern associated with zygomatic implants placed externally to the maxillary wall is the possibility of disturbing buccal soft tissues, ending up with a dehiscence and a potential infective problem. Recently, a new methodology known as the Zygoma Anatomy-Guided Approach (ZAGA) has been described based on the concept of delivering specific therapy for each patient. ZAGA involves a variety of possibilities of implant trajectory from the intrasinus to an eventual extrasinus passage according to variations in patient anatomy. ZAGA methodology includes a rationale of how to prevent most of the reported complications of zygomatic implants. The objective of this technical note is to introduce the "Scarf Graft" as a part of the ZAGA protocol intended to prevent soft tissue dehiscence around extramaxillary zygomatic implants. A pediculated connective tissue graft is placed around the neck of the extramaxillary zygomatic implants. The increased connective tissue thickness consistently gives stable gingival tissue for prevention of recession. Currently, the treatment of soft tissue dehiscence around zygomatic implants does not have predictable results. Protocols for its prevention, such as the proposed ZAGA Scarf Graft, should be incorporated if an eventual dehiscence is foreseen. Keywords: extramaxillary implants, Scarf Graft, soft tissue dehiscence, soft tissue recession, ZAGA, zygomatic implants