ZYGOMA 2.0 - Allon4 Concept
The objective of the All-on-4 technique is to use only four implants strategically placed in regions of high bone density, enabling immediate loading.
The Allon4 classifications:
When you perform zygomatic implants but do not understand the All-on-4 philosophy, you often overtreat the patient, install zygomatic implants in cases that could be resolved with conventional tilted implants (Allon4 Standard).
If I could say what the core, the essence, the heart of the All-on-4 Standard technique is, I would say there are three pillars:
The palatal approach
Learn to position the posterior implants on the anterior wall of the maxillary sinus
maintain the spatial relationship of the initial perforation with the center of the face.
Let´s see how to tangent the anterior wall of the maxillary sinus
There are four strategies to do that:
1) For transparency
Immediately after total mucoperiosteal detachment, it might be possible to identify a more bluish region on the outer wall in the posterolateral part of the maxilla. It happens because of the thin thickness of the lateral bony lamina of the maxillary sinus. In such situations, it is easy to define the anterior limit of the maxillary sinus visually.
2) Drilling and probing
In cases where the outer cortical bone is thicker, and it is not possible to see a bluish region, we can make a small lateral opening in the maxillary sinus. We can use a probe or curette to touch where the anterior limit of the maxillary sinus is found. As we will not be placing particulate bone, there are no concerns regarding the integrity of the sinus membrane.
3) Post-extraction socket reference
When there are associated extraction procedures, it is possible to use the references of the position of the alveoli with surrounding bone availability so that we can define the position where it is possible to make the perforations.
4) Tactile perception
After the installation of the anterior implants, you can measure according to the tomographic exam and make the initial perforation inclined to the anterior one and notice if you have found bone resistance during the entire perforation or felt a sensation of "falling into the void" inside the maxillary sinus. If you have fallen into the void, you have to change the direction of the perforation toward anterior until you find bone resistance.
Simplicity is the maximum degree of sophistication.
Leonardo da Vinci
Yes, the Allon4 is a simplified technique, but it is not simple. Learning all the technical details is essential.
I am preparing some detailed videos with these and other technical details about the Allon4 technique.
Soon I will share more about it.
The problem is that, when it comes to Allon4 Hybrid or Zygoma, there are no clear visual references, and the teaching process is directed to Branemark, Stella, Extra Sinus, or ZAGA technique. That´s here that the ZYGOMA 2.0 Concept can help us.
In order to optimize my assertiveness, I would like to know from you what kind of information my video must-have.
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