Guided Zygomatic Implant - The SkinGuide Concept
- Fernando Giovanella
- Apr 18
- 8 min read
For dental surgeons venturing into the intricate realm of zygomatic implant procedures, achieving consistently predictable and remarkably accurate osteotomy has historically presented a formidable challenge. The inherent variability of the zygomatic bone's internal architecture, often exhibiting a stark contrast to its external contours, can frequently lead to implant misplacements and subsequent complications.
Moving Beyond Deceptive External Anatomy
Experienced zygomatic implant surgeons intimately understand that placing complete reliance on external anatomical landmarks alone is a strategy fraught with potential pitfalls.
The external anatomy of the zygomaric area does not correspond to the internal anatomy
The anatomical structures described in textbooks often present a simplified or idealized version of the human body. However, in clinical practice, we are frequently faced with a striking reality: the anatomy of each individual patient varies significantly. This is particularly true in the maxillary and zygomatic regions, where there is an enormous range of anatomical variability. Differences in bone volume, sinus size, cortical thickness, and the spatial relationship between the maxilla and the zygomatic bone can greatly influence surgical planning and outcomes. These variations mean that the “standard” anatomy we study during our training rarely represents the reality we encounter in the operating room.
This critical insight underscores the inherent unreliability of attempting to achieve the ideal implant position based solely on visual assessment during surgery.
The application of traditional full guided surgery for zygomatic implants introduces its own set of complexities, stemming from the substantial length of drills required and the inherent difficulty in establishing stable guide fixation. These challenges can unfortunately result in apical deviations during drilling and even the frustrating breakage of the guide itself.
The limited surgical access often renders the placement and secure fixation of these bulky guides exceptionally difficult. Compounding this issue is the fact that zygomatic implant surgery necessitates the use of exceptionally long drills. In conventional guided surgery, it is well-established that the most significant deviation in drill trajectory tends to occur at the apical tip of the osteotomy due to the constraints of the guide sleeve. Given the extended length of drills used in zygomatic implant procedures, this apical deviation can be substantially amplified, potentially leading to unintended and even dangerous outcomes.
The inherent difficulty of achieving stable guide fixation on the often oblique surfaces of the zygomatic bone, coupled with the tangible risk of guide breakage under the considerable pressure exerted by long drills, further underscores the limitations of this approach. The challenges extend to the surgical workflow itself, with the bulkiness of these guides potentially hindering flap repositioning, visualization of the surgical site, and irrigation during the critical osteotomy phase. Furthermore, the lack of standardized surgical guide kits specifically designed for zygomatic implants often forces surgeons to improvise with mismatched components, an approach that is far from ideal.
A New Approach
But what if there existed a beautifully simple yet extraordinarily effective solution to these persistent challenges? Allow us to introduce the SkinGuide© Concept, a truly simple approach poised to transform the landscape of zygomatic implantology.
This innovative method seamlessly translates the precision of virtual surgical planning into tangible, intraoperative guidance, ushering in an era of unprecedented predictability and a newfound sense of calm for surgeons performing these complex procedures. See the whole concept below:
This concept was inspired by the simple truth that "if you have two points just two simple points you can draw a line. And with a line you create a path. A clear path is all you need to achieve perfection in zygomatic implants".
The Skin Guide Solution: Elegantly Simple in Design
Here's a more detailed breakdown of how the SkinGuide elegantly bridges the gap between virtual planning and precise surgical execution:
Virtual Precision as the Foundation: The process commences with meticulous virtual treatment planning using specialized software. During this crucial stage, the ideal three-dimensional position of the zygomatic implant is precisely determined, taking into careful consideration both the available bone volume and the desired prosthetic outcome. This detailed planning culminates in the identification of point A and point B – these two simple yet profoundly important points define the perfect and intended implant path. As the video emphasizes, this virtual clarity holds immense potential, but its true power is realized when it can be translated into the physical surgical environment.
Tangible Guidance in the Surgical Field: The SkinGuide acts as the crucial intermediary, transforming this virtual precision into a tangible surgical template. Crafted based on the individual patient's anatomy and the pre-determined points A and B, the Skin Guide is designed for accurate and stable placement directly onto the bone. The surgeon then simply places the SkinGuide onto the appropriate anatomical region and marks the two designated points onto the bone surface using a surgical pencil. This seemingly straightforward step effectively transfers the ideal surgical path, meticulously planned in the digital realm, directly onto the ideal portion of the zygomatic bone.
Eliminating the Guesswork and Stress: This ingenious approach fundamentally eliminates the need for "trial and error or large bone windows" during the critical osteotomy phase. Surgeons are no longer required to rely on subjective visual assessments or the potentially misleading external anatomy to determine the correct drilling trajectory. Instead, the clearly marked path on the bone provides a definitive guide, allowing the surgeon to concentrate on executing a single, accurate osteotomy with confidence and precision.
Our goal is to finish the case like this. You're proper planning your case. You're put your implants in the best position and that's it. There is no room for error. You're planning and execute". This shift towards a pre-defined and validated trajectory significantly reduces the anxiety and insecurity often associated with zygomatic implant surgery.
Perfect planning end execution Re-evaluating the Role of Prototypes: From Trial and Error to Smart Guidance
The Skin Guide Concept also prompts a critical re-evaluation of how prototypes are utilized in zygomatic implant surgery. The video strongly cautions against the common but misguided practice of using prototypes for "trial and error" to haphazardly locate the zygoma during surgery. Instead, it champions the use of "smart prototypes" as sophisticated tools to verify the pre-planned implant trajectory and depth. The true, and far more effective, function of the prototype is to "show you the best path of the dental implant that you have already planned in the software". By virtually positioning the implant in the planning software and then subtracting it from the bone model, a "virtual osteotomy" prototype is created, providing a clear visual guide to the intended osteotomy site and depth. This approach ensures that the prototype serves as a confirmatory tool, validating the pre-planned surgical strategy rather than being used as a means of exploration in the surgical field.
The Synergistic Role of the Smart Prototype: The Skin Guide is frequently employed in conjunction with a Smart Prototype. This prototype is generated digitally by virtually subtracting the planned implant volume from the three-dimensional bone model. The resulting physical prototype, often featuring a perforation indicating the planned implant axis, serves as an invaluable depth guide.
Virtually osteotomized prototype. Why do it freehand? By visually referencing the Smart Prototype during osteotomy preparation, the surgeon can ensure that the drilling reaches the ideal depth as determined during the virtual planning stage. It effectively acts as a "road map", providing a visual confirmation of the intended osteotomy pathway and depth. This eliminates the often misguided use of prototypes for "trial and error" to locate the zygoma. Instead, the Smart Prototype's true function is to "show you the best path of the dental implant that you have already planned in the software".
The Key Advantages of the Skin Guide Concept:
Unparalleled Simplicity: The Skin Guide embodies the principle of elegant simplicity, requiring the identification and transfer of just two points to define the ideal implant trajectory. As the video emphasizes, "It isn't complicated or complex. It's elegantly simple". This ease of use translates to a more streamlined surgical workflow and a reduced learning curve for surgeons adopting the technique.
Enhanced Predictability: By directly transferring the meticulously planned virtual implant position onto the surgical site, the Skin Guide significantly elevates the predictability of zygomatic implant placement. Surgeons can approach the procedure with a "calm and confident mind", knowing that they are following a pre-validated path to the optimal implant location.
Accuracy: The SkinGuide empowers surgeons to consistently achieve the "best position" for the zygomatic implant, maximizing bone engagement and primary stability, which are critical for successful osseointegration. This focus on accuracy aligns perfectly with the fundamental principle of leveraging the "maximum bone availability according with the internal anatomy".
Significant Reduction in Stress and Anxiety: By providing a clear and unambiguous surgical pathway, the SkinGuide plays a crucial role in mitigating the "anxiety [and] insecurity" often experienced by surgeons during complex zygomatic implant procedures. The elimination of guesswork and the reliance on precise pre-planning foster a greater sense of control and confidence.
Prosthetically Driven Implant Placement: The Skin Guide Concept strongly encourages a prosthetically driven approach to treatment planning. By considering the final prosthetic restoration during the initial virtual planning phase, the Skin Guide ensures that the implant is ideally positioned not only for optimal bone anchorage but also for the delivery of a functional and aesthetically pleasing prosthesis. As the video highlights, the main reason for bone anchorage is to "delivery a good prostesis to our patients".
Ideal prosthetic planning Embracing the "Sniper Surgeon" Philosophy: The SkinGuide facilitates the adoption of a "sniper surgeon" mentality – the ability to "define the right position and give one shot and it's done". This philosophy emphasizes meticulous planning and precise execution, minimizing the need for intraoperative adjustments and maximizing the efficiency of the surgical procedure.
Conclusion: Embracing a Future of Predictable and Confident Zygomatic Implant Surgery
The SkinGuide Concept undeniably represents a significant leap forward in the field of zygomatic implantology. By championing simplicity, accuracy, and a seamless integration of virtual planning with surgical execution, it empowers surgeons to achieve consistently predictable, remarkably accurate, and significantly less stressful outcomes for their patients. It encourages a move away from the inherent uncertainties of relying solely on external anatomy and the practical limitations of traditional full guided surgery. By embracing the SkinGuide and the principles of meticulous virtual planning and precise physical guidance, surgeons can confidently step into the role of the "sniper surgeon", delivering exceptional results with calm assurance and enhanced predictability.
Are you ready to elevate your zygomatic implant practice and embrace the predictability and confidence offered by the SkinGuide Concept? Stay tuned for full online course or clinical training. Check de links below.
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