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Background <p>Rehabilitation of the severely atrophic maxillae poses significant challenges. Traditional zygomatic implant techniques often result in implant platform at the second premolar/second premolar-first molar junction, leading to unfavourable distal cantilevers. Alternative option of pterygoid implant presents surgical and prosthetic challenges. This paper introduces the ZyRAX protocol, a novel approach designed to eliminate cantilevers and simplify surgical management.</p> Methods <p>A retrospective case series of 15 patients (age 18–78) with severe maxillary atrophy is presented herein. The ZyRAX protocol combines the Rajan buttress zygoma technique (placing zygoma implants with emergence in the 1st or 2nd molar region) with the anterior implant placement (AX) in zones 1 and 2 (using axial, tilted, or trans-nasal approaches). Immediate loading with screw-retained PMMA bridges was performed within 24–96&#xa0;h.</p> Results <p>Twenty-six zygoma implants achieved adequate primary stability for immediate full-arch provisionalization. Two implants required a shortened dental arch provisional due to lower stability (&lt; 30 Ncm). Complications were limited to minor sinus membrane perforations (<i>n</i> = 2) and transient ecchymosis (<i>n</i> = 3), with no permanent neurosensory deficits.</p> Conclusion <p>The ZyRAX protocol effectively rehabilitates the severely atrophic maxillae by giving zygoma implant support in the first or second molar region, thereby eliminating distal cantilevers. The anterior implants are placed following the All-on-X concept. This approach theoretically could offer a biomechanically favourable alternative that may reduce the necessity for pterygoid or ipsilateral double zygoma implants.</p>

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ZyRAX Protocol: A Novel Concept of Maxillary Full Arch Implant Rehabilitation Using the Buttress Zygoma Implant

  • 期刊论文

  • 发表日期：

    2026年3月24日

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  • Gunaseelan Rajan,
  • Piet E. J. Haers,
  • L. K. Surej Kumar,
  • Harshhan Dhamu,
  • Tarunikaa Gopinath

摘要

Background

Rehabilitation of the severely atrophic maxillae poses significant challenges. Traditional zygomatic implant techniques often result in implant platform at the second premolar/second premolar-first molar junction, leading to unfavourable distal cantilevers. Alternative option of pterygoid implant presents surgical and prosthetic challenges. This paper introduces the ZyRAX protocol, a novel approach designed to eliminate cantilevers and simplify surgical management.

Methods

A retrospective case series of 15 patients (age 18–78) with severe maxillary atrophy is presented herein. The ZyRAX protocol combines the Rajan buttress zygoma technique (placing zygoma implants with emergence in the 1st or 2nd molar region) with the anterior implant placement (AX) in zones 1 and 2 (using axial, tilted, or trans-nasal approaches). Immediate loading with screw-retained PMMA bridges was performed within 24–96 h.

Results

Twenty-six zygoma implants achieved adequate primary stability for immediate full-arch provisionalization. Two implants required a shortened dental arch provisional due to lower stability (< 30 Ncm). Complications were limited to minor sinus membrane perforations (n = 2) and transient ecchymosis (n = 3), with no permanent neurosensory deficits.

Conclusion

The ZyRAX protocol effectively rehabilitates the severely atrophic maxillae by giving zygoma implant support in the first or second molar region, thereby eliminating distal cantilevers. The anterior implants are placed following the All-on-X concept. This approach theoretically could offer a biomechanically favourable alternative that may reduce the necessity for pterygoid or ipsilateral double zygoma implants.