W2 Technique for the placement of zygomatic implants and the new guidelines for optimal implant surgical approach: a technical note.

There are several published scientific articles warning about the risks and complications of penetration of zygomatic implants into the orbital cavity, some of which lead to irreversible consequences. Digital dentistry is a reality, with positive impact on the manufacture of surgical guides for the placement of zygomatic implants, which should decrease orbital iatrogenesis. However, contemporary literature has revealed that there is still a minimal difference between the planned position and positioning of the implants, resulting in small deviations. Within this context, it is necessary to follow protocols that support the digital workflow so that the zygomatic implant placement technique can be performed safely by a higher number of surgeons, who still feel confident about performing the technique freehand. The purpose of this technical note is to present a safe freehand surgical protocol for the placement of zygomatic implants, entitled the W2 Technique, in cases where there is anatomically no buccal bone tissue at the head of the zygomatic implant and the middle and cervical thirds of the implant are exteriorized, with part of the zygomatic implant body visible and outside the maxillary sinus, and to present new guidelines for the surgical approach to optimal implants, based on the radiographic zones of the maxilla. The surgical protocol presented is a safe protocol for the placement of zygomatic implants freehand, with the aim of reducing the risk of ocular complications and adjacent tissues.