Z-classification: an anatomy-based ridge–sinus–zygoma classification and decision funnel for zygomatic implantology

The rising demand for zygomatic implants (ZIs) in contemporary dental implantology underscores the need for an anatomy-based categorization system and a surgical decision-making panel that takes into account anatomical, biomechanical, and prosthetic factors to determine the final surgical strategy. This article proposes a new Z-Classification, the anatomical division of the maxillo-zygomatic complex. The classification was developed from the authors’ clinical experience of 882 ZIs placed in 234 patients across two centres over a ten-year period. According to anatomical presentations, 6 classes were described. The classification is intended as a practical framework for preoperative assessment and treatment planning in ZI rehabilitation. It has not yet been validated against clinical outcomes. Additionally, a decision funnel for surgical strategy development and the structured checklists consisting of crucial clinical parameters for long-term success in ZI therapy were proposed. The presented tools will potentially optimize a complex decision-making algorithm in zygomatic implantology. The proposed Z-Classification and the decision funnel carry the potential to reduce the risk of complications associated with zygomatic surgery.