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Over the past decade numerous approaches to the rehabilitation of severe maxillary atrophy have been suggested. Most approaches involve the utilization of the Zygoma for anchorage of specially developed extra long Implants. These implants often must either enter through the sinus or pass along the outside of the sinus wall depending upon the transverse discrepancies and horizontal ridge resorption issues as well as future occlusal scheme with the mandibular arch. Different ZAGA approaches have been suggested and most today are using an extra-maxillary approach with the implants passing outside the lateral sinus wall. This approach has the potential compromising issue of maintaining the soft tissue around the long smooth collar without recession and mucositis. This new approach described in this presentation addresses this potential compromise through extra-maxillary bone grafting performed at the time of Zygoma placement utilizing fresh frozen iliac bone and bone marrow aspirate. Multiple cases will be highlighted and short term follow up described.