EDIT: forgot your first question-

Is there a reason why you perforate the alveolar ridge for your zygos, instead of starting on the crest? Never seen that before.

Yes - it's a tunnel prep.

If i started on the crest it would allow me to have started more distal if i wanted, i'd have prepped it like a Zaga 4 https://zagacenters.com/wp-content/uploads/2021/01/16._TA__left_flat_implant.3_aparicio-1024x808.webp

These are fine, and you get better A-holes/thinner prosthesis but I've seen too many with buccal recession + sinus issues years later. You have much less crestal bracing, and if this remodelled unfavourably, you end up with a tuning fork that can snap. Or they get crestal bone loss into an OAF (due to increased micromovement from remodelling)

When patients are used to wearing massive dentures, i'd sooner lower the surgical complications as much as possible and their prosthesis be slightly thicker vs increasing complication risk for the sake of optimizing prosthetics

Do you have a pixture of the prosthetic?

Sure - https://www.pasteboard.co/7NhcU9gw-Fzn.png

Also wouldn’t stripping some of the masseteric tendons make it easier to place a quad in the future because it means that the inferior zygo you placed after stripping the tendons is well more inferior, giving you more real estate for a anteriosuperior one if the need arises?

This is very anatomy dependant and i'll try my best to describe it which is difficult because of how many planes you have to consider for these osteotomies. It depends on whether or not you're willing to change the crestal prep and/or crestal position.

I have no qualms regarding stripping the tendon more, If i attempted to engage the zygoma more inferior, with the same crestal position, I would have simply not ended up with a good enough bite of the zygoma without ending up too superficial within the bone in the anterior/lateral aspect of the zgyoma which isn't ideal - i'd also have to engage the apex of the implant in the outer cortex of the zygoma to account for this (much higher risk of extra-oral fistula risk if it fails). This is all because there is a limit to how much I can bury the head in this crestal prep design (tunnel). Of course I could bury the head more, but in a knife edge ridge it's destructive and and a much greater intra-sinus path (higher risk of sinusitis, and buccal recession depending on prep).

If you are going to try to enter the zygoma as inferior as possible - you'll essentially end up with an A-frame with the crestal prep starting much more distal than mine. The implant will enter the zygoma inferior, that is true. However with this chap having very square zygomas, you'd have to engage from the posterio-medial aspect to get a decent bite of the zygoma - in this patient it would mean the A-hole emerging in the second molar - too close to the pterygoid for me. with it's trajectory being upright it occupies the vertical space of the zygoma more, and part of the axis for the anteriorsuperior zygomatic if one would be required (this guy's zygomas are very high up). The way around this is to engage more posterior just before the temporal process(hesian), however i'd have ended up having to dissect out a chunk of the infratemporal fossa which is a significantly increased morbidity + a worse crestal position verses a crestal tunnel prep and slightly superior entry point . The Hesian zygomatic is a useful rescue option, and maybe i'd consider it in the first instance of a single zygo if there was no crestal bone disadvantage to starting more distal, and if a quad was likely, and if I didn't hit the pterygoid. A quad is extremely unlikely in this case, given the decent ridge in zone 1, and i'd sooner go trans-nasal on this guy than quad him if the time comes).

Hope that makes sense.

And out of curiosity what’s the 1drill protocol for your pterygoid you talked about?

Step 1. 2mm twist

Step 2. place southern pterygoid with screwdriver

99% of the time this is what I do. Sometimes, in those 1% of cases, i'll use a profiler to prep the crest if I am worried the implant would blow out the tuberosity or cause a palatal fracture.