Increasing the chances of a successful full-arch implant integration is a no-brainer. But how do we actually do that?
Here are 6 ways that I try to improve the probability that a full-arch implant case will successfully integrate:
1. Maximize AP spread (Surgeon)
If you can reduce or eliminate a cantilever (I prefer a one-tooth cantilever or less), your chances of integration will skyrocket.
2. Maximize Torque (Surgeon)
While a CTV (composite torque value) of 120 N-cm is the accepted standard for immediate loading, I aim for a CTV of 180 N-cm or greater for each case.
3. Reduce/Limit the Prosthetic Cantilever (Restorative Provider & Surgeon)
We addressed AP spread (the surgeon’s job). Management of the cantilever, however, is the job of the restorative doctor (within reason). Working closely as a team to make strategic prosthetic changes to reduce a cantilever is key to consistent success.
4. Avoid Abutment Changes After Surgery (Restorative Provider)
Changing abutments after surgical closure is less than ideal for several reasons. Avoid this if at all possible.
As the surgeon, this assumes you are placing abutments in prosthetically driven positions before handing the case off to your restorative provider.
Ideally, an abutment check is completed during surgery with your restorative provider. Changing abutments during surgery when your flap is open is the preferred time for this to occur.
5. Optimize Occlusion/Occlusal Forces (Restorative Provider)
Optimal/Balanced occlusion is paramount to successful integration. A poor occlusion will beat a great surgery every time.
6. Spend Time Educating Patients (Surgeon & Restorative Provider)
Take time to personally discuss things like post-op diet, nightguard use, and hygiene to improve the chances of successful surgical healing and eliminate the risk of a compliance-related failure.
Focus on perfecting these 6 areas, and you’ll have immense success in full-arch surgery.
“We always hope for the easy fix: the one simple change that will erase a problem in a stroke. But few things in life work this way. Instead, success requires making a hundred small steps go right, one after the other, no slipups, no goofs, everyone pitching in.”
Atul Gawande