Full-arch surgical techniques, theory, and clinical expertise.
Integrated implants in the way of your arch? They are usually less of a problem than they look. The three options every full-arch surgeon should consider, and when to tread carefully.
Read Article →Confirming osseointegration of full-arch implants is typically done by most providers at the 4 month mark. I also adhere to this standard. There are many different techniques, as well as some fancy…
Read Article →
At the heart of any hospital based procedure is a pre-operative protocol that includes a “surgical time-out”. This is a brief but important time where everyone in the OR stops and confirms…
Read Article →
No fluff. Just the good stuff. 1. Resist the temptation to offset less AOX experience by placing more implants per case. Four well placed implants with good torque and A-P spread are…
Read Article →
One of the many benefits of All-On-X surgery is that it is typically a graftless procedure. That being said, there are no absolute rules regarding when to graft and when not to…
Read Article →
A debate as old as time… Ok, not really. But it’s a logical question. Should we start with the maxilla or the mandible first when performing AOX surgery?? Or, should it vary…
Read Article →
I’m a huge fan of Graphite-Guided Surgery. This technique, however, relies heavily on being able to utilize anatomical references or bony irregularities to demarcate where to apply our graphite-guide. When delineating our…
Read Article →
The vast majority of the time I place my anterior implants in an “Inverted V” configuration at lateral incisor sites #7/10. The rationale behind placing the anterior implants at these anatomical locations…
Read Article →
I remember residency well 👆. Countless surgeries, endless learning opportunities, and little sleep. These were some of the most difficult, yet also some of the best years of my life. While OMFS…
Read Article →
The atrophic jaw often presents significant challenges for All-On-X surgeons. This is especially true in the setting of immediately loaded prosthetics. Not only can these cases be difficult clinically, but they can…
Read Article →
AOX Surgery seems to be the sought-after procedure in dentistry right now. With proper patient selection, it can have a profoundly positive and life changing effect for patients in need. It can…
Read Article →
Those of you who have read my articles for some time, know that I am a huge fan of palatal root implants in full-arch surgery. When a palatal root implant is indicated,…
Read Article →
Mandibular full-arch surgery can, at times, be simple and straightforward. And yet at other times, it can present the most difficult of surgical scenarios. The reason as to why this significant variance…
Read Article →
I absolutely love Platelet Rich Fibrin. I have found it to be incredibly beneficial in All-On-X surgery. Furthermore, PRF comes at almost no cost to the practice and requires no additional surgical…
Read Article →
First of all, I’d like to say that it is rare that I am doing any significant grafting during All-On-X surgery. However, in about 10-15% of cases, I will do low volume…
Read Article →
I love pterygoid implants. And, I place them often. That being said, if available, I will almost always opt for a palatal root implant in place of a pterygoid implant. Why? 1.…
Read Article →
We’ve all seen it. And if you’ve done enough All-On-X cases, you’ve done it too. I know I have. Despite my best efforts, I cannot argue with that post op scan. Those…
Read Article →
I know, I know, it’s embarrassing right? Your assistants are watching you struggle. You’re trying to keep your cool. But despite your best efforts, you cannot get the $#$%!# torque wrench driver…
Read Article →
Failure. We all want to avoid it. We all hope that it doesn’t happen to our full-arch cases. We all want to believe that everything is going to work out wonderfully. While…
Read Article →
A previous blog post titled, Abutment Placement: A Strategic Sequence, discussed the order in which I place my abutments for both optimal prosthetic flexibility and patient centered prosthetic design. Following the article,…
Read Article →
It never fails. Ever. I’m in the middle of an extremely difficult case and all the torque I can muster up on a particular implant is 25 N-cm. My composite torque is…
Read Article →
If you aren’t fracturing some roots, you aren’t taking out enough teeth. It happens. Here’s how I manage a fractured root and/or root tip during AOX surgery: First of all, I don’t…
Read Article →
In a recent article titled Breaking Down The Math: Why AOX Efficiency Is More Important Than You Think, I highlighted the math behind the ways in which efficiency directly impacts our patients,…
Read Article →
My target torque value for all of my implants is 45-60 N-cm. You can read more about why here. In order to fully seat my implants and to confirm the torque value,…
Read Article →
The anterior mandible is an anatomic region well known for its dense bone and predictable implant torque. But… The lower anterior jaw has its own unique challenges and is great at…
Read Article →
One of the most difficult aspects of treatment planning I encountered when I began doing full-arch surgery, was assessing the edentulous maxilla. Without teeth in place, it was difficult to identify reference…
Read Article →
Today’s post is a continuation of the most recent article titled, Your AOX Questions Answered (Part 1). This article, in similar fashion, will answer additional full-arch surgery questions that were submitted by…
Read Article →
Crestal or Subcrestal? There are many different opinions when it comes to crestal versus subcrestal implant placement. I don’t technically fall into either camp. My preference for AOX implants is…
Read Article →
For those of you working in, and/or considering working in a full-arch style practice, it is no secret that the working relationship between the restorative doctor and the surgeon is paramount to…
Read Article →
A recent @aoxsurgery post on Instagram asked what questions you may have regarding full-arch surgery that you would like answered here on the blog. I received a lot of great questions and…
Read Article →
It is said that experience breeds both greatness and humility. This could not be more true than in the world of AOX surgery. While confidence is important, the more experience I…
Read Article →
While the mandibular arch often presents with more predictable bone volume and density, it comes with its own headaches. Most notably, the tongue and the floor of the mouth. Working around these…
Read Article →
The lone standing maxillary molar. A prized possession for the AOX surgeon – yet also a formidable adversary. In atrophic, partially dentate patients, a lone standing maxillary molar is one of my…
Read Article →
It happens. Sometimes implants fail. Ironically, whether you work in a DSO style full-arch practice or a traditional private practice, it is often the restorative provider who first notices a potential failed…
Read Article →
Whether you’re just starting out in AOX surgery, or are a seasoned veteran, I want to share with you a quick look at 5 surgical instruments I feel are of vital importance…
Read Article →
“Why don’t you run your own full-arch practice?” I wanted to address this frequent question today in somewhat of a philosophical, AOX opinion piece. This article is not meant to…
Read Article →
AOX surgery is a team sport. There is simply no way around it. For those of us in a referral relationship, one of the most important aspects of the full-arch team culture…
Read Article →
The dreaded total arch failure. An uncommon occurrence, but a devastating one nonetheless for both patient and practitioner. In my clinical experience, there are 3 key suspects in a total arch failure.…
Read Article →
We all like to show cool x-rays on social media. I’m no different. And in my opinion, pterygoid implants are the coolest looking titanium on a post-op scan. They just sort…
Read Article →
Ahhh bruxism… The irony. Patients who frequently require a procedure like AOX, yet a group who we are often hesitant or unwilling to treat. Should we or should we not treat bruxers?…
Read Article →
We’ve all been there. Feeling confident. Implant #4 in – Torque 45 N-cm. Implant #7 in – Torque 50 N-cm. Implant #10 in – Torque 50 N-cm. Implant #13…in…? Torque…
Read Article →
Last week’s newsletter discussed how I manage mandibular third molars in the setting of full-arch surgery. The take home being, that I have gotten more conservative the more arches I have cut.…
Read Article →
One of my biggest pet peeves as an AOX surgeon is when someone tells me, Oh so and so is such a great surgeon. They never turn anyone away. They treat every…
Read Article →
I love seeing my full-arch patients present with third molars intact (cue the sarcasm)… Least favorite of all, are those pesky mandibular third molars. Partially impacted. Kind of in the way.…
Read Article →
Why are we all in such a hurry?? I am often perplexed by the need so many of us feel to progress from full-arch beginner to full-arch expert…somehow, miraculously, overnight. …
Read Article →
In a previous article titled Benefits of Performing Reduction on Both Jaws Prior to Implant Placement, I discussed 5 key advantages as to why I prefer to perform my bone reduction on…
Read Article →
I am shocked at how many times I’ve been asked: “Do you place your own abutments?” My response is always, Since I began writing ArchGhost.com, I have encountered the following two recurring…
Read Article →
AOX surgery is a different animal. There is an unparalleled reward and an unmatched sense of fulfillment for the surgeon upon completion of an AOX case. However, there can also be a…
Read Article →
All-On-X surgery is about as big a procedure as is consistently done in the outpatient oral surgery setting. Given the magnitude and transformative nature of the procedure, there is a lot at…
Read Article →
If you haven’t performed a “remove & replace”, you haven’t cut enough arches. Removing a failed implant, and replacing a new implant to maintain a loaded prosthetic, is simply part of full-arch…
Read Article →
“What are you doing?!? Do NOT change those drill settings!!?” I may or may not have said those words with passion a few times in the operating room. I am very protective…
Read Article →
Many surgeons are naturally interested in full-arch surgery. Most, however, are hesitant about looking at a “full-time” career in All-On-X surgery. As a surgeon that focuses solely on full-arch surgery, I am…
Read Article →
I have yet to bury a pterygoid implant at the time of surgical placement. I want to admit that in writing this, I will probably have to bury a pterygoid implant within…
Read Article →
I always attempt, with a fervent passion, to avoid removing a full arch prosthetic during the first four months of osseointegration. During this time, the implants have not yet integrated. Furthermore, the…
Read Article →
Retracting the palatal tissue via “stay sutures” is a popular technique for providing improved visual access to the maxillary arch during AOX surgery. While this is a completely valid and arguably beneficial…
Read Article →
There are many different surgical styles when it comes to where a surgeon positions themselves relative to the patient in order to complete different aspects of the AOX procedure. I have been…
Read Article →
Last week’s newsletter discussed the AOX Surgical Time-Out. This is the checklist that I perform before every single All-On-X surgery. In similar fashion, I also utilize an “End of Surgery Checklist” that…
Read Article →
I do not routinely perform bone grafting during All-On-X surgery. While opinions on grafting during full arch surgery vary widely, in my experience, one of the more profound benefits of the AOX…
Read Article →
I always attempt to perform both the maxillary and the mandibular bone reductions, prior to beginning my implant placement. Ok, full disclosure: There are a few select instances where I will not…
Read Article →
I am fortunate to have the luxury of practicing alongside a prosthodontist. Therefore, in my practice I do not do the prosthetic work-up for our All-On-X cases. And quite frankly, that’s how…
Read Article →
Ok – I know this isn’t an action packed clinical technique article. But hold on just a minute before you skip to the next post… As a surgeon, this may very well…
Read Article →
Closure says more about who a surgeon is than any other aspect of AOX surgery. It separates those surgeons who are meticulous, from those who just want to be done. Closure not…
Read Article →
The periodontal probe is not the surgical instrument most commonly associated with All-On-X Surgery. In fact, I’m not even sure you can classify it as a “surgical instrument”. I avoided the perio…
Read Article →
The infamous, anxiety-ridden, dreaded high smile line. This is the patient that has kept many an All-On-X provider up at night, tossing and turning restlessly. Some lay awake wondering if that transition…
Read Article →
Ahhh… the amazing maxillary molar palatal root socket. So frequently overlooked. And yet it keeps showing up, waiting patiently to be noticed. Hoping to help make our lives easier. A built in…
Read Article →
I almost always load all of the AOX implants in my arch at the time of initial surgery. In the vast majority of cases, I am confident in achieving adequate and…
Read Article →
Teeth are out. Bone reduction is complete. And, implants have all torqued well. Smooth sailing now. But what the…?! Why can’t I get that freaking abutment to fully seat in the implant…
Read Article →
I exclusively use a tapered implant for All-On-X surgery. And by exclusively, I mean 100% of the time. While most implant options today are tapered, there are still parallel walled (and/or very…
Read Article →
I have had the opportunity to work with many exceptional All-On-X assistants over the years. I have learned a great deal from these assistants that has shaped how I perform surgery today.…
Read Article →
An All-On-X surgeon should not look at an incision as a way to create access to their surgical field. This is merely a byproduct of the incision. An All-On-X surgeon should see…
Read Article →
I am not a fan of traditional surgical guides in the setting of All-On-X surgery. Not even a little bit. To be fair, while I have seen traditional AOX reduction and implant…
Read Article →
While it should not be common, a complication that you will see on more than one occasion in All-On-X surgery, is incision line dehiscence. A dehiscence can be troublesome as it can…
Read Article →
Ahhh, abutment placement. The end of the surgery is near. You can relax a little. Your mind might start to wander a bit. Your team may even begin to remove a few…
Read Article →
There are many benefits to All-On-X surgical efficiency. However, providers often assume that it takes hundreds of arches to reach a predictable, smooth AOX workflow. While there is some truth to this,…
Read Article →
One of the best pieces of All-On-X advice I ever received had nothing to do with surgical technique. Before completing my very first arch, I was told by a friend and mentor, …
Read Article →
In a recent blog post, I addressed a question I received from a colleague regarding what to do if you cannot get primary closure during your surgery. I wanted to piggyback on…
Read Article →
The blog post Why I Converted to an Inverted V Configuration is one of the most frequently read articles on ArchGhost.com. It is also one of the posts I receive the most…
Read Article →
All-On-X Surgery has a lot of moving parts, pieces and skill sets. It’s easy to get lost in the surgery and before we know it we are 2 hours, or more, into our…
Read Article →
We’ve all been there. Some, more frequently than others. We’re proud of the All-On-X case we just completed. Another one in the books. While closing our surgical site, we are deep in…
Read Article →
I think we can all agree that being more efficient is better than being less efficient. And to clarify, I am never trying to be “fast”. My goal, first and foremost, is…
Read Article →
Achieving clinically acceptable torque is critical to the consistent success of immediately loaded All-On-X surgeries. In my experience achieving great torque… more than just the minimum clinically acceptable values, leads to a…
Read Article →
“It takes 100 arches to know what the heck you’re doing and 1000 arches to become an expert”. My clinical director told me this when I first began my All-On-X journey, and…
Read Article →
In honor of the New Year and all the goal setting that surrounds it, I wanted to post a motivational article specific to All-On-X surgeons. It is my hope that this article…
Read Article →
I recently received an intra-op phone call from a colleague, a twinge of stress in their voice, asking what to do if they couldn’t get primary tissue closure for their All-On-X case. …
Read Article →
I love efficiency! But there is one time during my All-On-X surgery where I slow down significantly. During the drilling of my implant osteotomies I drill at a speed well below what…
Read Article →
When I look back on how my All-On-X career started, I realize that I was very fortunate in the clinical scenario in which I was placed. The surgical opportunities and experiences I…
Read Article →
The beloved Midline Implant. A favorite of many a practitioner and part of the 5 Implant Configuration used frequently in All-On-X surgery. As someone who almost never…ever…places a midline implant, I…
Read Article →
All-On-X surgery draws on many different aspects of oral & maxillofacial surgery. This is one reason the procedure is so challenging, yet fun and rewarding at the same time. Because this procedure…
Read Article →
The piriform rim is a thin, cortical layer of bone that outlines the nasal aperture. In laymen’s terms, it’s a rim of dense bone around the nose. The maxilla, often having more…
Read Article →
There are many things that make a great All-On-X surgeon. That being said, the one most likely to make you restorative friends, keep your referrals flowing, and make you enjoyable to work…
Read Article →
The acclaimed movie Rounders, tells the story of a professional poker player (Matt Damon) grinding it out to make a living, ultimately trying to make it big at the World Series of…
Read Article →
Most practitioners who routinely perform All-On-X surgery have some preference toward a certain implant size. Sure, depending on the case, we adjust as necessary. But there tends to be a certain implant…
Read Article →
I extract all teeth in the arch before I make my surgical incision. Cue the “Gasp”?! I realize that I am in a very small minority, if not a loner when it…
Read Article →
While often overlooked, I feel that closure is one of the single most important aspects of All-On-X surgery. I believe that the quality of surgical closure directly impacts both soft and hard…
Read Article →
Inadequate alveolar reduction is one of the worst, but most avoidable, All-On-X complications. Insufficient reduction of the alveolar ridge can lead to a thin prosthesis prone to fracture, having to unnecessarily open…
Read Article →
There are three primary ways to place anterior maxillary implants (#7/#10) in an All-On-X configuration. 1. Vertical Orientation 2. “M” or “M-4″ Configuration 3. “Inverted V” or “V-4” Configuration All…
Read Article →
We’ve all been there… 45 minutes into an All-On-X “digital” treatment planning session with [insert your implant company of choice], wondering why this process takes sooo long… For those of us that…
Read Article →
If you’ve done enough All-On-X cases you know that quite possibly the worst, gut wrenching feeling you can get is realizing post operatively that reduction was inadequate. This leads to a host…
Read Article →
I started my All-On-X journey as inexperienced as you can get. Four years out of OMFS residency, I had yet to do a single fixed arch. On top of that I was…
Read Article →
Full-arch surgery techniques, tips, and product updates. Unique content, different from the blog. Same Arch Ghost style.
New subscribers receive the Full-Arch Surgical Time-Out Checklist free.
New here? Read this first →
Unsubscribe anytime.
