Patient-Centered Dental Treatment Planning

The dawn of artificial Intelligence use in full arch reconstruction is here, and within 5 years will be involved or manage imaging, diagnosis, treatment planning, consent, implant selection, placement, follow up, billing, staff, failure management, and marketing. This course will discuss the legal implications, risks, and licensure issues of unavoidable employment of AI and offer guides and tips to eliminate or reduce legal exposure and/or licensure sanctions.

Learning Objectives

• Understand the inevitable applications of AI in full arch reconstruction.
• Learn the potential and probable legal and licensure exposure caused by AI.
• Be able to employ systems, protocols, and staff to reduce or eliminate legal consequences of failures.

All on X cases are complex requiring extensive planning and coordination of multiple specialist’s laboratories and imaging services.  Do not forget that there is a patient attached to that mandible and maxilla who is likely to have a host of underlying medical issues.

If the medical issues are not handled appropriately, the stress of the procedure, and potential complications can derail the best laid plans.

The most threatening issues are Obesity, Difficult Airway, Diabetes, Hypertension, Cardiac Disease, Pulmonary Disease, Renal Disease Atherosclerosis, and Mental Illness. The goal of this brief lecture is to expose the participants to these factors, and how to deal with them.

Learning Objectives

• What is medical clearance? How do we get it?
• How do we avoid complications?
• How do we manage pain?

Maxillary and mandibular AO4/AOX has become commonly accepted treatment for not only the edentulous but for the terminal dentition as well. Numerous surgical techniques have been developed to overcome the multitude of anatomical challenges; however they do bear the risk of cranial nerve damage. Sensory disturbance in CN V Div II and Div III have been well documented in the surgery literature but most of the data has been extrapolated from the placement of vertical single implant fixtures. With the advent of posterior mandibular tilted implants, the risk balance has evolved from the previous accepted surgical techniques and it has perhaps added to sensory nerve injury risk.

The increased popularity of zygomatic implant placement has placed CN V Div III at risk for neurosensory damage. The extent of the needed surgical exposure has been implicated in nerve injury without actual physical damage which can be difficult to ascertain and treat. Improper implant angulation can lead to more severe nerve damage associated with the orbital contents.

Learning Objectives

• Proper anatomic CBCT evaluation of pertinent anatomy
• Use of pre-operative stereolithic models
• Review of nerve injury mechanism and classification
• Review of surgical techniques which will minimize the risk of nerve injury
• Patient preparation for possible risk of post-operative sensory deficiency
• Mitigation of risk and management of actual nerve injury

The extramaxillary approach to zygomatic, Pterygoid, and Z-point implant placement offers a valuable solution for patients with severe maxillary atrophy, but it is also associated with a distinct set of complications that may necessitate revision surgery. Failures related to malposition, inadequate prosthetic trajectory, peri-implant soft tissue dehiscence, and chronic sinus or oroantral issues present unique challenges for the surgeon.

This lecture will focus on revision strategies for extramaxillary implants, emphasizing surgical planning, anatomical considerations, and intraoperative techniques for removal, repositioning, or conversion to alternative anchorage sites. Specific attention will be given to management of compromised bone–implant interfaces, reconstruction of deficient soft tissues, and optimization of implant emergence profiles to facilitate prosthetic rehabilitation.

Case-based examples will illustrate salvage procedures, staged revision protocols, and outcomes, with the goal of providing a systematic framework for addressing complications while minimizing patient morbidity.

Learning Objectives

• Learn the limitations of certain extramaxillary implants
• Learn techniques for revision of extramaxillary implants
• Learn the philosophy of revisions of extramaxillary implants

Oroantral communications (OAC) are openings between the oral cavity and the maxillary sinus, most often caused by extractions of upper posterior teeth and placement of zygomatic implants. If not managed promptly and properly they can lead to chronic sinus infections, persistent fistulas, and patient discomfort.

This lecture will help practitioners recognize OACs through clinical signs and imaging, understand when conservative management is appropriate, and learn surgical techniques such as buccal advancement flaps, palatal rotation flaps, and the use of the buccal fat pad. Emphasis will be placed on early diagnosis, infection control, and step-by-step approaches to closure, along with practical tips to prevent OACs during extractions, placement of zygomatic implants and improve patient outcomes. 

Learning Objectives

• Recognize the Causes and Risk Factors - Understand the common etiologies of oroantral communications, with a focus on extractions of maxillary posterior teeth, placement of zygomatic implants and how to identify high-risk cases before surgery.
• Perform Complex Surgical Closure Techniques - Gain step-by-step knowledge of commonly used surgical techniques such as buccal advancement flaps, palatal rotation flaps, and buccal fat pad grafts.
• Prevent Complications and Recurrence - Apply strategies for infection control, postoperative care, and prevention of oroantral communications during routine dental extractions and zygomatic implant placement

This comprehensive clinical presentation will feature the most common intraoperative, early and late postoperative complications of zygomatic implant therapy.  It will focus on prevention as well as recommended treatment protocols for these misadventures.  It will also include case presentations that will emphasize the importance of attention to detail of both surgical and prosthetic principles of full arch immediate reconstruction.

Learning Objectives

• Understand the range of intraoperative, early and late postoperative complications associated with zygomatic implants
• Understand the preventative measures that can be taken to minimize complications associated with zygomatic implant complications
• Understand recommended treatment for zygomatic implant complications

Palatal and trans-sinus implants occupy a unique middle ground between conventional All-on-4 solutions and more complex zygomatic approaches.  While often overlooked, they can be the key to resolving complications and expanding treatment options in challenging cases.  This lecture will focus on how to anticipate and prevent problems through accurate reading of the local anatomy and the strategic use of bone-level surgical guides.

Practical insights on planning, instrumentation, and surgical execution will be shared, offering clinicians predicable, complication-free outcomes in full arch rehabilitation.

Learning Objectives

• Understand how palatal implants expand the surgical armamentarium and how mastery of local anatomic landmarks minimizes complications.‍
• Evaluate the role of trans-sinus implants as a reliable alternative to sinus grafting, emphasizing key anatomic criteria for safe execution.
• Apply structured workflows, including the use of bone-level guides, to streamline surgical execution and minimize complications in full-arch rehabilitation. 

Zygomatic implants have revolutionized the rehabilitation of patients with severe maxillary atrophy, providing immediate function and avoiding complex grafting procedures. However, their unique anatomical trajectory and proximity to vital structures introduce a spectrum of potential complications that require careful consideration. This lecture will explore the “dark side” of zygomatic implantology, highlighting both early and late complications such as sinusitis, oroantral communication, soft tissue dehiscence, implant failure, orbital or intra-cranial injury, and prosthetic challenges.

Emphasis will be placed on understanding the anatomical risk zones, strategies for prevention, and evidence-based approaches to complication management. Through clinical cases and surgical pearls, participants will gain a comprehensive perspective on anticipating, diagnosing, and addressing complications to ensure safe and predictable outcomes in zygomatic implant therapy.

Learning Objectives

• Identify the most common early and late complications associated with zygomatic implants and understand their underlying anatomical risk factors.
• Apply evidence-based strategies for prevention, early diagnosis, and effective management of complications in zygomatic implant therapy.
• Integrate clinical insights and surgical pearls into daily practice to enhance patient safety and improve long-term treatment outcomes.

Successful full arch restorations depend not only on prosthetic precision and osseointegration but also on the establishment and long-term stability of healthy peri-implant soft tissues. This lecture focuses on achieving predictable soft tissue outcomes in full arch rehabilitation through strategic surgical techniques and proper case selection.

Key indications and protocols for soft tissue augmentation will be presented, including the use of Free Gingival Grafts (FGG), Connective Tissue Grafts (CTG), Apically Positioned Flap (APF) and Vascularized Interpositional Periosteal Connective Tissue flap (VIP-CT) .

The lecture will also address the timing and sequencing of soft tissue procedures relative to implant placement and prosthetic loading, with clinical cases demonstrating the impact on long-term outcomes. Additionally, strategies for complication prevention and management will be discussed.

By the end of the session, participants will have a structured framework for soft tissue decision-making in full arch cases and practical tools to enhance predictability and patient satisfaction.

Learning Objectives

• Understand the indications and selection criteria for soft tissue augmentation techniques in full arch restorations
• Learn the step-by-step surgical protocols for achieving predictable soft tissue outcomes and optimizing peri-implant health and esthetics
• Recognize, prevent, and manage soft tissue complications

Are surgical and prosthetic complications interrelated? This prevention aims to illustrate the bidirectional relationship between surgery and prosthetics, emphasizing how both patient outcomes and clinician satisfaction depend on proactive planning and execution across disciplines.  This prevention will show how surgical and prosthetic complications are inter-related and how they affect the patient, surgeon and restorative doctor. Ultimately, preventing complications is key.

Learning Objectives

• Proper diagnosis, surgical and prosthetic, to avoid surgical and prosthetic complications. 
• Understand prosthetic consequences of surgical complications.
• Understand surgical consequences of prosthetic consequences. 
• Quantity physical, financial & emotional pain of patient, surgeon and restorative doctor related to complications. 

Full-arch implant rehabilitation offers life-changing outcomes, yet its long-term success depends on a proactive approach that prioritizes prevention and prepares clinicians for inevitable challenges.

This lecture will explore evidence-based preventive protocols that minimize biological and mechanical complications in full-arch therapy, with a focus on surgical precision, prosthetic design, and maintenance strategies. In addition, advanced approaches for the management of complications and failures—including peri-implant disease, prosthetic breakdowns, and implant loss—will be highlighted.

Through clinical cases and practical insights, participants will gain the tools to optimize treatment outcomes, safeguard patient satisfaction, and confidently navigate complex rescue scenarios.

Learning Objectives

• Identify patient surgical and prosthetic related risk factors for complications in full-arch implant rehabilitation.
• Apply evidence-based preventive protocols to enhance the long-term success and stability of full-arch implant restorations.
• Evaluate and implement advanced clinical strategies for the diagnosis and management of biological and mechanical failures in full-arch implant cases.

Full arch implant reconstruction therapy offers a predictable and effective solution for edentulous patients, providing improved functionality and aesthetics. However, the complexity of these treatments, which often involve the use of endosseous, zygomatic, pterygoid, and subperiosteal implants, presents a range of potential complications that can impact both short-term and long-term outcomes. Often the failure cases undergo multiple revisions with patient specific implants. This lecture explores the various complications associated with patient specific revision full arch reconstructions.

Patient Specific Implants can be quite complex and require a special skill set for placement and to dela with the unique complications. Patient Specific implants, used in patients with extreme bone resorption, can result in complications such as fenestration, fractures, chronic infection, framework failure and soft tissue irritation and large oronasal, oroantral and cutaneous fistulas.

Risk factors that increase the likelihood of complications include systemic health conditions, smoking, poor bone quality, and inadequate surgical planning. Additionally, prevention strategies such as preoperative assessments, thorough surgical techniques, and appropriate post operative management and care. The importance of regular follow up for early detection intervention is emphasized to ensure the long-term success of full arch implant therapy.

By the end of the session, participants will gain a comprehensive understanding of the potential complications associated with patient specific full arch implant therapy, enabling them to better manage and mitigate these issues for improved patient outcomes.

Learning Objectives

• Understand the various types of complications that can arise in Patient Specific full arch implant reconstruction therapy, including surgical, prosthetic, and biological issues.
• Identify patient-related risk factors (e.g., systemic conditions, smoking, poor oral hygiene) and procedural factors that may increase the likelihood of complications during and after the procedure.
• Discuss preventive measures for complications, including proper patient selection, pre-operative planning, and post-operative care protocols.
• Recognize how to identify the proper treatment following a complication based on scenario and patient circumstance.

The number of toothless patients worldwide, according to the World Health Organization, is 15% of the world's population. Potentially, these are patients with moderate or severe jaw atrophy. In addition, in my practice, I note an annual increase in the number of patients with unsuccessful all-on-4, who require the use of remote extramaxillary anchoring techniques during repeated implant treatment.

In these cases, the use of the Quadro Zygoma protocol is predictable and well described in the literature, but has a greater number of complications and requires a surgeon with a higher experience. This is dictated by the fact that there are risks of complications when placing zygomatic implants. Installation of four zygomatic implants may be limited in cases where the dimension of the zygomatic bone is insufficient for placing two zygomatic implants, since there is a risk of zygomatic bone fracture. In addition, in such cases, perforation of the orbit by the medial zygoma may be observed, especially in inexperienced surgeons. In certain anatomical conditions, when there is a pronounced concavity of the anterior wall of the maxillary sinus (type IV according to the ZAGA classification), the placement of zygomatic implants, especially the medial one, is risky in terms of the exposure of the zygomatic implant body through the mucosa.

As an alternative to the use of medial zygomatic implants, there is a treatment option with the placement of transnasal implants, which allows avoiding complications associated with the Quadro Zygoma protocol, as well as expanding the rehabilitation options for patients with complete atrophy of the upper jaw, for whom the placement of four zygomatic implants is contraindicated. The use of transnasal implants is more physiological than the placement of a medial zygomatic implant, has better conditions for the adaptation of soft tissues, and, according to available statistics, has fewer complications.

Learning Objectives

• Understand the anatomy of the nasal cavity and paralacrimal zone.
• Understand the basic principles of planning and placing transnasal implants, as well as dealing with complications.
• Understand how to use the transnasal technique in full arch re-implant treatment.

The focus of oral rehabilitation should always be the outcome, not any specific method or materials. However, severely atrophied jaws, sinus morphology and/or poor quality bone present significant limitations and challenges to treatment planning for dental implants, especially in a patient-centred approach involving fixed and immediate function.

Zygoma implants offer an ability to overcome certain limitations, but involve advanced invasive surgery which, when necessarily focusing on technique alone, may lead to poor prosthetic outcomes in terms of cleanability, comfort and restorability. Additionally, the challenges which are evident on the radiographs may differ from what the surgeon encounters at surgery, and may require a modification to the surgical approach or an abandonment of the plan.

This program will explore the efficacy of Fibishenko’s approach to Zygomatic implants and combination of other advanced yet predictable surgical and restorative techniques as a means to control the outcome. It will feature treating the edentulous, as well as those with failing dentitions and complex anatomical or clinical presentations using a digital workflow.

Dr Fibishenko will describe and compare four surgical methods to idealise the placement of Zygoma implants for an optimal patient-centred prosthetic outcome, and will present results of his clinical study:

• comparing the differences between planned and executed (or abandoned) treatments involving Zygoma.
• life table analysis of performance (interruptions to fixed function).
• patient-reported outcomes relative to various initial clinical presentations (edentulous, partly edentulous and fully edentulous).
• recorded clinical outcomes

Learning Objectives

• Understanding maxillary anatomy in deciding on the safest and most predictable prosthetically-driven approach to place zygomatic implants 
• Drilling protocol to control the osteotomy for precision with Zygomatic implant placement
• Understanding how to control adaptation through biomechanical considerations including using immediate finals

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Immediately loaded full arch dental implant procedures such as All-On-X have a 20+ year history of successful performance. While most short-term studies show extremely high survival, mid to long term studies have shown trends of increasing failure rates for conventional implants in such cases. Many AOX cases have minimal bone to begin with, and these situations are exacerbated when implants fail. Remote anchorage techniques such as zygomatic and pterygoid implants can rescue failing AOX cases with applications such as the PATZi protocol. What can be done, however, when these advanced implants fail. The Holtzclaw Extrasinus Infratemporal Anchorage (HESIAn) zygomatic implant protocol is a highly advanced method which can rescue these cases. In addition to reviewing the principles of the PATZi protocol, this lecture will describe the HESIAn protocol, its indications, and provide an analysis of multiple cases with up to 3 years of follow up.

Learning Objectives

1. Understand the PATZi protocol and its applications
2. Understand the HESIAn protocol and its applications
3. Understand how to recognize and appropriately treat full arch implant complications

Full arch implant reconstruction therapy offers a predictable and effective solution for edentulous patients, providing improved functionality and aesthetics. However, the complexity of these treatments, which often involve the use of endosseous, zygomatic, pterygoid, and subperiosteal implants, presents a range of potential complications that can impact both short-term and long-term outcomes. This lecture explores the various complications associated with each implant type in full arch reconstructions.

Endosseous implants, while the most commonly used, are prone to complications such as peri-implantitis, mechanical failure, and osseointegration failure. Zygomatic implants, which are employed in cases of severe maxillary bone loss, can experience complications such as malpositioning, sinus involvement, fractures, oronasal and oroantral fistulas and issues related to prosthetic support. Pterygoid implants, often utilized for patients with insufficient posterior maxillary bone, pose risks like improper angulation, sinus membrane perforation, bleeding, pterygoid complex fractures and nerve injury. Lastly, subperiosteal implants, used in patients with extreme bone resorption, can result in complications such as fenestration, fractures, chronic infection, and soft tissue irritation and large oronasal or oroantral fistulas.

Risk factors that increase the likelihood of complications include systemic health conditions, smoking, poor bone quality, and inadequate surgical planning. Additionally, prevention strategies such as preoperative assessments, thorough surgical techniques, and appropriate post operative management and care. The importance of regular follow up for early detection intervention is emphasized to ensure the long-term success of full arch implant therapy.

By the end of the session, participants will gain a comprehensive understanding of the potential complications associated with full arch implant therapy, enabling them to better manage and mitigate these issues for improved patient outcomes.

Learning Objectives

1. Understand the various types of complications that can arise in full arch implant reconstruction therapy, including surgical, prosthetic, and biological issues.
2. Identify patient-related risk factors (e.g., systemic conditions, smoking, poor oral hygiene) and procedural factors that may increase the likelihood of complications during and after the procedure.
3. Discuss preventive measures for complications, including proper patient selection, pre-operative planning, and post-operative care protocols.
4. Recognize how to identify the proper treatment following a complication based on scenario and patient circumstance.

Reported dental implant success rates are high resulting in an ever-increasing number of patients being treated with implants. 

Over time however, the percentage of dental implant complications & failures increases because of biological and technical issues. As prevention is better than cure, clinicians need to be able to identify high risk patients, and take the necessary steps and precautions to prevent these complications. Inevitably however complications will occur, and clinicians will have to dedicate more time in dealing with ailing and failing dental implants.

The most predictable management of these cases appears to be implant removal & replacement. The aim of this lecture is to describe an atraumatic method & treatment modality in dealing efficiently with these cases.

The decision to treat or remove (explant) a failing implantis a judgement that needs to be made by the treating clinician and needs to bebased both on clinical and radiographic evaluation.

Dental implant removal may be indicated in cases of advanced bone loss around implants.

Implant removal devices are now available that facilitate removal of failed implants with a predictable technique that permits conservative implant extraction and the same time preserving most of the viable soft and hard tissue.

This clinical protocol aims to:

1. Explant the infected implant.
2. Decrease the bacterial load by curettage and decontamination of the implant socket.
3. Maintain the regenerative capacity of the surrounding alveolar walls.
4. Achieve primary stability for the immediate replacement implant either in the same or adjacent site.
5. Immediately load the replacement implants. 

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Learning Objectives

Upon completion of this presentation participants should beable to:

1. Identify high risk patients for complications. 
2. Take the necessary steps to prevent complications.
3. Identify atraumatic methods of removing failed implants.
4. Become familiar with the concept of immediate replacement of failed implants in the same or adjacent site.
5. Become familiar with the protocol of immediate loading of replaced implants.
6. Identify cases where immediate replacement is not possible, and a delayed protocol is indicated.

Zygomatic implants have proven to be a reliable and predictable solution for severe maxillary atrophy as per a number of long-term studies. There are, however, complications that are associated with this technology.

This presentation will focus on intraoperative, early and late postoperative complications that are associated with zygomatic implant therapy. Prevention, recognition and treatment of these problems will be covered in detail. Emphasis will be on addressing the prevention and treatment of the most commonly seen complications.

After this presentation attendees will:

1. Understand and recognize intraoperative, early and late post op zygomatic implant complications.
2. Understand and treat intraoperative, early and late post op zygomatic implant complications.
3. Understand strategies to prevent intraoperative, early and late post op zygomatic implant complications.

Zygomatic implants are currently a reliable, predictable and long-term solution for rehabilitating severe maxillary atrophy. The surgical procedure for successful treatment with zygomatic implants is based largely on a thorough knowledge of the specific anatomical situation of the patient; on the awareness of the possible complications, to prevent them from the outset; on the adaptation of surgical protocols to each patient and site; as well as on the choice of the most appropriate material and designs to treat it 

The ZAGA concept standardizes anatomical knowledge, planning of the implant trajectory and precise positioning to reduce the risk of long-term complications, such as rhinosinusitis, soft tissue dehiscence or biomechanical failure. Recent studies also demonstrate the biomechanical suitability of the ZAGA concept over other procedures, concluding that the ZAGA osteotomy coupled with optimized implant placement leads to less stress on all components of the system. 

Learning Objectives

• To understand the fundamentals of the ZAGA concept 
• To understand how to avoid complications 
• To understand the biomechanics of the zygomatic implant

Learning Objectives

1. Modified Bone Zone Classification to assist in prescribing appropriate treatment options.
2. Understanding ZAGA classifications and their impact on techniques to maximize bone-to-implant contact.
3. Use of Additional Implants: This includes the considerations for pterygoid, pyriform, and trans-nasal implants.
4. Soft Tissue: A decision-making tree to guide surgeons in selecting the most appropriate soft tissue incision based on the intended surgical technique.

This lecture we will share the FullArchPlus concept, emphasizing a straightforward and efficient approach to immediate loading and feature key success factors to optimize both esthetic and functional outcomes. 

We will go through this innovative protocol addressing both standard and extremely atrophic maxillary cases while effectively avoiding the need for zygomatic implants. 

It will feature a unique palatal approach, use the paranasal bone, and the Golden Triangle along with the use of Pterygoid implants.

All-on-X full-arch rehabilitation offers reliable functional and aesthetic results for edentulous patients, but complications such as implant failure, bone loss, and peri-implantitis can demand advanced surgical management. When conventional implant sites are no longer usable, remote anchorage using zygomatic, pterygoid, or transnasal implants provides a stable alternative. This lecture covers diagnosing and managing All-on-X failures, indications for remote fixation, and key surgical techniques. Emphasis will be placed on patient selection, risk assessment, and strategies for long-term success, supported by case studies and evidence-based insights.

Learning Objectives

By the end of this lecture, participants will be able to:

1. Recognize common All-on-X complications and their causes.
2. Understand when to consider remote anchorage solutions.
3. Learn the surgical principles of zygomatic, pterygoid, and transnasal implants.
4. Plan treatments that reduce risk and enhance long-term results.
5. Apply case-based strategies for managing and preventing complications.

Learning Objectives

• Incorporate basics of Dynamic Navigation to the prosthetic and surgical armamentarium
• Demonstrate the digital flow management,  a restorative driven concept, from the data acquisition to planning and the delivery process.
• Discuss the predictability of the dynamic navigation concept
• FP1 design; minimally invasive surgical vision will be addressed
• When things go wrong; how to modify the initial plan and be able to continue utilizing dynamic navigation during the surgery
• Advantages of dynamic photogrammetry and basic photogrammetry
• Team approach-Surgical/Restorative/Laboratory, inter-disciplinary mentality

Rapidly evolving dental technology is making full mouth implant rehabilitation easier for practitioners, while making it more accessible to the masses. This consequently comes with the challenge that treatment planning/execution is not uniform for providers nationally (and globally). This presentation will discuss an individualized approach to implant rehabilitation ranging from the fundamentals of treatment planning to the intricacies of an FP1 implant rehabilitation.

Learning Objectives

• Understand the traditional prosthetic approaches to full-mouth reconstruction
• Appreciate the evolution of prosthetic (and surgical) workflows within the modern digital era
• Identify the different applications of a modern workflow for both surgical and prosthetic applications in full-mouth reconstructions