5 Ways I Jump-Started My All-On-X Career

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 encountered helped me to rapidly grow my All-On-X skillset. While some of the items listed below were a conscious decision on my part, many were just a blessing in disguise. 

I understand that not everyone can control all of these factors. However, if you are focused on honing your All-On-X skills, the following suggestions may benefit you in your AOX journey. 

I realize now, how important the following 5 items were in my growth as an All-On-X surgeon. 

5 Ways I Jump-Started My All-On-X Career

1. I began working at an All-On-X focused practice.

I started my AOX journey at ClearChoice Dental Implant Center in 2019. Why? I needed a job. It was that simple. 

While I didn’t understand the value of working at an AOX focused practice at the time, it quickly became apparent to me. 

If you are truly serious about developing your AOX skills I would encourage you to look into an AOX center. Many offer both full and part time work. So this is something you can do alongside your private practice. While most are focused on oral & maxillofacial surgeons, there are also opportunities for general practitioners and other dental specialists. 

Why is an AOX focused practice so beneficial? 

Volume. And lots of it. 

The volume of AOX surgery you can get at an AOX focused practice is simply unmatched by any other clinical scenario. 

In most AOX practices you will be doing 2-4 arches per day. This means even working 1 day a week you can perform 8-16 arches each month. Unless you have a very busy surgical private practice, you are unlikely to be matching that volume. 

To put this in perspective, at my current position at Nuvia Dental Implant Center, I am doing ~30-40 arches per month and have cut as many as 76 arches in one month. That is a lot of arches and a lot of experience that you simply cannot get in most clinical settings. 

Access to top surgeons. 

Most AOX practices will have at least a few very experienced surgeons. While it may be hard to speak with or learn from these surgeons on your own…once you are part of the practice you are “part of the club”. 

The hands on learning from these providers can literally be invaluable. 

An almost endless network for surgical learning and discussion. 

Similar to the point above, as part of an AOX practice you have a built in network of some of the most experienced surgeons in the country when it comes to AOX procedures. 

This allows for a lot of open dialogue, case discussion, and advanced learning. 

Learning with and from a restorative doctor for each and every surgical case. 

Finally, one of the most underappreciated benefits to an AOX focused practice is that the surgical provider gets to work directly alongside the restorative provider. 

Communication regarding cases is incredibly easy and provides the surgeon with instant prosthetic feedback. In this setting, you will learn how to provide an optimal, prosthetically driven surgery. 

This type of feedback is typically hard to get in the private practice setting where the restorative doctor is often not a part of the surgery at all. 

Capitalizing on this opportunity and learning how to deliver a surgery that is easy to work with prosthetically is what will really make you a great surgeon.

2. I learned from some of the best All-On-X surgeons in the world.

When I started my AOX journey in 2019, I had cut a whopping… zero arches. 

In order to get up to speed quickly, I hopped on a plane to Denver and Atlanta to work with two of the most experienced full arch surgeons in the country. 

At the time, between these two surgeons was ~6000-7500 arches of wisdom. 

I am a firm believer that the time I spent with them one on one, took me instantly from 0-100 arches in skill level. The experience was invaluable and set me immeasurably ahead. 

This is an example, of having access to world class surgeons and learning opportunities that I wouldn’t normally have access to outside an AOX center. 

3. I had no prior All-On-X experience.

While this may not sound advantageous…the hidden benefit was that since I had no AOX experience, I had no bad habits. 

Now, couple this with the fact that my initial training was with arguably some of the best AOX surgeons in the world, and I was off and running.

The key to this point is that if you want to do AOX surgery, but have little to no AOX experience, don’t fall into the trap of waiting. I often hear from other surgeons,  “I’ll look into working at an AOX center when I get more experience in my own practice”. 

This is exactly what I told myself…and 4 years went by without me doing any arches at all in my own practice. 

Even if I had cut 20 arches during that time, in reality, 20 arches is honestly not much different than 0 arches. Especially when you factor in the possibility of some bad habits being developed. 

Unless you are going to string together a few hundred arches in your own practice, jump in and go for it at an AOX focused practice. Don’t wait for more AOX experience before starting. Just start.  

Disclaimer: In giving this advice, I am assuming you have the surgical skillset and training necessary for the different aspects of AOX surgery. 

4. I began my All-On-X journey working with an experienced surgeon.

When I began my AOX career, I worked alongside a very experienced surgeon. This allowed me to start slowly, as they were able to handle the more “complex” cases that came into the practice. 

I began with cases I was comfortable with and worked up from there. 

If it all possible for new surgeons, I believe this to be a vital part of success. 

Why? Starting with more routine surgeries allows you to see positive results, build confidence and hone your skills prior to tackling more difficult cases. 

I have repeatedly seen new AOX surgeons attempt one too many complex cases before they were ready. 

The less than ideal results can become a huge shot to their confidence and can even make them wonder if they want to continue doing this procedure. 

5. I began working at an All-On-X practice that had been open for nearly 20 years.

While I may not have enjoyed this at the time…this was a huge advantage for me as a new surgeon, and one I still carry with me today.

Let me explain.

For those that do not know, an AOX center that has been open for some time typically means: surgical problems. 

Even in the best of surgical hands, there will be implant failures. Combine that with time…patient non-compliance…and often multiple surgeons with differing skill levels…and you get failing AOX cases. 

If you do enough arches, you will get implants that fail. It’s simply part of playing the game. 

With 20 years worth of cases, I learned pretty quick how to rescue a case. While this was annoying to have to do, the training was invaluable. 

I know many surgeons, some of whom have completed a few hundred arches, that are not confident at rescuing cases. Not because they are not great surgeons, but because they may be at a “new office” or have moved around to a few offices and haven’t seen the failing cases come back yet. 

Learning what goes wrong, why, and how to fix it – is and should be a critical part of an AOX surgeon’s training and tool box.

The is exactly the skillset I developed by working at a 20 year-old AOX practice. 

I can already hear the grumblings… So in closing, let me clarify a few items. 

Do I believe that everyone that wants to do AOX surgery has to work at an AOX focused practice? 

No. 

Do I believe the only people qualified to do AOX surgery work at an AOX focused practice. 

No. 

I do believe the 5 points listed above helped me achieve a level of AOX surgical competency much faster than the average surgeon who did not have those same opportunities. 

And, if your goal is to be the best AOX surgeon you can be, in the shortest amount of time, I would recommend considering the points listed above as you navigate your surgical journey. 

There are many paths you can take to get to the same destination. This path was mine. I hope that you can find some value in it so that your path may be straighter, smoother, and more enjoyable. 

Matthew Krieger DMD