Archived Newsletter Re-Post.
The AOX Newsletter • April 2025 #46
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 better than eight poorly placed implants. (Yes, I’m aware some cases require more than 4 implants – but you get the point).
2. If you elect to perform a delayed load and “bury” your implants – remember to check abutment angulation and position, correcting implant timing if necessary – before you place cover screws and close.
Surgeons (including me) are notorious for forgetting this step when implants are buried. It goes without saying that making these adjustments after integration is…well…impossible.
3. Always have an extra implant stash or “Go-Bag” of commonly used implant sizes on hand with you in the OR.
This way you don’t have to stop and have an assistant run back to your implant storage if you change your mind intra-operatively.
4. The panorex image is your best full-arch treatment planning friend.
Ensure you always have a high quality panorex image on hand.
5. Many very experienced AOX surgeons become slightly more conservative with time – not slightly more aggressive. Food for thought.
6. The most important contributions a surgeon can make to a full-arch case are achieving great torque and solid A-P spread.
7. The most important contributions a restorative doctor can make to a full-arch case are achieving balanced occlusion and limiting the presence of any prosthetic cantilever.
8. Don’t celebrate too soon. We should all feel good when we finish an arch. But remember, there is a 4 month marathon that still has yet to be run.
9. A poorly planned and/or poorly made prosthetic will overpower a great surgery any day of the week.
10. Surgical treatment planning should take 2 min or less (not two hours).
11. Tactile feedback is paramount to consistent AOX success. Learn to “feel the bone”.
While using the starter drill we should already be calculating our final drill size, how much we will under or over-prepare, depth, and planned implant size.
12. Closure says more about a surgeon than any other aspect of surgery.
13. Not all wisdom teeth need to be removed.
In fact, in AOX surgery, most impacted wisdom teeth do not need to be removed.
14. Our goal should be to treat almost all patients. Rarely is treating “every” patient the right answer in AOX.
15. “It takes 100 arches to know what the heck you’re doing and a 1000 to become an expert” – TB .
Here’s how I’d outline the first 1000.
16. Adaptability is the single most important trait a full-arch surgeon can have.
17. Mastering freehand surgery is paramount to immediate loading.
18. If you’re not immediately loading the vast majority of your arches – you’re falling behind the standard of care.
The days of delayed loading are behind us. Patients want an immediately loaded prosthetic and if you cannot consistently provide that, it’s likely they will go somewhere else.
19. The prosthetic aspect of AOX Surgery is just as important as the surgical aspect.
If you think otherwise… you will become very good at performing “remove and replace” surgeries.
20. The mandibular external oblique ridge is a built in, high powered, anatomical reduction guide. Check it out.
Sincerely,
Matthew Krieger DMD
“It’s on the strength of observation and reflection that one finds a way. So we must dig and delve unceasingly.”
Claude Monet
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