The Pros & Cons of Being a Full-Time AOX Surgeon

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 often asked why I chose this path and if I truly enjoy only performing All-On-X surgery… and nothing else. 

The answer, which you may imagine, is that I love what I do. That’s why I chose to focus on this surgical path. However, I admit that this career choice is not for everyone. 

In today’s article, I want to touch on both the Pros and the Cons of being a full-time All-On-X surgeon – as there are definitely pluses and minuses.

My hope is that this can provide insight for those contemplating a career path in full-arch surgery or those considering opening an All-On-X practice. Or, maybe this article will simply help you hone in on how much or how little full-arch surgery you want to pursue.

Pros of Being a Full-Time AOX Surgeon

1. Volume – and lots of it. 

The most obvious benefit of full-time AOX surgery is getting the opportunity to perform a higher volume of arches. Why does this matter? Simply put – the more arches you cut, the better you will get. And, the quicker you can get access to those arches, the faster your skills will improve. 

2. Immediate and consistent learning opportunities. 

One struggle I often see for those who perform this surgery inconsistently (a few times a month or less), is that it is harder to identify and improve surgical weaknesses. After completing a full-arch case, you may mentally note a few areas that were difficult and/or assess your post-op CT scan and see a couple of areas that require improvement. 

However, if you don’t perform your next arch for another 4 weeks, despite the best of intentions – these learning points are often forgotten by that time. 

On the other hand, if your next AOX surgery is the following day, you can easily implement changes and work on surgical weaknesses that are fresh in your mind. Ultimately, this leads to a much faster growth in AOX surgical skill. 

3. Low daily patient volume. 

As a surgeon, this is one of my favorite aspects of full-arch surgery. While it is true that your volume of arches will be high, your actual overall patient volume will be low compared to other practice models.

Traditional oral surgery requires a high volume of surgical patients to generate a profitable revenue. Practice volume is dependent on a variety of factors, but most will see 5-15 surgical patients per day. That’s a lot of patient interactions, notes, turn over, etc. 

With full-arch surgery, I typically see 1-3 surgical patients per day. Mentally, this is a lot less stressful to manage.

4. Anesthesia is administered by a dedicated anesthesia provider. 

I will admit that while I am well trained and capable, I have never truly enjoyed providing anesthesia. On the other hand, some providers have a passion for this aspect of oral surgery.

This “Pro”, therefore, is purely personal preference. I appreciate and prefer having a dedicated anesthesia provider, especially for full-arch surgery where cases are typically 1-2 hours and patients can have significant medical comorbidities. 

The reason I feel this is a “Pro” specific to AOX surgery, is that it can be difficult to make other aspects of oral surgery financially justify a dedicated anesthesia provider. However, this is much more feasible to do in AOX surgery given the cost and profit margin of the procedure. 

5. Mentally, I can focus on one surgery, one skill set, and one area at which to excel. 

I have never been one who likes to dabble in multiple things. Throughout my life I have consistently chosen one area or idea and gone “all in”. 

All-On-X surgery has provided me this unique opportunity.

I get to focus on this one procedure day in and day out. I get repetition and experience on a revolving, consistent basis that allows me to constantly improve my AOX surgical skill set.  

For me, this is not only mentally rewarding, but it also provides a level of mental relief knowing that my surgical focus is not being pulled in countless directions.

Cons of Being a Full-Time AOX Surgeon

1. As a surgeon, you lose skills you don’t use. 

One of the benefits mentioned above, is that focusing solely on one procedure allows you to rapidly develop a strong surgical skill set in that area. This is absolutely a benefit. 

However, focusing only on one surgical aspect can lead to a loss of other surgical skills.

I will admit that I have experienced this first hand.

I am incredibly thankful to have found AOX surgery.  In addition, I am even more thrilled that I have had the opportunity to focus on it for the past 5 years and learn from some of the best surgeons in the world. 

That being said, as a result of my intense focus, I have also given up some skills.

I no longer perform OMF trauma, orthognathic surgery, or manage large/extensive pathology cases. I have lost my comfort with large reconstructive facial surgery – because well… I haven’t done it for years. And while I feel I could get those skills back with the right exposure – it would take focus, time and effort to regain that comfort. 

While I love what I do and have gone “all in”, many would argue (and rightly so) that this is a huge negative of focusing only on one surgical skill. This is absolutely something to consider if you are pondering the full-time full-arch path.  

2. Your mental focus is on the same thing – every single day. 

I enjoy this. However, I know many practitioners that truly do not like this. These surgeons prefer a variety of cases and they want some change in their day to day to keep things interesting. 

I would say that craving variety is normal. I think that I am actually abnormal in this respect. 

The mental drain on some surgeons of doing the same procedure over and over is significant. In my experience, for most surgeons, doing the same procedure day in and day out is a “Con”.

3. AOX surgery typically has a higher level of stress than other traditional oral surgery procedures.

This is obviously subjective and is not always true. 

However, based on my own experience and in talking to many different surgeons who work in both an AOX focused practice and a traditional practice, there is a recurring theme that while full-arch surgery is rewarding, it is often perceived as much more stressful than other in-office procedures. 

I will note that the more arches you cut and the more experienced you become, the less the stress becomes a factor. Sure, full-arch surgery always has the potential to be highly stressful on any given day. But with experience, it becomes more enjoyable than it is stressful. 

4. Full-arch surgery is taxing manual labor.

AOX surgery, day in and day out, is not easy on your neck and your back. It is hard work and it is hard on your body. 

The difference with this surgery, as compared to other office based oral surgery procedures, is that AOX surgery keeps you in a focused working position for 1-2 hours at a time without rest. And that’s if your efficient. When many surgeons start out, they may actually be in surgery for 3-6 hours at a time.

On the other hand, if your focus is wisdom teeth, while you may perform a couple of hours of surgery a day – in reality you’re doing 10 surgeries that are 15 minutes each or less. As a result, you get a constant break and change in posture. This is unfortunately not the case with full-arch surgery. 

All-On-X surgery is a unique procedure within the world of outpatient oral & maxillofacial surgery. It requires a combination of surgical skills, focus, and time that most other office based surgical procedures do not. 

Given its demands, there are both strong Pros and Cons to performing this procedure full-time. 

In focusing solely on this procedure, I have found my passion and I love what I do. In all honesty, full-arch surgery literally revived me from a state of career burnout and a desire to leave the OMFS field. 

That being said, moving to a full-time AOX career is not for everyone. My hope is that this article provides you insight and wisdom so that you can find just as much happiness and excitement in your career (whatever path you choose), as I have. 

Matthew Krieger DMD