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Episode 8 - Preparation for Full Arch Surgery

Full-Arch Restoration - Mission Possible (Mini-Series)

Preparing for the surgical stage of any full arch case requires insight into the patient’s anatomy and existing dental condition. In this episode, "Preparation for Full Arch Surgery" of the “Full-Arch Restoration…Mission Possible” series, Dr. Frank LaMar will explore the most important elements to consider as well as the role technology plays in supporting the surgical process.

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Episode 8 - Preparation for Full Arch Surgery

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For more information, click here to Contact Us or call (585) 319-5400. We look forward to bringing you the next episode of Full-Arch Restoration - Mission Possible.

Watch the Hybridge Podcast Video: Episode 8 - Preparation for Full Arch Surgery


Randal: Joining me today on Full Arch Restoration: Mission Possible is Dr. Frank LaMar. Dr. LaMar, what are the factors you consider when you prepare a full arch restoration, both in the maxilla and the mandible?

Dr. LaMar: A good foundation of knowledge is important. There seems to be a general hope, I think, that technology is going to make up for any deficiencies in either surgical or prosthetic knowhow. I think that’s kind of getting a little dangerous in the full arch space. I do think technology can help us, and we do use CBCT whether it’s pre-extraction, or pre-implant or both. And certainly knowing in advance exactly what the anatomy is, and even sometimes, actually, doctors that haven’t done a lot of these surgeries will order a 3D printed maxilla or mandible. It gives them an opportunity to really get an understanding of what the anatomy looks like, where the undercuts are.

So, let’s take the maxilla first. Prosthetically when we are evaluating these cases, if it’s a dentate case, we want to know how much alveolar reduction we want to take at the time of extractions. And so, CBCTs are really important at knowing exactly how much bone is there to start in that first pre-molar to first pre-molar area. So, we do measurements, from the crest of the ridge all the way up to whatever the superior limit is, whether it is the nasal floor or whether it’s the maxillary sinus.

And so, for example if there’s 18mm of alveolar height in those areas where the teeth are there and we know that minimally, we need an extra 5 mm of inter-arch space after the teeth are removed we can do some very simple math and calculations based on those to decide, well if we have 18 and we take away 5, that leaves us with 13mm of bone. So, these calculations and this insight pre-extraction in the maxilla is really critical, and it gives us an idea for what things are going to look like after extractions are done. Also gives us an idea for if we were to extract those teeth and do the plasty, could we then place the implants at the time of extraction, and we talk about this as a one-stage approach. And so, all of this is diagnostic, and it’s doctor diagnostic. Now again, technology can only go so far, so I think it’s imperative that a doctor actually has a way to look at these cases pre-treatment and use the technology available to make key decisions.

Randal: And, your approach on the mandible?

Dr. LaMar: Dr. LaMar: So, very different. You know, as we’ve talked about, probably 70% of the time we don’t do a one-stage process in the maxilla. But, in the mandible about 100% of the time we take a dentate patient, we extract, we do an alveoloplasty. At a pre-determined level, so pre-determined based on CBCT pre-treatment and some basic calculations as to if, again, if we have so much bone, how much bone do we want to reduce, therefore how much bone are we left with? In the mandible, usually that bone around
the lower incisors, if you look to the apex to those lower incisors, we generally don’t get to the good bone until we are below that. So, these scans can give us an idea for if we were to reduce to the apices of the incisors, which would give us on average maybe 8-10mm of additional interarch space—where are we and what does the bone look like? This can all be done just by carefully analyzing these scans. Also, it gives us an idea for where are the mental foramen, and where is the (we generally look at the first pre-molar on each side), where is the apex of the first pre-molar relative to where the foramen is. Doctors who aren’t as comfortable manipulating that nerve and dissecting it, really want to know where
that nerve is and this is a really great way to kind of know where you are at all times. And so, the amount of reduction is pre-determined, and knowing exactly where the foramen is, is pre-determined, all on CBCT, and then these surgeries can be done really predictably with a surgical guide, which is nothing more than a duplicate of the final set up.

Randal: And in the Hybridge XD process, does anything in terms of your considerations change?

Dr. LaMar: In the mandible, it really doesn’t. The approach to how much bone to reduce, where is the good bone, and how to distribute the spread of the implants between the foramen is all the same, whether we are doing a conventional Hybridge protocol or an express digital protocol.

Randal: Thank you ladies and gentlemen for joining us today, on Full Arch Restoration: Mission Possible. For more information call 585-319-5400 or visit us online at We look forward to bringing you the next episode of Full Arch Restoration: Mission Possible.

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