Surgery day: three different surgical approaches

Given appropriate pre-surgical planning including 3-dimensional radiographic imaging, proper case selection and the surgeon's level of experience provide the basis for choosing between free-hand, partially guided or fully guided approaches for the surgery execution.

Freehand surgery

A full flap freehand surgery, also known as the traditional approach allows full visualization of the surgical site and bone in full arch rehabilitations on 4 implants.

This surgical approach be executed if any or all of the below listed anatomical conditions is diagnosed to the patient's maxillary bone candidate for the treatment:

• Failing/terminal dentition
• Alvelolaectomy required
• Lack of keratinised gingiva

Dr. Steven Bongard demonstrates the freehand approach in an All-on-4  surgery.

Pilot guided surgery

Guided pilot drilling can address the challenge of initial drill positioning, orientation or angulation and depth of the first drill, which are crucial to initial site preparation for All-on-4 treatment. 

The pilot  guided surgery can be executed if any, or all of the below listed anatomical conditions is diagnosed to the patient's maxillary bone:

• Fully edentulous or terminal dentition
• Alveolectomy required
• Lack of keratinized gingiva

Learn how to approach the All-on-4 surgical treatment using guided pilot drilling with Dr. Armando Lopez. Note the pins used to stabilize the surgical template, which is crucial for accurate implant placement especially using guided surgery with edentulous patients.

Fully guided surgery

The fully guided approach allows for a minimally invasive (flapless) surgery. This approach is recommended for clinicians with acquired expertise.

The fully guided surgery can be executed if any, or all of the below listed anatomical conditions is diagnosed to the patient's maxillary bone candidate for the treatment:

• Fully edentulous
• Bone reduction not required
• Adeguate keratinized gingiva 

Learn how to approach the All-on-4 treatment using a fully guided approach in a total edentulous patient. Patient factors such as mucosal thickness can be a challenge affecting the fit of the surgical template.

Continue your learning journey

This module is now completed. Continue your learning journey by accessing the next one.