Full Arch Complications: A 360° Global Summit

Full arch implant reconstruction therapy offers a predictable and effective solution for edentulous patients, providing improved functionality and aesthetics. However, the complexity of these treatments, which often involve the use of endosseous, zygomatic, pterygoid, and subperiosteal implants, presents a range of potential complications that can impact both short-term and long-term outcomes. Often the failure cases undergo multiple revisions with patient specific implants. This lecture explores the various complications associated with patient specific revision full arch reconstructions.

Patient Specific Implants can be quite complex and require a special skill set for placement and to dela with the unique complications. Patient Specific implants, used in patients with extreme bone resorption, can result in complications such as fenestration, fractures, chronic infection, framework failure and soft tissue irritation and large oronasal, oroantral and cutaneous fistulas.

Risk factors that increase the likelihood of complications include systemic health conditions, smoking, poor bone quality, and inadequate surgical planning. Additionally, prevention strategies such as preoperative assessments, thorough surgical techniques, and appropriate post operative management and care. The importance of regular follow up for early detection intervention is emphasized to ensure the long-term success of full arch implant therapy.

By the end of the session, participants will gain a comprehensive understanding of the potential complications associated with patient specific full arch implant therapy, enabling them to better manage and mitigate these issues for improved patient outcomes.

Learning Objectives

• Understand the various types of complications that can arise in Patient Specific full arch implant reconstruction therapy, including surgical, prosthetic, and biological issues.
• Identify patient-related risk factors (e.g., systemic conditions, smoking, poor oral hygiene) and procedural factors that may increase the likelihood of complications during and after the procedure.
• Discuss preventive measures for complications, including proper patient selection, pre-operative planning, and post-operative care protocols.
• Recognize how to identify the proper treatment following a complication based on scenario and patient circumstance.

Full-arch implant rehabilitation offers life-changing outcomes, yet its long-term success depends on a proactive approach that prioritizes prevention and prepares clinicians for inevitable challenges.

This lecture will explore evidence-based preventive protocols that minimize biological and mechanical complications in full-arch therapy, with a focus on surgical precision, prosthetic design, and maintenance strategies. In addition, advanced approaches for the management of complications and failures—including peri-implant disease, prosthetic breakdowns, and implant loss—will be highlighted.

Through clinical cases and practical insights, participants will gain the tools to optimize treatment outcomes, safeguard patient satisfaction, and confidently navigate complex rescue scenarios.

Learning Objectives

• Identify patient surgical and prosthetic related risk factors for complications in full-arch implant rehabilitation.
• Apply evidence-based preventive protocols to enhance the long-term success and stability of full-arch implant restorations.
• Evaluate and implement advanced clinical strategies for the diagnosis and management of biological and mechanical failures in full-arch implant cases.

Are surgical and prosthetic complications interrelated? This prevention aims to illustrate the bidirectional relationship between surgery and prosthetics, emphasizing how both patient outcomes and clinician satisfaction depend on proactive planning and execution across disciplines.  This prevention will show how surgical and prosthetic complications are inter-related and how they affect the patient, surgeon and restorative doctor. Ultimately, preventing complications is key.

Learning Objectives

• Proper diagnosis, surgical and prosthetic, to avoid surgical and prosthetic complications. 
• Understand prosthetic consequences of surgical complications.
• Understand surgical consequences of prosthetic consequences. 
• Quantity physical, financial & emotional pain of patient, surgeon and restorative doctor related to complications. 

Successful full arch restorations depend not only on prosthetic precision and osseointegration but also on the establishment and long-term stability of healthy peri-implant soft tissues. This lecture focuses on achieving predictable soft tissue outcomes in full arch rehabilitation through strategic surgical techniques and proper case selection.

Key indications and protocols for soft tissue augmentation will be presented, including the use of Free Gingival Grafts (FGG), Connective Tissue Grafts (CTG), Apically Positioned Flap (APF) and Vascularized Interpositional Periosteal Connective Tissue flap (VIP-CT) .

The lecture will also address the timing and sequencing of soft tissue procedures relative to implant placement and prosthetic loading, with clinical cases demonstrating the impact on long-term outcomes. Additionally, strategies for complication prevention and management will be discussed.

By the end of the session, participants will have a structured framework for soft tissue decision-making in full arch cases and practical tools to enhance predictability and patient satisfaction.

Learning Objectives

• Understand the indications and selection criteria for soft tissue augmentation techniques in full arch restorations
• Learn the step-by-step surgical protocols for achieving predictable soft tissue outcomes and optimizing peri-implant health and esthetics
• Recognize, prevent, and manage soft tissue complications

Zygomatic implants have revolutionized the rehabilitation of patients with severe maxillary atrophy, providing immediate function and avoiding complex grafting procedures. However, their unique anatomical trajectory and proximity to vital structures introduce a spectrum of potential complications that require careful consideration. This lecture will explore the “dark side” of zygomatic implantology, highlighting both early and late complications such as sinusitis, oroantral communication, soft tissue dehiscence, implant failure, orbital or intra-cranial injury, and prosthetic challenges.

Emphasis will be placed on understanding the anatomical risk zones, strategies for prevention, and evidence-based approaches to complication management. Through clinical cases and surgical pearls, participants will gain a comprehensive perspective on anticipating, diagnosing, and addressing complications to ensure safe and predictable outcomes in zygomatic implant therapy.

Learning Objectives

• Identify the most common early and late complications associated with zygomatic implants and understand their underlying anatomical risk factors.
• Apply evidence-based strategies for prevention, early diagnosis, and effective management of complications in zygomatic implant therapy.
• Integrate clinical insights and surgical pearls into daily practice to enhance patient safety and improve long-term treatment outcomes.

Palatal and trans-sinus implants occupy a unique middle ground between conventional All-on-4 solutions and more complex zygomatic approaches.  While often overlooked, they can be the key to resolving complications and expanding treatment options in challenging cases.  This lecture will focus on how to anticipate and prevent problems through accurate reading of the local anatomy and the strategic use of bone-level surgical guides.

Practical insights on planning, instrumentation, and surgical execution will be shared, offering clinicians predicable, complication-free outcomes in full arch rehabilitation.

Learning Objectives

• Understand how palatal implants expand the surgical armamentarium and how mastery of local anatomic landmarks minimizes complications.‍
• Evaluate the role of trans-sinus implants as a reliable alternative to sinus grafting, emphasizing key anatomic criteria for safe execution.
• Apply structured workflows, including the use of bone-level guides, to streamline surgical execution and minimize complications in full-arch rehabilitation. 

This comprehensive clinical presentation will feature the most common intraoperative, early and late postoperative complications of zygomatic implant therapy.  It will focus on prevention as well as recommended treatment protocols for these misadventures.  It will also include case presentations that will emphasize the importance of attention to detail of both surgical and prosthetic principles of full arch immediate reconstruction.

Learning Objectives

• Understand the range of intraoperative, early and late postoperative complications associated with zygomatic implants
• Understand the preventative measures that can be taken to minimize complications associated with zygomatic implant complications
• Understand recommended treatment for zygomatic implant complications

Oroantral communications (OAC) are openings between the oral cavity and the maxillary sinus, most often caused by extractions of upper posterior teeth and placement of zygomatic implants. If not managed promptly and properly they can lead to chronic sinus infections, persistent fistulas, and patient discomfort.

This lecture will help practitioners recognize OACs through clinical signs and imaging, understand when conservative management is appropriate, and learn surgical techniques such as buccal advancement flaps, palatal rotation flaps, and the use of the buccal fat pad. Emphasis will be placed on early diagnosis, infection control, and step-by-step approaches to closure, along with practical tips to prevent OACs during extractions, placement of zygomatic implants and improve patient outcomes. 

Learning Objectives

• Recognize the Causes and Risk Factors - Understand the common etiologies of oroantral communications, with a focus on extractions of maxillary posterior teeth, placement of zygomatic implants and how to identify high-risk cases before surgery.
• Perform Complex Surgical Closure Techniques - Gain step-by-step knowledge of commonly used surgical techniques such as buccal advancement flaps, palatal rotation flaps, and buccal fat pad grafts.
• Prevent Complications and Recurrence - Apply strategies for infection control, postoperative care, and prevention of oroantral communications during routine dental extractions and zygomatic implant placement

The extramaxillary approach to zygomatic, Pterygoid, and Z-point implant placement offers a valuable solution for patients with severe maxillary atrophy, but it is also associated with a distinct set of complications that may necessitate revision surgery. Failures related to malposition, inadequate prosthetic trajectory, peri-implant soft tissue dehiscence, and chronic sinus or oroantral issues present unique challenges for the surgeon.

This lecture will focus on revision strategies for extramaxillary implants, emphasizing surgical planning, anatomical considerations, and intraoperative techniques for removal, repositioning, or conversion to alternative anchorage sites. Specific attention will be given to management of compromised bone–implant interfaces, reconstruction of deficient soft tissues, and optimization of implant emergence profiles to facilitate prosthetic rehabilitation.

Case-based examples will illustrate salvage procedures, staged revision protocols, and outcomes, with the goal of providing a systematic framework for addressing complications while minimizing patient morbidity.

Learning Objectives

• Learn the limitations of certain extramaxillary implants
• Learn techniques for revision of extramaxillary implants
• Learn the philosophy of revisions of extramaxillary implants

Maxillary and mandibular AO4/AOX has become commonly accepted treatment for not only the edentulous but for the terminal dentition as well. Numerous surgical techniques have been developed to overcome the multitude of anatomical challenges; however they do bear the risk of cranial nerve damage. Sensory disturbance in CN V Div II and Div III have been well documented in the surgery literature but most of the data has been extrapolated from the placement of vertical single implant fixtures. With the advent of posterior mandibular tilted implants, the risk balance has evolved from the previous accepted surgical techniques and it has perhaps added to sensory nerve injury risk.

The increased popularity of zygomatic implant placement has placed CN V Div III at risk for neurosensory damage. The extent of the needed surgical exposure has been implicated in nerve injury without actual physical damage which can be difficult to ascertain and treat. Improper implant angulation can lead to more severe nerve damage associated with the orbital contents.

Learning Objectives

• Proper anatomic CBCT evaluation of pertinent anatomy
• Use of pre-operative stereolithic models
• Review of nerve injury mechanism and classification
• Review of surgical techniques which will minimize the risk of nerve injury
• Patient preparation for possible risk of post-operative sensory deficiency
• Mitigation of risk and management of actual nerve injury

All on X cases are complex requiring extensive planning and coordination of multiple specialist’s laboratories and imaging services.  Do not forget that there is a patient attached to that mandible and maxilla who is likely to have a host of underlying medical issues.

If the medical issues are not handled appropriately, the stress of the procedure, and potential complications can derail the best laid plans.

The most threatening issues are Obesity, Difficult Airway, Diabetes, Hypertension, Cardiac Disease, Pulmonary Disease, Renal Disease Atherosclerosis, and Mental Illness. The goal of this brief lecture is to expose the participants to these factors, and how to deal with them.

Learning Objectives

• What is medical clearance? How do we get it?
• How do we avoid complications?
• How do we manage pain?

The dawn of artificial Intelligence use in full arch reconstruction is here, and within 5 years will be involved or manage imaging, diagnosis, treatment planning, consent, implant selection, placement, follow up, billing, staff, failure management, and marketing. This course will discuss the legal implications, risks, and licensure issues of unavoidable employment of AI and offer guides and tips to eliminate or reduce legal exposure and/or licensure sanctions.

Learning Objectives

• Understand the inevitable applications of AI in full arch reconstruction.
• Learn the potential and probable legal and licensure exposure caused by AI.
• Be able to employ systems, protocols, and staff to reduce or eliminate legal consequences of failures.