Pikos Symposium 2025

While rapidly evolving dental technology is making full mouth implant rehabilitation easier for practitioners, it is simultaneously making it more accessible to the masses. Unfortunately, this transformed landscape comes with its own unique set of challenges. Namely, the treatment planning needs of these patients is not uniform for providers nationally (and globally). This presentation will aim to bridge that gap by discussing an individualized approach to implant rehabilitation. We will discuss a spectrum of topics ranging from the fundamentals of treatment planning to the intricacies of an FP1 implant rehabilitation.

Focus Areas

• Understand the traditional prosthetic approaches to full-mouth reconstruction
• Appreciate the evolution of prosthetic (and surgical) workflows within the modern digital era
• Identify the different applications of a modern workflow for both surgical and prosthetic applications in full-mouth reconstructions.

The increasing adoption of All-on-X full-arch implant rehabilitation has provided edentulous patients with predictable functional and aesthetic outcomes. However, complications such as implant failure, severe bone loss, peri-implantitis, and prosthetic issues may necessitate more advanced surgical interventions. In cases where traditional implant sites are no longer viable, remote anchorage fixation using zygomatic, pterygoid, or transnasal implants offers a viable solution for restoring function and stability. This lecture will explore the diagnosis and management of complications in failed All-on-X cases, the indications for remote anchorage fixation, and surgical techniques to optimize outcomes. A focus will be placed on patient selection, risk assessment, and long-term success strategies to enhance clinical decision-making. Through case presentations and evidence-based discussions, attendees will gain insights into managing complex cases with confidence.

Learning Objectives:

By the end of this lecture, participants will be able to:

1. Identify the most common complications associated with All-on-X full-arch treatments and understand their underlying causes.
2. Evaluate the indications for transitioning to remote anchorage fixation in cases of implant failure and severe bone loss.
3. Understand the biomechanics and surgical principles of zygomatic, pterygoid, and transnasal implant placement.
4. Develop treatment plans that incorporate remote anchorage techniques while minimizing risks and maximizing long-term outcomes.
5. Analyze case studies to recognize key decision-making factors and learn strategies for complication management and prevention

Learning from Real Cases

This session will present various case studies in dental implantology, highlighting successful outcomes and lessons learned from challenging cases. Participants will engage in discussions to deepen their understanding.

Case Study Highlights

• Successful Outcomes
• Challenges Faced
• Lessons Learned

Effective Marketing Strategies

This session will cover marketing strategies for dental practices focusing on implantology. Attendees will learn how to effectively communicate the benefits of implants to potential patients and enhance practice visibility.

Marketing Techniques

• Online Marketing
• Patient Testimonials
• Community Outreach

Objectives

• Incorporate basics of Dynamic Navigation to the prosthetic and surgical armamentarium
• Demonstrate the digital flow management,  a restorative driven concept, from the data acquisition to planning and the delivery process.
• Discuss the predictability of the dynamic navigation concept
• FP1 design; minimally invasive surgical vision will be addressed
• When things go wrong; how to modify the initial plan and be able to continue utilizing dynamic navigation during the surgery
• Advantages of dynamic photogrammetry and basic photogrammetry
• Team approach-Surgical/Restorative/Laboratory, inter-disciplinary mentality

The focus of oral rehabilitation should always be the outcome, not any specific method or materials. However, severely atrophied jaws, sinus morphology and/or poor quality bone present significant limitations and challenges to treatment planning for dental implants, especially in a patient-centred approach involving fixed and immediate function.

Zygoma implants offer an ability to overcome certain limitations, but involve advanced invasive surgery which, when necessarily focusing on technique alone, may lead to poor prosthetic outcomes in terms of cleanability, comfort and restorability. Additionally, the challenges which are evident on the radiographs may differ from what the surgeon encounters at surgery, and may require a modification to the surgical approach or an abandonment of the plan.

This program will explore the efficacy of Fibishenko’s approach to Zygomatic implants and combination of other advanced yet predictable surgical and restorative techniques as a means to control the outcome. It will feature treating the edentulous, as well as those with failing dentitions and complex anatomical or clinical presentations using a digital workflow.

Dr Fibishenko will describe and compare four surgical methods to idealise the placement of Zygoma implants for an optimal patient-centred prosthetic outcome, and will present results of his clinical study:

• comparing the differences between planned and executed (or abandoned) treatments involving Zygoma.
• life table analysis of performance (interruptions to fixed function).
• patient-reported outcomes relative to various initial clinical presentations (edentulous, partly edentulous and fully edentulous).
• recorded clinical outcomes

Learning Objectives:

• Understanding maxillary anatomy in deciding on the safest and most predictable prosthetically-driven approach to place zygomatic implants 
• Drilling protocol to control the osteotomy for precision with Zygomatic implant placement
• Understanding how to control adaptation through biomechanical considerations including using immediate finals

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Measuring Patient Satisfaction

This session will focus on the importance of patient satisfaction in dental implant procedures. Attendees will learn how to assess satisfaction levels and implement strategies to enhance the patient experience.

Key Discussion Points

• Patient Feedback Mechanisms
• Improving Patient Experience
• Long-Term Satisfaction

Zygomatic implants are currently a reliable, predictable and long-term solution for rehabilitating severe maxillary atrophy. The surgical procedure for successful treatment with zygomatic implants is based largely on a thorough knowledge of the specific anatomical situation of the patient; on the awareness of the possible complications, to prevent them from the outset; on the adaptation of surgical protocols to each patient and site; as well as on the choice of the most appropriate material and designs to treat it 

The ZAGA concept standardizes anatomical knowledge, planning of the implant trajectory and precise positioning to reduce the risk of long-term complications, such as rhinosinusitis, soft tissue dehiscence or biomechanical failure. Recent studies also demonstrate the biomechanical suitability of the ZAGA concept over other procedures, concluding that the ZAGA osteotomy coupled with optimized implant placement leads to less stress on all components of the system. 

Learning objectives:

• To understand the fundamentals of the ZAGA concept 
• To understand how to avoid complications 
• To understand the biomechanics of the zygomatic implant

Zygomatic implants have proven to be a reliable and predictable solution for severe maxillary atrophy as per a number of long-term studies. There are, however, complications that are associated with this technology.

This presentation will focus on intraoperative, early and late postoperative complications that are associated with zygomatic implant therapy. Prevention, recognition and treatment of these problems will be covered in detail. Emphasis will be on addressing the prevention and treatment of the most commonly seen complications.

After this presentation attendees will:

1. Understand and recognize intraoperative, early and late post op zygomatic implant complications.
2. Understand and treat intraoperative, early and late post op zygomatic implant complications.
3. Understand strategies to prevent intraoperative, early and late post op zygomatic implant complications.

Reported dental implant success rates are high resulting in an ever-increasing number of patients being treated with implants.

Over time however ,the percentage of dental implant complications & failures increases because of biological and technical issues. As prevention is better than cure clinicians need to be able to identify high risk patients & take the necessary steps and precautions to prevent these complications. Inevitably however complications will occur and clinicians will have to dedicate more time in dealing with ailing and failing dental implants.

The most predictable management of these cases appears to be implant removal & replacement. The aim of this lecture is to describe an  atraumatic method & treatment modality in dealing efficiently with these cases.

The decision to treat or remove (explant) a failing implant is a judgement that needs to be made by the treating clinician and needs to be based both on clinical and radiographic evaluation.

Dental implant removal may be indicated in cases of advanced bone loss around implants.

Implant removal devices are now available that facilitate removal of failed implants with a predictable technique that permits conservative implant extraction and at the same time preserving most of the viable soft and hard tissue.

This clinical protocol aims to:

1. Explant the infected implant.
2. Decrease the bacterial load by curettage and decontamination of the implant socket.
3. Maintain the regenerative capacity of the surrounding alveolar walls.
4. Achieve primary stability for the immediate replacement implant either in the same or adjacent site.
5. Immediately load the replacement implants.

Learning Objectives

Upon completion of this presentation participants should be able to :

1. Identify high risk patients for complications.
2. Take the necessary steps to prevent complications.
3. Identify atraumatic methods of removing failed implants.
4. Become familiar with the concept of immediate replacement of failed implants in the same or adjacent site
5. Become familiar with the protocol of immediate loading of replaced implants.
6. Identify cases where immediate replacement is not possible,and a delayed protocol is indicated.

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. This lecture explores the various complications associated with each implant type in full arch reconstructions.

Endosseous implants, while the most commonly used, are prone to complications such as peri-implantitis, mechanical failure, and osseointegration failure. Zygomatic implants, which are employed in cases of severe maxillary bone loss, can experience complications such as malpositioning, sinus involvement, fractures, oronasal and oroantral fistulas and issues related to prosthetic support. Pterygoid implants, often utilized for patients with insufficient posterior maxillary bone, pose risks like improper angulation, sinus membrane perforation, bleeding, pterygoid complex fractures and nerve injury. Lastly, subperiosteal implants, used in patients with extreme bone resorption, can result in complications such as fenestration, fractures, chronic infection, and soft tissue irritation and large oronasal or oroantral 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 full arch implant therapy, enabling them to better manage and mitigate these issues for improved patient outcomes.

Learning Objectives: 

1. Understand the various types of complications that can arise in full arch implant reconstruction therapy, including surgical, prosthetic, and biological issues.
2. 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.
3. Discuss preventive measures for complications, including proper patient selection, pre-operative planning, and post-operative care protocols.
4. Recognize how to identify the proper treatment following a complication based on scenario and patient circumstance.

Immediately loaded full arch dental implant procedures such as All-On-X have a 20+ year history of successful performance. While most short-term studies show extremely high survival, mid to long term studies have shown trends of increasing failure rates for conventional implants in such cases. Many AOX cases have minimal bone to begin with, and these situations are exacerbated when implants fail. Remote anchorage techniques such as zygomatic and pterygoid implants can rescue failing AOX cases with applications such as the PATZi protocol. What can be done, however, when these advanced implants fail. The Holtzclaw Extrasinus Infratemporal Anchorage (HESIAn) zygomatic implant protocol is a highly advanced method which can rescue these cases. In addition to reviewing the principles of the PATZi protocol, this lecture will describe the HESIAn protocol, its indications, and provide an analysis of multiple cases with up to 3 years of follow up.

(AGD Code 690)

Objectives:

1. Understand the PATZi protocol and its applications
2. Understand the HESIAn protocol and its applications
3. Understand how to recognize and appropriately treat full arch implant complications