How risky is full-arch implant surgery, and what makes it safer?

Why "boring" is good

We want your surgery to be uneventful.

When a procedure is done the same way every time, it becomes a routine. The instruments come out in the same order, and the assistant knows the next step without being asked. Nothing has to be figured out while you're sedated.

Decisions made during surgery are made in a hurry. Decisions made beforehand aren't. A settled routine moves as many decisions as possible to before you're in the chair.

"The same way every time" doesn't mean you're just a number. Your bone, your healing, your anatomy and the smile you want are all yours. Keeping the routine parts routine frees us to focus on what's unique about you.

Less water, less bleeding, less time

Here's one example of how simpler can be safer.

During full-arch surgery we smooth down a small amount of bone along the ridge. Many practices use a saw or drill, which gets hot and needs a steady stream of water. Water in the mouth of a sedated patient can make you cough or feel like you're choking, so the surgery pauses while you settle. Cutting bone this way also opens tiny blood vessels, which means more bleeding.

We clip the bone instead. No water, so no coughing or pauses. The bone is pressed rather than cut, which tends to protect more of its blood supply.

That one change makes the surgery shorter, with less bleeding and more comfort for you, and it works by taking a step away.

When a plan made in advance goes wrong

Guided systems plan everything ahead of time: how much bone to smooth, where each implant goes, where the teeth will sit. The surgeon then follows a physical guide. When the plan matches the patient, it works well.

The catch is that each step depends on the one before. If the bone reduction is off by a couple of millimeters, the implants can end up in the wrong place, and nobody knows until it's done.

Guided surgery isn't wrong. But your surgeon should be able to see when the plan and your mouth disagree, and change course. Ask what they do when that happens.

Placing each implant once

An implant holds because the bone grips it. Every time it's moved after it's placed, that grip weakens.

So the rule is to know exactly where it's going before making the hole. Under pressure it's tempting to adjust, and each adjustment costs bone that doesn't come back. A site that's been reworked a few times may need a wider implant.

When we train other surgeons, one of the first things we watch is how much they move an implant once it's in.

Planning from the teeth back

The textbook rule is to plan from where each tooth needs to end up, then work back to the implant underneath. Everyone learns it. It's much harder to stick to during surgery, when bone does something unexpected.

A surgeon who also knows how the teeth are made sticks to it better. They've seen what a badly placed implant causes later, like a screw hole in the wrong spot or teeth built to make up for it.

We learn and adjust

Some years ago we started using a highly regarded electrosurgical scalpel. It cut with very little bleeding, as promised. It also burned tissue, and one patient had altered nerve sensation afterward. She was the last patient we used it on.

Good tools and good reasons can still lead to the wrong call. When that happens, we change.

What to ask

• How many of these do you do in a normal month?
• What happens if what you find doesn't match the plan?
• How long is the operation, and how long am I sedated?
• If an implant fails, who replaces it, and what will it cost me?