23/02/2025
An Orthognathic Approach to Fixing Failures 🧐
With more practitioners offering full arch implant rehabilitation, revision cases are becoming more common. Many failures aren’t due to implant placement errors, rather they stem from a breakdown in prosthodontic and biomechanical principles.
⚫️ An Overlooked Principle in Full Arch Failure
This patient presented with:
❌ Multiple failed implants
❌ TMJ dysfunction & joint pain
❌ Occlusal instability
❌ Excessive VDO & facial imbalance
Implant positioning looked ok in the bond, but for 5 years, the patient struggled with bite instability, severe TMJ pain, and chewing difficulty.
🤔 The issue wasn’t the implants—it was the occlusal plane.
⚫️ The Orthognathic Surgery Parallel 💀
In orthognathic surgery, occlusion must be controlled first before repositioning the maxilla or mandible.
👨⚕️ Example:
-In maxillary downgrafting, if the maxilla is repositioned first, the intermediate splint becomes too thick, displacing the TMJ and causing relapse - increasing risk for relapse.
-Solution? Mandible-first sequencing—establishing occlusal stability first.
This full arch failure mimicked a down-grafted maxilla, forcing the mandible into an unstable, counterclockwise rotated position.
⚫️ Prostho-Gnathic Thinking in Full Arch Surgery
When posterior alveoloplasty is inadequate, it leads to:
🔹 Thick anterior prosthesis, thin posterior
🔹 An inverse occlusal plane angle
🔹 Posterior interference, forcing the mandible into instability
🚨 The result? Joint pain, muscle strain, excessive VDO, and prosthetic failure.
The fix? Not replacing implants—correcting the occlusal plane first through posterior alveoloplasty, allowing the mandible to auto-rotate naturally—just like in a well-planned orthognathic case.
Before tackling zygomatic and pterygoid implants, surgeons must first master occlusion, biomechanics, and alveoloplasty.
🚀 The PATZI Primer – Coming Soon 👀
A strategic playbook on full arch rehabilitation—surgical sequencing, biomechanics, occlusion, and troubleshooting.
🔗 Join the waitlist now—link in bio.
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