What if the “new” thing in full-arch isn’t actually new—and the real breakthrough is remembering what already worked? We sit down with Dr. Samuel Jirk to unpack eight decades of subperiosteal design and how those lessons should guide today’s patient‑specific implants. From the first time he watched a 14‑unit FP1 delivered over 10 implants at daybreak, to building an in‑house digital lab, his path reveals how mentorship, biomechanics, and occlusion still decide who gets predictable outcomes.

We walk through the foundations laid by the Misch Institute—prosthetics before surgery, divisions of available bone, and RP1–FP4 categories—and why that structure keeps full‑arch treatment safe as complexity rises. Then we challenge the hype around PSIs: CT‑based subs have a long history, and success has always hinged on load direction and soft tissue tolerance. You’ll hear why remote anchorage to the lateral ramus and symphysis reduces crestal stress, how lattice “snowshoe” concepts translate to modern titanium, and why molar‑emerging posts invite dehiscence in thin tissue and active muscle zones. The goal isn’t thicker frameworks; it’s smarter ones—debulked, contoured, and placed where biology says yes.

Along the way, we talk real‑world fabrication—segmenting DICOMs, designing in Exocad and Blender, printing and milling, and even casting cobalt‑chrome when indicated. We also spotlight the underreported side of PSI literature, where two‑year complication rates near 26% demand humility and better design, not complacency. If you’re a surgeon or restorative dentist navigating AOX cases, zygos, or subperiosteals, this is a roadmap to pairing digital precision with time‑tested biomechanics and occlusion.

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