If “more titanium and more screws” sounds like a plan, this conversation may change your mind. We take you behind the curtain of subperiosteal implant design—what the classic meso bar frameworks did brilliantly, why many custom PSI trends miss critical load paths, and how occlusion often determines whether a case survives decades or fails in months. Drawing on tough lessons from early HA-coated, multi-post maxillary cases and the happiest patients who lived well with two-thirds of a frame, we unpack where repairability, segmenting, and tissue-friendly geometry still outperform shiny shortcuts.

We walk through the real differences between mandible and maxilla: cortical density, palatal and nasal spine engagement, lateral sinus walls, and the unforgiving mucosa over pneumatized spaces. You’ll hear how palatal coverage and canine eminences lifted success rates historically, and why skipping them today invites the same old complications with a digital gloss. We challenge the “ladder” mindset—singles to All-on-4 to pterygoids to zygos to PSI—and propose a more honest sequence: remote anchorage first, maxillary subs as rescue, and mandibular subs as a predictable workhorse when designed and maintained correctly.

This is a prosthetic-first blueprint. Nail the occlusal scheme, align DICOM and STL perfectly, and design frames that are thin, recessed, and biologically sensible. Use materials and guidance that absorb shock, control lateral excursions, and make revisions feasible. We share a sobering maxillary failure with sinus fistulas to underline the stakes and offer a practical checklist for vetting labs and designers who can speak both biomechanics and biology, not just software. If you want growth without trophy hunting, and long-term function your hygiene team can support, this one will sharpen your judgment.

Enjoyed the conversation? Follow, share with a colleague who’s PSI-curious, and leave a quick review telling us where you draw the line on maxillary subs.

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.

If this conversation sharpened your thinking, follow the show, share it with a colleague, and leave a review with your biggest takeaway. Your feedback helps more clinicians find practical, proven full‑arch insights.

The waiting room tells the story before we do: patients are traveling, paying more, and asking for three‑on‑six because it feels like teeth—thin, cleanable, and quiet—without carving bone to hide bulk. We sat down with Dr. Randy Roberts and Dr. Logan Lock efor a candid look at FP1‑based full‑arch care, and why a prosthetic‑first plan can upend old assumptions about high smile lines, bone reduction, and “the lab will save it” thinking.

Across a week in their clinic, we watched uncherry‑picked live seats, learned how every extraction and implant becomes a fiducial, and saw why direct‑to‑fixture workflows with internal angle correction make or break access. The mantra is simple but demanding: set the incisal edge first, design ideal teeth, then place implants to serve the prosthetic. That’s how segmented bridges seat fast, phonetics settle quickly, and hygiene stays human. We also walked through high smile line protocols that often avoid macro reduction entirely—suturing tissue to the prosthetic and letting biology re‑establish space—sometimes with nothing more than a subtle 2 mm contour to adjust lip support and display.

For clinicians, this is less about picking a side—FP1 vs FP3—and more about expanding options and matching them to the right patient. Younger arches with good bone and tissue deserve a conversation that preserves structure; complex FP3 remains essential when indications call for it. We compare cost positioning, outline a sane training path that builds from solid FP3 into guided FP1 before extreme anchorage, and share the thousand tiny steps that keep a 30‑minute seat from turning into two hours. Most of all, we talk value: why educated patients don’t want the cheapest full‑arch, they want the thinnest, most natural, and most durable one they can maintain for years.

If this conversation sparks ideas—or challenges your habits—hit follow, share the episode with a colleague, and leave a review with your biggest FP1 question. Your feedback guides future deep dives and live case breakdowns.

Dive deep into the advanced world of pterygoid implant placement with Dr. Clark as he shares game-changing insights that can transform your full-arch implant practice. This episode tackles one of the most challenging aspects of full-arch rehabilitation – achieving perfect prosthetic outcomes through precise surgical execution.

Dr. Clark challenges conventional wisdom about pterygoid implant placement depth, advocating for a more nuanced approach where anterior implants are placed first, followed by adjusting pterygoid depth to ensure all abutment platforms align perfectly. This seemingly subtle shift eliminates uneven prosthetic thickness and tissue complications. The discussion on tissue management reveals how proper thinning of tuberosity and palatal tissues creates silky smooth foundations for prosthetics, saving chairtime and preventing fractures despite initial hesitation about bleeding management.

Perhaps most revolutionary is Dr. Clark's definitive stance on implant configurations, declaring the inverted V superior to traditional axial placement. With persuasive reasoning about prosthetic flexibility and surgical contingencies, he demonstrates why angled implants provide infinitely better options for screw channel positioning. His detailed explanation of multi-unit abutment height selection challenges widespread misconceptions, showing how matching abutment height to implant depth (using 1.5mm abutments for 1mm subcrestal implants) accounts for post-surgical bone resorption and creates beautiful emergence profiles without prosthetic flanges.

For clinicians struggling with postoperative complications, Dr. Clark offers practical solutions like doxycycline protocols and bleeding management techniques using 2-0 chromic gut suture. These pearls of wisdom demonstrate why even experienced surgeons continue to learn from each visit to his courses.

Ready to transform your approach to full-arch implant cases? Listen now to gain insights that will elevate your practice and create more predictable, aesthetic outcomes for your patients. Share your experiences with these techniques and join the conversation about the evolution of implant dentistry.

Mastering complex anatomy in full-arch implant cases requires both technical skill and the wisdom to know your limitations. Dr. Clark Damon joins The Fixed Podcast to share rare but invaluable techniques for challenging anatomical situations that every implant dentist will eventually encounter.

The conversation centers around two advanced procedures: sinus crushing and pterygoid implant placement. Dr. Damon reveals that despite completing 3,000 arch cases, he's only performed sinus crushes on three patients—a testament to both the rarity of proper indications and the importance of understanding when this approach is truly necessary. He walks through his precise technique, from the diamond burr scoring to the use of collagen tape rather than particulate graft, explaining how this one-surgery approach can transform cases with pneumatized sinuses that would otherwise require multiple procedures.

Perhaps most valuable is Dr. Damon's candid discussion about knowing when to collaborate with specialists. "Too many clinicians are taking on cases they really shouldn't be doing," he observes, emphasizing that revenue pressure often leads to complications that "come home to roost fairly quickly." Instead, he advocates bringing specialists into your office for complex cases—creating learning opportunities while maintaining the patient relationship.

The episode showcases Dr. Damon's pterygoid expertise, having placed over 1,000 implants with a stunning 99.5% success rate. He details precise placement techniques, including his preferred 18mm length and entry point between the second and third molar positions. Using the analogy of aiming between the "field goal posts" of the lateral and medial pterygoid plates, he demystifies this advanced technique that dramatically reduces stress on anterior implants.

Whether you're looking to expand your implant capabilities or simply understand when to call for reinforcements, this episode delivers practical wisdom from one of implant dentistry's most experienced practitioners. The techniques discussed may be advanced, but the philosophy is universal: always prioritize predictable outcomes over pushing clinical boundaries beyond your comfort zone.

Remote anchorage techniques have revolutionized what's possible in full arch restoration, and few clinicians have as much experience implementing these advanced approaches as Dr. David Zelig. With nearly 1,000 pterygoid implant placements and decades of surgical experience, Dr. Zellig shares the hard-earned wisdom that can only come from extensive clinical practice.

The conversation begins with a detailed exploration of pterygoid implant technique, where Dr. Zelig reveals his systematic approach to navigating this complex anatomical region. From precisely identifying the hamular notch to utilizing the pyramidal process of the palatine bone for primary anchorage, listeners gain valuable insights that go well beyond textbook knowledge. "The real stability is along that path in the palatine bone," Dr. Zelig explains, demystifying a placement that many clinicians find intimidating.

When discussing potential complications, particularly bleeding management in the pterygoid region, Dr. Zelig provides practical solutions while emphasizing preventative measures through proper technique. His thoughtful approach to zygomatic implants similarly balances clinical efficacy with tissue management, revealing his preference for extra-maxillary approaches in most cases and innovative soft tissue handling techniques that minimize dehiscence.

Perhaps most valuable for practicing clinicians is Dr. Zelig's candid discussion of surgical ergonomics and professional longevity. Rather than slowing down after decades of practice, he remains passionate about advancing the field and mentoring the next generation of implant surgeons. "I feel like it is spring again," he shares, describing how these advanced techniques maintain his enthusiasm for patient care.

As full arch restoration continues evolving, Dr. Zelig anticipates further advances in patient-specific implants and prosthetic design while cautioning against unrealistic expectations regarding maintenance-free restorations. His balanced perspective, combining cutting-edge innovation with pragmatic clinical wisdom, offers listeners a roadmap for incorporating these advanced techniques into their own practices.

Ready to elevate your implant practice? Subscribe to the Fixed Podcast for more conversations with leaders who are pushing the boundaries of what's possible in implant dentistry.

Discover the unexpected intersection of technical mastery and life philosophy in this enlightening conversation with Dr. Nester Marquez, who brings a refreshingly holistic approach to full arch implant dentistry.

Dr. Marquez takes us behind the scenes of his renowned "Ways of the Arches" course—an unconventional educational experience combining rigorous clinical training with desert adventures that include shooting ranges, explosions, and sunset complication lectures. It's a CE course where you literally sign a waiver acknowledging the risks, yet participants consistently describe it as transformative both professionally and personally.

The clinical pearls in this episode are abundant and practical. Dr. Marquez details his apical fenestration technique, an approach where the implant tip intentionally perforates the buccal plate by 1-2mm to achieve cortical engagement and superior stability. He walks through his Empire State drilling concept that consistently yields torque values of 60-70 Ncm rather than the typical 25-30 Ncm. These aren't just theoretical concepts—they're battle-tested techniques explained with the clarity that comes from extensive experience.

What truly distinguishes this conversation is Dr. Marquez's philosophical depth. He candidly discusses how his early chase for professional recognition left important aspects of his life unattended, leading to his "Ways of the Heart" philosophy. His perspective on innovation—"Not everything that shines is gold, but the only way to find anything shiny is by digging"—reminds us that advancement requires exploration and occasional rule-breaking. Most poignantly, he emphasizes that while technical skill matters, true fulfillment comes from family and meaningful relationships.

Whether you're an experienced implant surgeon or just beginning your journey into full arch treatment, this episode offers valuable technical insights while reminding us of the bigger picture: At the end of the day, no one will hang your dental achievements on their wall, but the impact you have on patients and loved ones creates a legacy worth pursuing.

What happens when Instagram perfection meets clinical reality? Dr. Nestor Marquez pulls back the curtain on full-arch implant dentistry in this candid conversation that every clinician needs to hear.

Practicing in the unique dental tourism hub of "Molar City" (Los Algodones, Mexico) while living just across the border in Yuma, Arizona, Dr. Marquez shares his unconventional journey from failed dental student and aspiring musician to respected implant clinician. With disarming honesty, he reveals how his father's tough love redirected his path toward dentistry—a decision that ultimately led to his passion for complex implant rehabilitation.

The heart of this discussion centers on proper clinical education in today's social media-driven landscape. Dr. Marquez challenges the contemporary rush toward advanced techniques, describing how he watched over 100 surgeries before attempting his first case and completed 500-600 traditional all-on-four cases before incorporating pterygoid implants. This measured approach contrasts sharply with clinicians who attempt complex techniques after a single weekend course.

Perhaps most valuable is Dr. Marquez's transparency about complications. "The gods of full arch have complications," he reveals, describing how even the most respected clinicians privately seek advice when cases go wrong. This reality check serves as a powerful antidote to the curated perfection of dental Instagram, where clinicians showcase their successes while keeping failures private. His advice on patient communication—never guaranteeing specific outcomes—stems from hard-earned experience.

Beyond technical skills, Dr. Marquez emphasizes the psychological components of implant dentistry: managing patient expectations, maintaining perspective, and knowing when personal factors might compromise clinical judgment. These human elements, often overlooked in formal education, prove essential for long-term success.

Whether you're an experienced implantologist or just beginning your journey, this conversation offers rare insights into the realities of full-arch implant treatment. Follow Dr. Nestor Marquez on Instagram (@dr_nes) for his exceptional clinical documentation and educational content that brings transparency to this complex field.

Ready to transform your dental practice into a facial aesthetics powerhouse? This eye-opening conversation reveals how implant dentists are perfectly positioned to tap into the $120 billion facial aesthetics industry—a market 24 times larger than implant dentistry itself.

Dr. Soren Paape and Dr. Tyler Tolbert explore how incorporating PRF (Platelet-Rich Fibrin) treatments can create substantial recurring revenue streams while delivering exceptional results for patients. The discussion unveils the stark contrast between one-time implant cases versus aesthetic patients who typically spend $3,000 annually on treatments, returning every 4-6 months like clockwork.

The conversation takes a fascinating technical turn with the introduction of the "PRF poncho technique"—a game-changing approach that dramatically reduces bacterial infiltration around implants. Learn how this simple yet powerful method creates a protective barrier of leukocyte-rich fibrin that significantly improves long-term implant success rates, especially for immediate placements.

Dental professionals will appreciate the detailed breakdown of PRF processing protocols, including critical insights about tube surface properties, oxygen exposure, and temperature control. The experts share practical tips for optimizing PRF quality, avoiding common mistakes, and efficiently integrating these services into your existing practice flow.

Perhaps most compelling is how these regenerative treatments can be partially delegated to trained dental assistants who are already comfortable with blood and sterile procedures. This creates new career advancement pathways for team members while maximizing practice productivity.

Have you considered how adding facial aesthetics could revolutionize your implant practice? Could the skills you already possess be worth considerably more in this expanding field? Listen now to discover if this could be your practice's next evolution.