The Lasting Smile Podcast

The Lasting Smile Podcast: Episode 1 Part 3

Explore how digital precision and surgical innovation are shaping the future of full-arch implant dentistry. In this episode, Dr. Frank Lamar and Dr. Julian Conejo break down the three main surgical approaches, from freehand to robotics, and explain how each impacts prosthetic accuracy, efficiency, and long-term success.

Introduction:

Welcome back to The Lasting Smile Podcast, where clarity meets innovation in full-arch dentistry. In Episode 1 Part 3, Hybridge Founder Dr. Frank Lamar and Clinical Lab Director Dr. Julian Conejo discuss the evolution of surgical techniques in full-arch implant therapy exploring how new technologies like stackable guides and robotics are redefining precision and predictability in the surgical phase.

Whether you’re a seasoned clinician or entering the world of full-arch for the first time, understanding these three approaches will help you choose the method that fits your workflow, your technology, and your patient’s needs.

Here are the 10 biggest takeaways from the conversation.

1. Three Paths to Full-Arch Surgery

There are now three distinct surgical options for full-arch clinicians:

1. Non-Restrictive (Freehand) – Traditional and flexible.
2. Stackable or Guided Surgery – Digitally planned and prosthetically driven.
3. Robotic Navigation Surgery – The newest evolution, offering real-time precision and control.
   

2. Non-Restrictive Guides: The Traditional Method

This “freehand” technique uses a duplicated denture as a guide for implant placement. While it offers freedom, it also depends heavily on the surgeon’s experience and spatial judgment. It’s a familiar starting point for many, but lacks the precision of today’s digital methods.

3. Guided Surgery: Static Precision

Also called static or stackable guided surgery, this method uses a digital plan to create surgical guides that dictate exact implant placement. The process ensures implants align perfectly with the final prosthetic design, combining accuracy with efficiency. As Dr. Conejo notes, “It’s one of the most exciting techniques because it connects planning directly to prosthetics.”

4. Stackable Guides: A Game-Changer in Efficiency

Stackable guides build on the static concept with multiple layers:

• A bone reduction guide to establish prosthetic space.
• A drill guide for osteotomy precision.
• A prosthetic pickup guide for immediate provisionalization.

This modular approach allows for precise, sequential surgery, reducing chair time and improving consistency across cases.

5. Robotic Surgery: Navigation in Real Time

Robotic-assisted or navigated surgery lets clinicians place implants using a live 3D model of the patient’s anatomy. The system tracks both the handpiece and bone in real time, ensuring exact angulation and depth. It’s a glimpse into the future combining visual feedback, accuracy, and safety for complex full-arch cases.

6. Bone Reduction: The Foundation of Longevity

As Dr. Lamar emphasizes, prosthetic space is everything. Inadequate reduction leads to material fatigue and long-term failure, no matter the material used. Proper bone reduction, guided digitally, ensures enough restorative space for strong, lasting prosthetics.

7. Guided Surgery Delivers Cleaner Osteotomies

Digital guides, whether stackable or robotic, create more precise and consistent osteotomies than freehand methods. They reduce angulation errors, increase insertion torque, and set the foundation for same-day provisionalization. The result: stronger implants and smoother workflows.

8. Robotic Accuracy Requires Reliable Data

Robotic precision depends on two critical factors:

• A high-quality CBCT scan.
• Stable recognition markers for navigation.
  

When calibrated correctly, robotic systems provide unparalleled accuracy in implant placement, with clean osteotomies and beautiful bone reduction, but they demand a well-coordinated clinical team.

9. Immediate Load Protocols: Two Proven Paths

Hybridge offers two approaches for same-day provisionals:

1. Stackable Guide Pickup – Attaching the provisional directly to the guide for perfect 3D positioning.
2. On-Demand Robotic Workflow – Capturing final implant positions, sending them to Hybridge’s design team, and printing the provisional in-office the same day.
   

Both workflows ensure that patients leave with a fixed smile, faster and more accurately than ever before.

10. One Goal: Precision That Lasts

Whether you choose stackable or robotic, success depends on high insertion torque and primary stability. Both Dr. Lamar and Dr. Conejo stress that precision isn’t just surgical, it’s what makes the prosthetic last. As Dr. Lamar concludes, “If you don’t have the space, you don’t have a lasting smile.”

The Takeaway

Today’s full-arch surgeon has more control, more data, and more precision than ever before. From freehand to guided to robotic, every approach aims toward the same goal, a prosthetically driven, long-lasting result. As technology evolves, Hybridge continues to lead the way in integrating surgical precision with restorative excellence.

About the Hosts

Dr. Frank Lamar is the founder of Hybridge and a pioneer in full-arch restorative dentistry.Dr. Julian Conejo is Hybridge’s Clinical Lab Director and a prosthodontist specializing in digital workflows, implant design, and advanced surgical planning.