The Lasting Smile Podcast

The Lasting Smile Podcast: Episode 1 Part 4

Discover how clinical strategy, surgical sequencing, and implant design intersect to create lasting, predictable outcomes in full-arch dentistry. In this episode, Dr. Frank Lamar and Dr. Julian Conejo explore one-stage vs. two-stage implant placement, the “All-on-X” concept, and how implant number and positioning directly influence long-term success.

Introduction:

Welcome back to The Lasting Smile Podcast, where clarity meets innovation in full-arch dentistry. In Episode 1 Part 4, Hybridge Founder Dr. Frank Lamar and Clinical Lab Director Dr. Julian Conejo examine the key surgical philosophies that define successful full-arch cases including when to perform one-stage vs. two-stage surgery, how many implants to place, and why proper planning begins with the prosthetic design.

From understanding the biology of bone to mastering implant distribution and prosthetic space, this episode brings the science of surgical decision-making into clear focus.

Here are the 10 biggest takeaways from the conversation.

1. One-Stage vs. Two-Stage: Understanding the Difference

A one-stage surgery combines extractions and immediate implant placement in a single visit, while a two-stage surgery separates the process, allowing healing and grafting before implants are placed. The choice depends on bone quality, infection, and prosthetic requirements.

2. The Shift Toward One-Stage Surgery

With today’s guided planning and imaging, one-stage surgery is now possible in 80% or more of maxillary cases. What was once considered too complex can now be executed predictably by visualizing implant positions, bone reduction, and prosthetic space digitally before surgery.

3. When Two-Stage Still Makes Sense

Two-stage surgeries are still indicated in cases with large bone defects, missing buccal plates, or active infections. By allowing time for bone graft maturation and tissue stabilization, clinicians can achieve stronger long-term implant support before restoration.

4. The Minimum: Four Implants — The Reality: More Is Better

While four implants per arch can support an immediate load, that’s the minimum threshold. Dr. Conejo emphasizes that five or six implants offer greater stability, redundancy, and long-term reliability, especially in the less-dense maxillary bone.

5. The Power of Cumulative Stability

Every implant adds to overall rigidity and resistance. As Dr. Lamar explains, “One implant doesn’t want to move, but six together create strength through splinting.” This cumulative stability ensures stronger provisionals and safeguards against implant loss.

6. Bone Density and Implant Strategy

The mandible typically offers denser bone and easier one-stage opportunities. The maxilla, however, demands strategic placement between the sinuses for optimal distribution. Guided technology helps maximize available bone while avoiding anatomic structures.

7. Why Six on Top and Five on the Bottom Works

For over 20 years, Hybridge has taught the same proven configuration, six implants in the maxilla and five in the mandible. This balance provides optimal biomechanics, redundancy, and prosthetic support, ensuring both immediate and long-term success.

8. Prosthetic Space Defines Surgical Planning

Implant planning starts with the prosthetic in mind. The type of restoration, whether an FP1 crown-and-bridge or a hybrid prosthesis, determines implant position, angulation, and depth. True prosthetically driven planning ensures proper restorative space and predictable function.

9. Avoiding the Temptation of the Molar Zone

While distal bone behind the sinuses or mental foramen may look tempting, posterior placement often compromises prosthetic space. Committing to a hybrid restoration means maintaining interarch clearance, typically 10 mm or more, and keeping implants anterior to these anatomical boundaries.

10. Guided Technology Makes It Possible

Modern digital workflows now enable clinicians to virtually plan extraction, reduction, and placement, transforming what used to be guesswork into precision. As Dr. Lamar notes, “With guided surgery, you can look at the whole picture and know you’re giving the patient the best, most lasting result.”

The Takeaway

Full-arch success depends on planning, precision, and prosthetic vision. The decision between one-stage and two-stage, the number of implants placed, and their positioning all come down to one principle: start with the end in mind. Hybridge’s approach continues to refine this process, ensuring every restoration is both biologically sound and built to last.

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 planning, and restorative integration.