ty_1_02-17-2026_163430 0:45

Hello, and welcome back to The FIX Podcast for another special episode with Dr. Clark Damon. Uh, things look a little bit different than usual. If you're just listening to us on the podcast, this probably won't be your episode. So this is actually designed, uh, to watch, um, Dr. Damon has put together, uh, several of his, uh, documentation from a lot of really good learning cases for us. So we put together a little presentation here, and we're gonna be talking through that. There's some videos, some photos. Um, you might still be able to glean some things with audio only, but I think, uh, you know, actually seeing the picture's gonna be really good. So make sure you're checking this out on YouTube. We'll also make some clips and things, um, for Instagram, um, and little bite-size things as Well, So welcome back to the show, Clark. I really appreciate you coming on.

damon_1_02-17-2026_183430 1:24

Well, thank you. Thank you for having me. And it's al always, always fun to be here. And you know, I can't tell you how many people wind up taking, uh, courses from the Texas Implant Institute

ty_1_02-17-2026_163430 1:35

Mm-hmm.

damon_1_02-17-2026_183430 1:36

and they're like, I'm like, where, where'd you guys, how'd y'all hear about me? And they're always like, oh, you know, on the, on the Fixed Fixed

ty_1_02-17-2026_163430 1:44

Oh, no way. Oh, that's fantastic. Yeah. I mean, I, I know that I, I've definitely, every time, um, and this goes for anybody that's gonna reach out to in the future, just know what I'm gonna say. Anybody that reaches out, That's wanting to get started, um, on full arch, or if they're looking to kind of take it to the next level, I'm always telling'em, like, Texas Implant Institute, go and do the cadaver courses. Even if you've like, already done one before, it's so worth it to go down there because I, I have gone down there multiple times and I learn something every time, and it's just one of the most high value, probably the most high value, full arch course in the country. Like I, I truly believe that. Um, and, uh, and yeah, it's, it's my number one recommendation. I, you don't need to go down to Brazil, you don't need to go to Mexico anywhere, or Guatemala. I mean, you can definitely go there. Those are great programs, but if you're just looking for like really good value to get like a very, very rock solid foundation that all of these things come back to Cadaver Corps, Texas Implant Institute every time's my blanket record. Yeah.

damon_1_02-17-2026_183430 2:38

uh, you know, I mean we've been, I've been teaching these courses since 2018 and, and, and really at that point I was the only center doing cadaver courses. And you know, now there's a lot of other people that have kind of jumped on the, the cadaver, uh, training bandwagon.

ty_1_02-17-2026_163430 2:54

Mm-hmm.

damon_1_02-17-2026_183430 2:55

you know, you know, Orca definitely has it down like that is a very good training program. Are you guys going here in a couple weeks?

ty_1_02-17-2026_163430 3:05

No, we're not. We, we've been debating on which one we're gonna go to'cause we know we're gonna do it. Um, it's just a matter of timing and when all three of us can go and, and do something like that. But, uh, we, we,

damon_1_02-17-2026_183430 3:15

If you're gonna take a, if I think for everybody to do, well, know, this wasn't available to me, uh, back in 20 20 12, whenever I started the journey, cadavers weren't even a port, uh, available.

ty_1_02-17-2026_163430 3:29

yeah.

damon_1_02-17-2026_183430 3:29

but you know, you need really good di you need good didactic, you need good hands-on, you need cadavers. So it's really all three. And then you need the live patient surgery. Now as you're evaluating, which you know where to do live patient, you know, I don't, I don't do live patient. but when I say that work has got it down, you know, I went there, I was faculty, um, you know, for, for one, uh, one of their programs. And the beauty of Orca is that their patients are under general anesthesia,

ty_1_02-17-2026_163430 4:06

Yeah.

damon_1_02-17-2026_183430 4:06

So a lot of live patient courses. Uh, and, and even, uh, I was invited down with Neo Den to do like some top secret training on, on a bunch of their new cool products that'll hit the market maybe in 27 that I can't really talk about. But, we. Even at ieo, we, we did some live training with, you know, some new implants, you know, standard implants, but also, you know, a, a nutter. Um, you know, still, it's, it's really hard to learn on live awake, patients, you know, people in Brazil, they're tough. But, know, that's, that's, that's where Orca has got it nailed down is the fact that those patients are under general, it's essentially a, a cadaver. It's a, it's a bleeding cadaver

ty_1_02-17-2026_163430 4:56

Mm-hmm.

damon_1_02-17-2026_183430 4:57

so you're able to get really the most, uh, learn. So anybody that's wanting to take a live patient course, you know, you, you've gotta have the patient under, under general anesthesia. You know, uh, Vichy does a, Vichy does a good one-on-one live training course. and obviously that's in his office. They're under general. So that's, that's one that I'd recommend, you know, you know, the only, only thing there is, it's kinda one patient

ty_1_02-17-2026_163430 5:27

Yeah. Right.

damon_1_02-17-2026_183430 5:28

Orca, you're, you're gonna be, you know, doing half the patient on, I don't know, five or six different patients. So that's, that's, that's always something, you know, really to consider is. If you're gonna go there for training and to, to try to get the most outta your money and education, the patient has to be fully under general. You know, whenever we went to Vander Lim, Vander Lim's, Vander Lim's course was great because they were totally knocked out.

ty_1_02-17-2026_163430 5:59

Yeah.

damon_1_02-17-2026_183430 5:59

was, it was in his, uh, hospital or surgery center that you go to. But at Vander Lim, we were down there for a week and we only got to do one patient. so, you know, or

ty_1_02-17-2026_163430 6:11

Yeah.

damon_1_02-17-2026_183430 6:12

kinda wins all of those

ty_1_02-17-2026_163430 6:14

Yeah.

damon_1_02-17-2026_183430 6:15

patient. But you know. You know, again, if you want to get the most outta that education, you really need to know what you're doing. And you're not gonna know what you're doing unless you have, you know, done a lot of cases, gotten a lot of cadaver experience. And so, you know, you, you kind of need a couple, a couple different cadaver experiences. You know, uh, one of the things I'll do on a random basis is actually just do a one day cadaver refresher

ty_1_02-17-2026_163430 6:43

Mm-hmm.

damon_1_02-17-2026_183430 6:44

if you've had didactic somewhere else, you've had didactic with me, and all you wanna do is just f around with the cadaver,

ty_1_02-17-2026_163430 6:51

Yeah.

damon_1_02-17-2026_183430 6:51

you know, we, we kind of offer one of those, you know, just kind of very sporadically if you want that, just, hit me up and, uh, yeah. You know what, I know we're recording this live. I'll, I'll put in the Texas Implant Institute, WhatsApp, uh, little QR code. And so if you're listening, you know, we'd love for you to join the Texas Implant Institute, WhatsApp. we'll pop, we'll pop that in here in a, in a

ty_1_02-17-2026_163430 7:19

Yeah.

damon_1_02-17-2026_183430 7:20

uh, just screenshot it and join and you'll, you'll be in the know.

ty_1_02-17-2026_163430 7:24

Mm-hmm. Yeah, no, absolutely. Yeah,

damon_1_02-17-2026_183430 7:27

I

ty_1_02-17-2026_163430 7:27

for sure.

damon_1_02-17-2026_183430 7:28

de derailed your thunder there, but, uh.

ty_1_02-17-2026_163430 7:31

No. No, not at all. I mean, I, I think you're, you're totally right. I mean, all your points land really well with me. I mean, I've done a lot of cadaver courses at this point. I've done courses where, um, and even talk courses where we just did, you know, models. And, you know, the limited models are okay because you just kind of get like the basic conceptual aspects of a technique. Um, but learning to do it on a model is nothing like doing it on, um, a cadaver, even if it's like a, you know, a bio model of an actual patient. Um, because with a cadaver you get the anatomy, you get all that variation and you know, anatomy is variation. You need to see multiple cases and you need to see how people are different. Um, how their bone density is different, how things are, you know, convex in one place, concave in another. Um, you know, that's, that's really the beauty of, of experience and like really learning the, the technique and doing it on, you know, different instances. And, um, you know, with cadavers you get that haptic feedback as well. From the bone it's a little bit different'cause it's not live bone anymore. Um, it's a little desimated and it's been treated and stuff. Um, but you at least get, you know, you can make the case look the way it should look on, you know, a li uh, not a live patient, but a, a real, you know, human and then you can move to live surgery. And I totally agree because I've, you know, I've done courses where, you know, we were working with oral sedation. If you're down in Brazil and they're doing oral sedation, it's gonna be like five MIGS of Valium. And you're Right. these people are totally built different, they're not like American patients at all. They do really well. But at the same time, like you're still, you know, you're working against the clock, you're trying to take care of the patient first and foremost. The priority isn't really education. It's treating the patient and then education, you fit in where you can. Whereas with journal anesthesia. The patient's gonna get treated just fine and you can stop, you can, you can take time to teach this or that or show them this or that. Um, and, and there's just a much better learning opportunity and, you know, you get a better outcome that is not being, uh, mitigated by the circumstances of the anesthesia or the patient's tolerance of pain or, or what have you. Um, so yeah, huge, huge advocate for that, um, doing those general anesthesia. And I totally agree that, um, you know, and, and then the other issue is not getting a whole lot of volume and that's something on all those points. Orca really knocks that out. And so, um, I think once, I totally agree. Once you've done some cadavers, you've gotten that experience, um, maybe you've done some basic, um, you know, cases at your home practice and you're ready to go to Orca. Like that's, you're ready to do live patient like Orca is the way to go. I totally agree with that. Um, and, and maybe you're not totally there yet. You can also do a spectator thing, Right. Like, so you can, there's tickets where you can just go and go around so many different cases and see how people are doing it. You can learn a lot from that as well. And just getting to see so many different cases teaches you so much too, because when you only do one case, like you learned really well how to do the case on that patient, you know, it doesn't necessarily scale to the next patient that comes along. Um.

damon_1_02-17-2026_183430 10:09

Well, just real quick, we're, we're talking about courses and I think that, you know, our experience, uh, is, is really good'cause it helps give your, your listeners a good little flavor. So tell me this, uh, you guys, did y'all go to Portugal? Tell me about, um, the full arch club.'cause don't they do a, uh, don't, don't they do a live patient, uh, course too.

ty_1_02-17-2026_163430 10:34

Yeah, they do. So when I took it, this was probably back in 20 20, 22. So the way they did it then, and he may have changed some things since then, but what, what you would do is you go to Portugal for the Master Corps. So that's your didactic, your models and stuff. And then, um, you're going to go to the clinic and you're gonna watch Bernardo do a surgery, um, live. You can participate to some degree. Um, at that time he was doing, uh, custom subperiosteal. So, people will kind of get a hand in that and they'll get the, you know, screw something in, but you're not really doing the case. You're still watching him do the majority of it. And then that's the prerequisite for going down to Brazil, which is the live patient course. so, the live patient to Brazil. Yeah. That, again, that may have changed since then, but yeah,

damon_1_02-17-2026_183430 11:16

so, so the, the, the, with the full arch club, you had to go from one to the other. Huh?

ty_1_02-17-2026_163430 11:21

I, I believe that is the case.

damon_1_02-17-2026_183430 11:23

Portugal and then over. All right.

ty_1_02-17-2026_163430 11:25

I, I think so. And I, I don't wanna speak for Bernardo on that one. Um, but at the time, that's how it was set up. Yeah.

damon_1_02-17-2026_183430 11:30

did you, did you do his, uh, live patient course in Brazil?

ty_1_02-17-2026_163430 11:34

I did, I did. So that's where I placed my first parago. Um, we did that, um, it, it was in Rio, but Rio is like a really big province. Like we, we flew into like Copa Cabana area, stayed there for a couple days, and then we took a shuttle out, like four hours to the, to the clinic. And then we had, um, I think it was three days of surgery. And we usually do two patients a day. I think it was give or take. Um, and it was pretty cool. Like he every, he split everybody off into pairs. Um, so you all have different teams and you would get graded on every case. So your flap, reflection, um, your anesthesia, patient managements, implant placements, alveo, like all, they had this sort of like five factor way of grading you. Then in the end, they tallied up everything and one team kind of went. So there was like this competitive, uh, element that was like really fun. Um, it was a great course, you know, I, I gotta do all that. And, but it was, it was oral sedation, you know, and that was a limitation in some cases. But, um, but still really high quality course.

damon_1_02-17-2026_183430 12:31

You know, the, the nice thing about, you know, and, and this is what I tell everybody is like, there is, there is not just one course that you can take. I mean, you know, I've taken five or six different zygomatic courses, you know, um, and, and, and, and even, even in fixed full arch, I mean, even if you may go, you know, to bernardo's course or you may go to my course, you know, or you know, maybe you go to over to four M or, you know, Colorado Surgical, you know, they're all gonna kind of teach it. You're, you're, you know, different. And, you know, there, there are definitely certain things that I don't, I don't agree with, but

ty_1_02-17-2026_163430 13:10

Yeah.

damon_1_02-17-2026_183430 13:10

gonna, you're gonna pick up some pearls, um, you know, really with everybody. And, and, and to be honest, everybody has a different style of teaching and. You know, it, it broadens your tribe, right? It broadens the people who are, you know, kind of in your corners. And I'll tell you what I mean, I get asked to be an expert witness on, you know, several cases a year, and I'm like, only this doc would've reached out to me the second they had a, they had a problem. Right.

ty_1_02-17-2026_163430 13:41

Yeah,

damon_1_02-17-2026_183430 13:42

You know, because then

ty_1_02-17-2026_163430 13:43

I

damon_1_02-17-2026_183430 13:43

just winds up spiraling outta control, and then it winds up, you know, into a refund status or the patient's upset, they go somewhere else and then fingers start getting to be pointed.

ty_1_02-17-2026_163430 13:55

Right.

damon_1_02-17-2026_183430 13:56

you know, just a little PSA, I mean, look like, like I know that we talk about full arch. It's obviously our passion, it's a lot of people's passion, I tell you what I mean, if, if you're not doing it every day and you don't know how to fix your problems, like. Your experience is gonna, is gonna be, is gonna be very, very difficult,

ty_1_02-17-2026_163430 14:19

Yeah.

damon_1_02-17-2026_183430 14:19

challenging. You know, this, this is incredibly humbling, you know, ex experience. And you really, if, if, if you're just in your own little box and you're not talking to other people and telling people about your problems, a you're not gonna learn from'em. You know? And, and that's, that's why I created the WhatsApp, uh, chat. I

ty_1_02-17-2026_163430 14:41

It's great.

damon_1_02-17-2026_183430 14:41

see me, you see the stuff I post in there. It's, you know, typically I'm just posting my complications and,

ty_1_02-17-2026_163430 14:48

Yeah.

damon_1_02-17-2026_183430 14:49

my complications are, are low, but, you know, when you're doing, you know, 30, 30 arches a month or 25, you know, I like to be on the, you know, 25 or less a month.

ty_1_02-17-2026_163430 15:00

Yeah.

damon_1_02-17-2026_183430 15:01

Um, you know, I say a bad month is 30, 32 arches a good month's 22. Uh, um. You know, these, these things are gonna happen. And, you know, that's, that's kind of why I'm, I'm a, you know, we've talked about this before. I'm a proponent for OIDs and I wanna do it on everybody so that when I need to do it, I can. And then also thinning, thinning the palate,

ty_1_02-17-2026_163430 15:24

Mm-hmm.

damon_1_02-17-2026_183430 15:25

as, as we'll see in these slides, you know, if you get a OAC, you need to be able to rotate that tissue over to be able to close it. And if not, then you're sending them to a surgeon or you're, you know, gonna have Juan fly in and, you know, who knows how much you're gonna spend on that. But,

ty_1_02-17-2026_163430 15:39

Yeah,

damon_1_02-17-2026_183430 15:40

you know, so anyways, sorry to derail you there, but, uh, well,

ty_1_02-17-2026_163430 15:44

no.

damon_1_02-17-2026_183430 15:44

get back on track.

ty_1_02-17-2026_163430 15:46

No, I think, I think it's all really good context and, you know, the WhatsApp group, I mean, that's, uh, that's been kind of this muse for this, uh, for this podcast for quite some time. And we, we just kind of go through there and look at discussions that happen there, and that, that inspires a lot of things. And, you know, when, when, uh, a lot of topics kind of mount up, we're like, okay, let's, let's get Clark on for another one. We gotta talk through some of these things. And, um, no, it's a, it's a great group and, uh, I totally, uh, agree that you can't, you know, do this in a silo and, um, you know, you have to be part of the, the full arch community and, and do this daily because, um, you know, there, there's so many people doing this at this point, and there is a, a pretty decently sized community around it that it's very unlikely that you're running into something that someone hasn't run into before. Like, it, it, the chances of you running into anything novel are very low. So if you're just making a practice of sharing those things and, and engaging with people and doing that without judgment, um, you know, you're gonna have that support. Um, and, you know, there's just no good reason to do this alone. It's just doing it hard for no reason. And, um, doing it hard can oftentimes get you in a lot of trouble, and maybe you won't be able to do it for very long. So, um, you know, that's just the way it is. But, uh, but yeah, I, I think, I think the, the, the WhatsApp group, the Tribe group is, um, definitely my most active group that I spend the most time in, and I, and I learned the most from. So I really appreciate you putting that together.

damon_1_02-17-2026_183430 17:00

Sweet.

ty_1_02-17-2026_163430 17:01

Awesome. Well, without further ado, let's, uh, let's get into our cases here. So we got about like nine or 10 different, uh, patient cases that teach a variety of different things. And, um, I don't even know, uh, what all of them are. I just kind of know, uh, what the topic is basically. Um, So I'm gonna be learning, you know right along with the audience here, so I'm pretty excited. Um, so what do we have here?

damon_1_02-17-2026_183430 17:20

So you know this, so the first case we're gonna talk about is a really good example of being in over your head. So, uh, the, the first case I actually treated two weeks ago, uh, he was in today. And so the, the, the picture that you have up is actually the, the, the picture of him, uh, that we took today.

ty_1_02-17-2026_163430 17:44

Oh, awesome.

damon_1_02-17-2026_183430 17:45

yeah, so kind of, kind of nice. This particular patient wound up going to a GP that did the case guided you know, Per the patient, and then also per the doctor, within two weeks everything was loose and all the implants came out and he had a quote, river of puss coming out at two weeks.

ty_1_02-17-2026_163430 18:09

That's gotta be overheating, right?

damon_1_02-17-2026_183430 18:11

You know, I don't know. I mean, maybe it's somewhat of an exaggeration. You know, gen generally speaking, an infection typically at least takes three weeks to really kind of brew and kind of get that big,

ty_1_02-17-2026_163430 18:27

Yeah.

damon_1_02-17-2026_183430 18:27

nobody's a super producer there, but, um, you know, either, you know, the patient was on four implants. And so what I suspect, what I suspect initially happened was there was a under reduction uh, alveolar reduction.

ty_1_02-17-2026_163430 18:46

Mm-hmm.

damon_1_02-17-2026_183430 18:47

in, in addition to that, because it was through a guide, I think there was some overheating.

ty_1_02-17-2026_163430 18:52

Yeah, that's what I,

damon_1_02-17-2026_183430 18:53

it, and because it was through a guide, I bet you that the flap, uh, was very minimal to non-existent. could have been some, uh, buccal fractures that were, were not notated. uh, you know, if, if you can't see, you don't really know where you're at and, and you don't really know when a buckle plate fractures, uh, you don't even know if your guide's actually fully seated either. So, uh, just, just, you know, a lot more challenges. You know, that's, that's kind of my mo is I, I think that guides are initially placed to where they're supposed to make it easier. But after, you know, you know, early in my journey, I did roughly 50 cases guided, and they were all hard. I was like, what? This is so hard,

ty_1_02-17-2026_163430 19:44

it's so hard.

damon_1_02-17-2026_183430 19:45

they were, they were all harder than doing things freehand.

ty_1_02-17-2026_163430 19:48

Yeah.

damon_1_02-17-2026_183430 19:50

now, you know, some people still need to be guided and, and, you know, and oriented, and I think that that helps. But, you know, out of 3,200 cases, I've never had a patient at two weeks lose all of their implants. Um, so just relatively odd. I think that, you know, maybe there was a lack of adequate torque. And so it was just a combination of just a few, you know, kind of minor errors, you know, and, and we see that in airplane crashes, right? It's

ty_1_02-17-2026_163430 20:19

Mm-hmm.

damon_1_02-17-2026_183430 20:19

one little minor thing, begins to happen and then there's just a slight deviation of, uh, an an idea that is, is well based, but it's just not, uh, adequate for the case. And then you just have a cascade of just little, little tiny events that happen all throughout that culminate in really a big problem.

ty_1_02-17-2026_163430 20:47

Yeah.

damon_1_02-17-2026_183430 20:48

uh, patient lost the upper, uh, within two weeks, I think they let him heal. I believe that it was re attempted again by the same, uh, GP and, uh, unsuccessful. Then he, uh, referred the patient to A OMS and, uh, bilateral sinus lifts were done. So then the patient healed again and now had his, like fifth surgery to get the implants installed. And then two of them failed. and then so they left him with a snap in on two,

ty_1_02-17-2026_163430 21:20

Oh.

damon_1_02-17-2026_183430 21:20

just a few sh a few short, you know, months or, you know, maybe a few short years. And then, you know, two of them fell out. So this particular patient was actually in a upper denture for seven years. Right? So oftentimes in, in the community. Let's go to the next slide. We can, we can kind of see his, his pre-op, how he presented to me, this is how he presented. he presented, you know, obviously with no more implants and because he had had, you know, multiple prior surgeries, you know, there's, there's, there's not any sub sub nasal bone. You know, there was like three to four millimeters of, of sub nasal bone, uh, nothing under the sinus. If you wanna go to the next, uh, screenshot,

ty_1_02-17-2026_163430 22:04

Is this, is this, um, was his denture. That was the

damon_1_02-17-2026_183430 22:08

locator

ty_1_02-17-2026_163430 22:09

my God.

damon_1_02-17-2026_183430 22:10

Yeah.

ty_1_02-17-2026_163430 22:11

Wow. Yeah. Wow.

damon_1_02-17-2026_183430 22:13

there's his, pre-op pano and it's fairly difficult to see. Uh, but you know, there's, there's not any sub sub nasal bone, there's not any sub antral bone, you know, however, there's, there's, there's a great tuberosity there. Like the tuberosity wasn't even reduced.

ty_1_02-17-2026_163430 22:28

Mm-hmm.

damon_1_02-17-2026_183430 22:29

but I mean, he had a, he had to oid We could have done, uh, he had a really good OID anatomy. So let's go to the next slide. So there you can just see, it's just kinda that pancake, you know, very flat, uh, maxilla. It's kind of a, a cross section there of the sub nasal bone. Let's go next. And there, there's, there's zero sub antral bone.

ty_1_02-17-2026_163430 22:51

Yeah.

damon_1_02-17-2026_183430 22:53

And so, uh, here's, here's how he presented. So when we got him flapped open, you know, there's really, there's really nothing there.

ty_1_02-17-2026_163430 23:01

No,

damon_1_02-17-2026_183430 23:02

but, you know, let's, let's just, let's just kind of go back, right? Let's just kind of think, okay. So, we had a failed arch, and then we sent them for bilateral sinus graft and, uh, you know, four implants. Okay? So, you know, if, if you already had four and they failed in short order, now we're gonna do bilateral sinus lifting. And as you can tell from the x-rays there, there's not any, there's not any evidence that there was ever a sinus graft done. Um, maybe there was, and it just wasn't even successful.

ty_1_02-17-2026_163430 23:37

right. Yeah.

damon_1_02-17-2026_183430 23:38

um. You know, there's, so, there's, there's always a thing that we go back, back and forth with, right? Like, what's, what's more conservative zygomatic or sinus lifts, right? And, you know, oftentimes that a simple zygomatic surgery is way more conservative, especially in a failed arch scenario. Uh, just because, you know, you, you don't know what that, what that bone and the sinus is gonna turn into, you know, oft oftentimes it doesn't really wind up giving us great, stability

ty_1_02-17-2026_163430 24:18

No.

damon_1_02-17-2026_183430 24:19

for those implants. Um, especially in full arch. You know, it works fine if you're doing a, a single implant and you've got six millimeters, you know, to, of, of alveolar bone that you can really lock that implant into, and you do a nice little sinus lift,

ty_1_02-17-2026_163430 24:36

Yeah.

damon_1_02-17-2026_183430 24:37

um, you know, to help get you some, some length. But in a, in full arch, you know, you can't, you can't really treat full arch like you do singles.

ty_1_02-17-2026_163430 24:48

Right.

damon_1_02-17-2026_183430 24:49

so anyways, I mean, this, this, this poor guy, you know, I just feel so, so bad for him. And you know, it, it comes back to having a tribe and having somebody to just say like, Hey, the insanity, you know? You know, going for four more implants in a guy that's already failed. Four, we need to get them to an advanced provider. And,

ty_1_02-17-2026_163430 25:14

Yeah.

damon_1_02-17-2026_183430 25:15

nothing, nothing is wrong with a lot of our oral surgery colleagues. Some of most of them do incredible work. but also many of them, especially if they're just bread and butter, oral surgery, and they just do single implants and third molars, many of them shy, shy away from OIDs, many of them even shy away from zygomatic. You

ty_1_02-17-2026_163430 25:40

Yeah.

damon_1_02-17-2026_183430 25:41

if you're not doing this on a regular basis, why do you want that headache? And, you know, you're gonna have the patient expectation, you know, to, to really kind of perform. And so, you know, I was talking with Dr. Fayette Williams,

ty_1_02-17-2026_163430 25:57

Mm-hmm.

damon_1_02-17-2026_183430 25:57

you know, he's a, he's a excellent, you know, oral surgeon, uh, you know, and, and, and a lot of what he does is these big free, flap free flaps and, you know, jaws, jaws in a day and, taking, taking parts and pieces and clothes and defects and doing head and neck cancer resections.

ty_1_02-17-2026_163430 26:16

Yeah,

damon_1_02-17-2026_183430 26:16

Um, and you know, so he teaches, he teaches with me to do the turid and, and, and zygoma course at the Texas Implant Institute. I was talking to him. I said, Hey. I said, do, do, do you really care? You know about. GPS place in implants. And he was like, as long as they're good, he said they're just, just because you're an oral surgeon doesn't necessarily mean that you're a good arch doctor.

ty_1_02-17-2026_163430 26:46

you bet.

damon_1_02-17-2026_183430 26:47

you know, I mean, even, even, even, even a oral surgeon is was saying like, listen, there are some gps that do arches way better than a oral, oral surgeon. You know, when, whenever I did my residency, uh, oral surgeons were graduating a four and a six year program with placing 40 implants. You know, I would, I would trust them all day long to do, you know, trauma surgery

ty_1_02-17-2026_163430 27:15

Yeah, of course.

damon_1_02-17-2026_183430 27:16

to, do big deep space infections, to, to, to manage a lot of these patients from a medical standpoint to do excellent sedation. But, you know, sometimes when it comes to full arch, it's, it's ultimately an entirely different animal. you know, it, so, so, you know, credentials don't necessarily always equal success.

ty_1_02-17-2026_163430 27:42

Yeah.

damon_1_02-17-2026_183430 27:43

And you know, you as a referring dentist, you always need to be ready to refer, but you don't necessarily just have to go to oral surgery. You can always refer'em to. Arch specialist, you know,

ty_1_02-17-2026_163430 28:00

Yeah.

damon_1_02-17-2026_183430 28:00

know that that's not, that, that's not a term out there. I mean, Dan Holtzclaw is a periodontist.

ty_1_02-17-2026_163430 28:06

Right.

damon_1_02-17-2026_183430 28:06

I I, would have Dan do surgery before a, you know, a board certified, you know, MV oral surgeon that does, you know, one, one or two arches a month, you know?

ty_1_02-17-2026_163430 28:19

Yeah.

damon_1_02-17-2026_183430 28:21

so, you know, just, just kind of think that through, there's, there, there's nothing wrong with, you know, sending a case to a Chris Barrett or a Raj or a Clark Damon or,

ty_1_02-17-2026_163430 28:33

Yep.

damon_1_02-17-2026_183430 28:34

know, um, just always kind of keep that in the back of your mind then all of a sudden, you know, you know, sometimes you gotta direct the ship and, and that's what the patients are looking at. And, you know, ultimately it comes down to who cares, you know? And, and as I, I go through life, you know, I, I have this term, it's just, you know, do, do people give a shit. you know, I, I continue to be astounded at the amount of people that don't give a shit. And, you know, it's, it's, it's nuts. Oh, we tried, we did the best we could. Well, at the end of the day, like, you know, results matter. You know, excellence matters and you know, you, you gotta care. And you know, I, I, I think if you don't care. Stop, stop what you're doing. Do, do some, do

ty_1_02-17-2026_163430 29:27

Yeah.

damon_1_02-17-2026_183430 29:27

you know? Um, because at the end of the day, we all have to sleep at night.

ty_1_02-17-2026_163430 29:32

Mm-hmm.

damon_1_02-17-2026_183430 29:33

you know, as long as I care and do, do, do, do the best work, and, and, you know, I, I wanna do surgery as well and as Juan Gonzalez or, or you know, Chris Barrett or you know, Dan Holka. I mean, those are the people that I want to do surgery better, know, and

ty_1_02-17-2026_163430 29:53

Yeah.

damon_1_02-17-2026_183430 29:54

it's def it's definitely a high bar and it, and it really pushes you. So, long, long aside. All right. So we, we will get back to this. So,

ty_1_02-17-2026_163430 30:02

Yeah.

damon_1_02-17-2026_183430 30:02

just in, in general, let's know that sinus lifting in a full arch patient to rescue a case is oftentimes not the best answer. Oftentimes the best answer is remote anchorage.

ty_1_02-17-2026_163430 30:18

Yeah.

damon_1_02-17-2026_183430 30:18

uh, so that, that's what we did. so here, you know, slide one, fully flapped, you know, all the way open. We have, uh, the nasal mucosa lifted. We, we've got the zygomatic buttresses opened up. We've got our, uh, OID reflection all the way back there.

ty_1_02-17-2026_163430 30:35

Mm-hmm.

damon_1_02-17-2026_183430 30:35

Uh, and the, the picture here, you know, if, if, if you zoom in close, I actually have the. Uh, posterior inferior zygoma already prepped, and I am now, we're, we're, yep. It's there. And so that's, that's, that's a nice, uh, I have bone buckle to that implant.

ty_1_02-17-2026_163430 30:58

Yeah.

damon_1_02-17-2026_183430 30:59

And so, you know, the sinus was in such a way where we didn't, uh, penetrate the sinus, uh, at, at the, the, the palatal crest or at the alveolar crest. Right. The sinus is a little bit higher. So, uh, you know, there will be no potential chance for an OAC. Um, if the sinus was very low, we would then vocalize our prep and we would do a channel. here on the patient's right side, the anterior superior zygoma is being prepped for a channel. posterior inferior is being prepped in a tunnel. Um, so whenever, whenever we prep the tunnel, we're able to just use our drill. So we start at the optimum, uh, uh, crest position, uh, prosthetic position. And then we prep, we, we use our drill. We, we go through the alveolar bone. And then, then as you can tell, it exited here. Uh, and then we went into, uh, the zygomatic bone and we then extended our. Tunnel prep all the way through. And then we exited out the other side, the, the lateral, uh, surface of the malar bone, which is the zygoma,

ty_1_02-17-2026_163430 32:16

Yeah.

damon_1_02-17-2026_183430 32:17

on the anterior superior zygoma. We had to, uh, channel. So I cannot actually prep. I have bone in the way. I have alveolar bone in the way in my, uh, uh, zygoma. So I have to use a channel. And so that's what you're seeing me here. Let's go to the next slide. There's actually should be a video.

ty_1_02-17-2026_163430 32:43

Yeah. I've got the.

damon_1_02-17-2026_183430 32:44

go. Go one more. Yep. So if you'll hit play there. So here, uh, everybody can see I am prepping this with kind of this, this, this barrel type prep bur, and I am, uh, channeling alongside the lateral maxillary alveoli up to the zygomatic entrance point. And so once we get there, we will then, uh, first we have to widen and we will widen with the barrel drill. Uh, let's go back a slide.

ty_1_02-17-2026_163430 33:26

Yep. Lemme see. Here we go. This guy.

damon_1_02-17-2026_183430 33:34

the left hand side that is kinda wi widening with the barrel bur,

ty_1_02-17-2026_163430 33:39

Mm-hmm.

damon_1_02-17-2026_183430 33:39

uh, so that's gonna create my channel that core corresponds directly to the, uh, zygomatic, uh, implant anatomy. Uh, then I'm gonna use the 2.3 drill, and then I'll be able to take that all the way into the zygoma. So, yep. So, so we, we've kind of gotta get our channel going before we can actually do, uh, are zygomatic osteotomy.

ty_1_02-17-2026_163430 34:14

Mm-hmm. I see.

damon_1_02-17-2026_183430 34:16

So, oftentimes new clinicians, you know, you think, and, and, and I prefer the Xga philosophy. you know, the xga philosophy is that every patient and really every zygomatic osteotomy, is, is prepped differently. Every zygomatic osteotomy is going to have a. Uh, you know, maybe you're gonna tunnel, maybe you're gonna channel

ty_1_02-17-2026_163430 34:42

Mm-hmm.

damon_1_02-17-2026_183430 34:43

you know, so, so sometimes, sometimes we'll vocalize everything and do it extra maxillary. There's nothing wrong with that. Um, but, you know, so sometimes you prep the zi, the zy, the zygoma first, and then, then you lean your barrel down, and then you channel that way.

ty_1_02-17-2026_163430 35:00

Yeah.

damon_1_02-17-2026_183430 35:00

sometimes you work, you work up into the zygoma as you're seeing here.

ty_1_02-17-2026_163430 35:06

Yeah.

damon_1_02-17-2026_183430 35:07

uh, it's, it's, it's oftentimes every case and every patient and every zygomatic osteotomy is, is, is very different. So you've gotta be very flexible. You've gotta have an open mind, uh,

ty_1_02-17-2026_163430 35:18

Mm-hmm.

damon_1_02-17-2026_183430 35:19

to kind of get there.

ty_1_02-17-2026_163430 35:21

I'm curious, it seems like the, uh, inferior posterior implant is a little bit more conducive to doing the tunnel approach than your anterior superior. Would that be accurate?

damon_1_02-17-2026_183430 35:33

Not necessarily if, if you, if you have a patient that, uh, you know, has a very thin anterior maxillary alveoli, uh,

ty_1_02-17-2026_163430 35:45

Yeah.

damon_1_02-17-2026_183430 35:46

the, the sinus, the, the nasal floor is a consideration for your anterior superior. speaking, uh, the sinus, the maxillary sinus is not a consideration in the anterior superior.

ty_1_02-17-2026_163430 36:01

Mm-hmm.

damon_1_02-17-2026_183430 36:01

the infraorbital nerve is, don't ever sacrifice that. Don't

ty_1_02-17-2026_163430 36:05

You?

damon_1_02-17-2026_183430 36:05

into that. But if you have one of those very thin maxillary alveoli, and if, if you don't need to remove it down for restorative space purposes, often oftentimes I actually find you can tunnel more in the maxillary anterior right

ty_1_02-17-2026_163430 36:25

Hmm?

damon_1_02-17-2026_183430 36:26

anterior superior, then tunneling in the posterior. we see cases where the maxillary sinus has dropped and is very pneumatized. oftentimes I am having to vocalize the prep where it's going to be more of a, uh, channel or more of a, uh, extra maxillary approach

ty_1_02-17-2026_163430 36:53

Yeah.

damon_1_02-17-2026_183430 36:54

inferior superior, uh, or post posterior sup, posterior inferior, excuse

ty_1_02-17-2026_163430 37:00

Yeah.

damon_1_02-17-2026_183430 37:01

posterior inferior zygoma. So, so

ty_1_02-17-2026_163430 37:04

see.

damon_1_02-17-2026_183430 37:05

I actually wouldn't agree with that. Um, more tunnels I think can occur in the anterior than they can occur in the posterior.

ty_1_02-17-2026_163430 37:15

Okay. Because you can kind of just go through that thin ridge And, use a little bit of that buckle bone to protect you.

damon_1_02-17-2026_183430 37:21

Yes.

ty_1_02-17-2026_163430 37:21

Okay. That makes sense.

damon_1_02-17-2026_183430 37:23

and, and why do we prefer, you know, bone buckle to our zygomatic?

ty_1_02-17-2026_163430 37:28

To prevent OACs, I would assume,

damon_1_02-17-2026_183430 37:30

Well, because tissue lives on bone.

ty_1_02-17-2026_163430 37:33

right? Yeah. Yeah.

damon_1_02-17-2026_183430 37:34

so, uh, now the, the thing that we have to, that is that that always wins every time is where is the sinus?

ty_1_02-17-2026_163430 37:44

Mm-hmm.

damon_1_02-17-2026_183430 37:44

So that we are not overly palatal. You know, it's, it's, it's, it's when you have penetrated the floor, the maxillary sinus in a palatal dimension that you wind up with a higher chance of an OAC.

ty_1_02-17-2026_163430 38:00

Yeah, that makes sense.

damon_1_02-17-2026_183430 38:02

being buckle there, uh, is, is, is, is really important. Um, I think, I think, uh, chow wrote, he's, he's, he's in Hong Kong. Uh, he's a z uh, has a Zaga center. He has a really good article, which I'll post in our WhatsApp chat

ty_1_02-17-2026_163430 38:22

Yeah.

damon_1_02-17-2026_183430 38:22

on how to, you know, take like a Zaga four to a Zaga two, um, or even two, two zoga one. Now, my preference is never to do any type of particulate grafting, or, or sinus. Like if I'm going to lift the sinus, which you'll see later in this case,

ty_1_02-17-2026_163430 38:47

Yeah,

damon_1_02-17-2026_183430 38:47

do not want to do any type of particulate grafting. Whenever I do zygomatic, I have just had, uh, you know, a little bone particulate, you know, kind of float up. After the case is done, I mean, we rinse these cases out really well,

ty_1_02-17-2026_163430 39:02

yeah, of course.

damon_1_02-17-2026_183430 39:03

my preference if we're going to manipulate the sinus is to use a collagen membrane. A resorbable, like a, like a a collar

ty_1_02-17-2026_163430 39:12

Color tape. Yeah.

damon_1_02-17-2026_183430 39:13

tape is my, is my preferred method of a sinus lift whenever we're doing a, uh, zygoma.

ty_1_02-17-2026_163430 39:21

Cool.

damon_1_02-17-2026_183430 39:23

So if you wanna go to the next slide,

ty_1_02-17-2026_163430 39:25

Of course. So this was where we creating the channel. Do we?

damon_1_02-17-2026_183430 39:29

uh, let's go ahead and move on next.

ty_1_02-17-2026_163430 39:31

Okay.

damon_1_02-17-2026_183430 39:33

So here, right, we can see, uh, the bilateral, uh, configuration here. Um, if you read a lot of textbooks or, you know, if you look in Riccio's original textbook or, or the Brazil textbooks, parallel a lot of times, uh,

ty_1_02-17-2026_163430 39:52

Yeah. Yeah.

damon_1_02-17-2026_183430 39:53

so, uh, you know, Juan, Juan Gonzalez really, you know, uh, has pushed, uh, the A-frame configuration and, you know, so, you know, the A-Frame is really nice because we get that zygomatic, know, especially the, uh, inferior posterior really into that first even second molar position.

ty_1_02-17-2026_163430 40:20

Yeah,

damon_1_02-17-2026_183430 40:21

here we can see a very nice A-frame distribution, and obviously that's gonna give us a really good AP spread. Okay, so we can, uh, check that out bilaterally. Now if you look on the patient's right side, on the right side of your screen, can see there that both of those were a, uh, ized, uh, and, and that they, they were a channel, right?

ty_1_02-17-2026_163430 40:46

yeah,

damon_1_02-17-2026_183430 40:46

So, uh, let's go ahead and go next. So this is, this is, uh, kind of what I'm referring to I'm talking about doing a sinus lift. So here, uh, you can tell that the post that the hung very low, low and I, I started my prep in the zygoma and then I used the barrel bur

ty_1_02-17-2026_163430 41:13

yeah.

damon_1_02-17-2026_183430 41:14

and

ty_1_02-17-2026_163430 41:14

To.

damon_1_02-17-2026_183430 41:15

lean leaned it medially. so that began to take away the maxillary alveolar bone. able to get that implant to where it's still pretty much within the buccal bony confines of the maxillary alveolis, right? We don't wanna speed bump.

ty_1_02-17-2026_163430 41:35

Right.

damon_1_02-17-2026_183430 41:35

Uh, and, and using a nice barrel bur, or a diamond bur allows the, uh, sinus membrane to stay intact. And I'll just lightly use a curette, elevate that membrane up, and then go ahead and, you know. Put, put the, uh, collar tape in and now I'm able to get a five millimeter sinus lift, to be superior to my fixture. so eventually that'll ossify over time and I'll have a really good, I'll, I'll actually get some sub antral bone

ty_1_02-17-2026_163430 42:14

Hmm.

damon_1_02-17-2026_183430 42:14

be superior to that. Uh, Xi zygoma reducing Any chance of OAC?

ty_1_02-17-2026_163430 42:23

So, yeah, so, uh, I know we have a video of this as well. We might as well just, yeah.

damon_1_02-17-2026_183430 42:29

the next slide. Let's watch the video. Let's see if you can, can you make it full screen?

ty_1_02-17-2026_163430 42:34

I'm gonna try. That's about as far as I can go. because the ratio,

damon_1_02-17-2026_183430 42:40

So sinus membrane is intact

ty_1_02-17-2026_163430 42:43

that's our call.

damon_1_02-17-2026_183430 42:44

is a collar tape that we are, putting in. You know, if, if, if the sinus membrane was, was, uh, perforated, I would've tried to elevate much more so that it would close in on itself.

ty_1_02-17-2026_163430 43:01

Okay. And is that tape kind of pushing the membrane as well as you're inserting it?

damon_1_02-17-2026_183430 43:06

Yes. So it's gonna push, it's gonna push that membrane, uh, superiorly and up.

ty_1_02-17-2026_163430 43:12

Yeah. I see.

damon_1_02-17-2026_183430 43:14

So, uh, turned out to be just a beautiful placement

ty_1_02-17-2026_163430 43:19

Really nice.

damon_1_02-17-2026_183430 43:20

And then here we are, this is probably a 30, maybe a 35, uh, millimeter length zygoma for our, uh, the patient's left side.

ty_1_02-17-2026_163430 43:32

Is that the neo dt, uh, James Zygoma, like the original one, I assume?

damon_1_02-17-2026_183430 43:35

this, is, this is the GM Zygoma? Yes.

ty_1_02-17-2026_163430 43:39

And do you,

damon_1_02-17-2026_183430 43:42

well, it's, it's really just their instrumentation. The,

ty_1_02-17-2026_163430 43:46

yeah.

damon_1_02-17-2026_183430 43:46

the s the zygoma s instrumentation is so long, uh, to, to really get it a frame and really get it very posterior. It's, it's actually very difficult. The Zygoma GM drills are a little bit shorter.

ty_1_02-17-2026_163430 44:02

Okay.

damon_1_02-17-2026_183430 44:02

I'm, I'm trying to work with Brazil to give us a smooth 4.0. zygoma, um, that would, that would be my preference with this, the shorter drills. Um, but they, they have their own ideas.

ty_1_02-17-2026_163430 44:20

I see.

damon_1_02-17-2026_183430 44:22

you

ty_1_02-17-2026_163430 44:22

Very good.

damon_1_02-17-2026_183430 44:23

I have, I have placed. I have placed probably five to 700 of those, uh, zygoma GMs.

ty_1_02-17-2026_163430 44:32

Yeah,

damon_1_02-17-2026_183430 44:32

you know, as long as you turn it to where you have that smooth side, uh, on, on the buckle, I, I, I generally don't have any, any issues with soft tissue distance, you know, I mean, I mean, even, even because it's smooth doesn't mean that you're not gonna get soft tissue dehiscence, you,

ty_1_02-17-2026_163430 44:48

for

damon_1_02-17-2026_183430 44:49

you, you, you

ty_1_02-17-2026_163430 44:49

sure.

damon_1_02-17-2026_183430 44:50

you still can in a, in a, in a smooth,

ty_1_02-17-2026_163430 44:53

You bet.

damon_1_02-17-2026_183430 44:54

you know, it just, that's kind of the next frontier, right? Is just improving our, uh, zygomatic tooling kit. You know,

ty_1_02-17-2026_163430 45:05

Yeah.

damon_1_02-17-2026_183430 45:06

I think, I think that the neo zygoma s uh, is nice. Um, I act, I actually really do like it. It's just if, if I could get the drill length cut in half,

ty_1_02-17-2026_163430 45:18

I see.

damon_1_02-17-2026_183430 45:19

I'd, I'd, I'd be happier. It ma it makes for the A-frame, uh, to be more difficult. And, you know, the challenge is so, so you know, if you, like, if you've read Riccio's book and you like the Zygoma or the the Zaga

ty_1_02-17-2026_163430 45:32

Mm-hmm.

damon_1_02-17-2026_183430 45:33

approach, what, you can't use the Norris kit because the Norris kit is all made for the ex extra maxillary approach.

ty_1_02-17-2026_163430 45:42

yes,

damon_1_02-17-2026_183430 45:43

they have shorter drills, All of those drills. You, you can't, you can't go with a small bur with, with, with a more narrow diameter burr. You know, they're all kind of like the same, same, the same width.

ty_1_02-17-2026_163430 45:57

Yeah,

damon_1_02-17-2026_183430 45:58

um, you, you have to prep that, you have to get your diamond to have the, the channel prepped for you before you can use the, the, the Norris drills. I like them because they're shorter. um, you know what, what really works for me is just the Zygoma s or sorry, the, the Neo DT GM zygoma. I like that two, two link kit better than the zygoma s So

ty_1_02-17-2026_163430 46:24

and and you wouldn't be able to,

damon_1_02-17-2026_183430 46:26

we're

ty_1_02-17-2026_163430 46:26

be able to use the, sorry, the GM kit and then places Igo mask.

damon_1_02-17-2026_183430 46:33

No, because really, you know, the zygoma S is, is a 3.5 or a 3.75 diameter.

ty_1_02-17-2026_163430 46:40

Right, right.

damon_1_02-17-2026_183430 46:41

and the, the, the, the drill, the depth drill, you, you need to use a 2.35. And that's not in the

ty_1_02-17-2026_163430 46:53

I see.

damon_1_02-17-2026_183430 46:53

zygoma, it's in the Zygoma s but it's just too long.

ty_1_02-17-2026_163430 46:58

I see.

damon_1_02-17-2026_183430 46:59

and so if you were to use the, the 3 7 5, which is the, the drill option that we have for the Neo Dent Zygoma gm, that's, that's too, uh, you, you've opened up your osteotomy

ty_1_02-17-2026_163430 47:13

Yeah. I see. Okay.

damon_1_02-17-2026_183430 47:15

it's, it's, it's a confluence of challenges. Uh, and then, uh, we'll just kind of move on. And then obviously this is placing a, i, I believe this length here was a 47 5

ty_1_02-17-2026_163430 47:28

Mm-hmm.

damon_1_02-17-2026_183430 47:29

implant. So we placed a, uh, zygoma s the posterior, here. Somehow I was able to do it, um, especially'cause that was a little bit intra sinus, uh, to,

ty_1_02-17-2026_163430 47:42

Right.

damon_1_02-17-2026_183430 47:42

too, right? So having, having a smooth collar it we're slightly intra sinus is, is, is very nice.

ty_1_02-17-2026_163430 47:49

Sure.

damon_1_02-17-2026_183430 47:50

but you know, we're, we're gonna cover these with a pedic eyes, connective tissue graft. That's, that's, you know, kind of my, my preference there.

ty_1_02-17-2026_163430 48:01

Okay.

damon_1_02-17-2026_183430 48:02

So, excellent torque. All these, all these were very high torque values. So

ty_1_02-17-2026_163430 48:13

Do you usually have a, uh, is that a midline releasing incision right there? Do you do a lot of that?

damon_1_02-17-2026_183430 48:19

yeah, I, I, I prefer never to do a midline releasing incision, but whenever we wind up with patients who have had, you know, three to four prior surgeries, you know, elevating that, you know, what's a, a tear is worse. And so,

ty_1_02-17-2026_163430 48:35

Mm-hmm.

damon_1_02-17-2026_183430 48:37

to, to get this guy's tissue degloved, it required a midline releasing

ty_1_02-17-2026_163430 48:41

Yeah. Got it. That makes sense. Very nice.

damon_1_02-17-2026_183430 48:50

So here we're using the patient's, uh, 3D printed, uh, MUA guide.

ty_1_02-17-2026_163430 48:55

Yep.

damon_1_02-17-2026_183430 48:56

mean, look at that. I mean that, that number seven, that anterior superior is, is right in the mean,

ty_1_02-17-2026_163430 49:02

Yeah.

damon_1_02-17-2026_183430 49:02

just right on the

ty_1_02-17-2026_163430 49:04

money. Yeah, absolutely.

damon_1_02-17-2026_183430 49:06

super nice, uh, on the right side. You can, you can appreciate here, uh, surgery's done, uh, I very important whenever we do a quad zygomatic configuration, I wanna have OIDs bilaterally and I also want to have a anterior implant. So this was, not necessarily a nasal palatine. I typically, know, just patients can get neuromas. They can, they can have, you know, altered sensation. I, I don't, I don't like messing with the nasal palatine canal. I don't clean it out, you know, we'll pull the tissue off of it. Um, but I don't, I don't like going in there and cleaning out the canal, and I definitely don't like going into the nasal palatine and, and, and placing an implant in there. this midline implant is actually just anterior to that. you know, because of the nasal crest, we were actually able to place a 10 millimeter length implant there. Uh, the reason that we want to have minimally a midline implant because now we're gonna rigidly connect all of our zygomatic, but there, can be a little bit of some micro movement with zygomatic and kind of that diving board effect.

ty_1_02-17-2026_163430 50:32

Yeah, of course.

damon_1_02-17-2026_183430 50:32

the, the goal is always to brace these implants along the basal bone. you know, the, the maxillary alveoli along the, the palatal, the palatal shelf, that buckle or that palatal wall, uh, that helps reduce, uh, the micro movement and the micro motion, um, addition to the kind of this anterior axi axial implant. So I've got. Uh, micro movement bracing coming from the OIDs and coming from, uh, right up in the anterior. And so it just, it just gives a very rigid, uh, fixation so that we really eliminate all of that micro movement, you know?'cause that's when zygomatic can break,

ty_1_02-17-2026_163430 51:23

You bet.

damon_1_02-17-2026_183430 51:24

the abutments can, can get loose. Um, all of those types, types of, you know, headaches and challenges. So,

ty_1_02-17-2026_163430 51:33

yeah. Is that something that you're doing on most of your quad cases now? Is a, is a midline implant?

damon_1_02-17-2026_183430 51:38

Yeah. Yeah. We, you on, on a, on a quad, you, we always want to, um,

ty_1_02-17-2026_163430 51:43

Okay.

damon_1_02-17-2026_183430 51:44

and, and so, you know, some, sometimes the consideration may have, may be, well, let me avoid a quad and let me do a transnasal.

ty_1_02-17-2026_163430 51:56

Mm-hmm.

damon_1_02-17-2026_183430 51:56

So this particular patient's, uh, you know, the, the, the, the, the, the bone that we had just there was, there was no, no bone to really anchor this transnasal bone, uh, up in that Krista Conia. There just, it was just, was not prevalent there. let's, let's say we were going to have attempted to try that. Well, well think of your osteotomies on either side, and then you go in and you drill a. Nasal palatine or, or, or you drill this kind of anterior implant you would crush. And I have seen it happen. It did not happen to me, it happened to a mentor in Brazil. I have seen it crush.

ty_1_02-17-2026_163430 52:41

Yeah.

damon_1_02-17-2026_183430 52:41

so, you know, I, I actually, um, had a case where I did a, where I tried to avoid a quad and I, avoided doing this because I had tried two trans nasals. And so that would, that would be a case where I would not do an anterior implant and I would, I, I would try to get the stabilization from the OIDs.

ty_1_02-17-2026_163430 53:06

Yeah, that makes sense.

damon_1_02-17-2026_183430 53:08

it's not a good day to crush the anterior maxilla. And so, and, and, and, and so,

ty_1_02-17-2026_163430 53:14

Yeah,

damon_1_02-17-2026_183430 53:14

the, to to, to this point, you need to have a bone fixation kit in your office and you

ty_1_02-17-2026_163430 53:20

yeah,

damon_1_02-17-2026_183430 53:20

able, uh, ace and salvin cells, some microplate. And so if you're gonna get into trans nasals, if you're gonna get into, you know, this type of work, you need to have on stand on standby, bone fixation, pins and screws, and you need some microplate in case that were to happen to you.

ty_1_02-17-2026_163430 53:43

yeah. No, that's, that's a great point because that's a tough, that's a tough referral to get that plated back together. It's something you. wanna be able to do right away.

damon_1_02-17-2026_183430 53:50

Well, and, and, and then if you don't. uh, oral nasal fistula, you would, would take a OAC day long versus a oral

ty_1_02-17-2026_163430 54:06

Yeah.

damon_1_02-17-2026_183430 54:07

fistula, you know, uh,

ty_1_02-17-2026_163430 54:08

Yeah.

damon_1_02-17-2026_183430 54:09

you know, tongue, tongue flap to fix that one.

ty_1_02-17-2026_163430 54:12

Oh.

damon_1_02-17-2026_183430 54:13

So, try, uh, try managing that. So,

ty_1_02-17-2026_163430 54:18

Yeah, for sure.

damon_1_02-17-2026_183430 54:19

fix, fix it. If you don't, you know, nasal fistula coming your way. All right, so let's go to the next,

ty_1_02-17-2026_163430 54:26

You got it.

damon_1_02-17-2026_183430 54:26

you know what, I'm sorry.

ty_1_02-17-2026_163430 54:28

Sorry.

damon_1_02-17-2026_183430 54:29

there because let's, let's talk about the closure here. Okay. um, what, what you're seeing here, I, I began to run outta time on this case. So I didn't take a picture of the ized connective tissue on the patient's right side,

ty_1_02-17-2026_163430 54:44

Mm-hmm.

damon_1_02-17-2026_183430 54:45

so, uh, we, we ply the connective tissue on, on the left, drilled a hole, kind of drilled osteotomy anterior to the, uh, anterior superior, uh, zygoma. And we rotated that.

ty_1_02-17-2026_163430 55:05

Yeah.

damon_1_02-17-2026_183430 55:05

really appreciate that ized connective tissue there. That is gonna then boost that biotype of the mucosa, uh, after it's closed. And then we'll use it, we'll use a tissue punch, to. To pull through that pal, uh, just just to, to pull through the palate. Uh, and then the palate, uh, is, is gonna then be buckle to our zygomatic abutment as well. So we're gonna have tons of keratinized, gingiva, buccal to all of those

ty_1_02-17-2026_163430 55:37

So for the, for the graft here, did you, is this a slice that was cut anterior, posterior and then wrapped around or did it kind of get flapped over and punched through? Just so I understand?

damon_1_02-17-2026_183430 55:49

we did not punch through the graft. Um, if you have a really thick pedicle graft, uh, you can, you can definitely punch through that.

ty_1_02-17-2026_163430 55:58

Yeah,

damon_1_02-17-2026_183430 55:59

and you know, I, I have created a OAC around, uh, a zygomatic, um, several times before. And so when I'm fixing that complication, uh, I will punch through the connective tissue graft right, with, with like

ty_1_02-17-2026_163430 56:16

yeah.

damon_1_02-17-2026_183430 56:16

tissue punch here. It is just solely buckle, uh, to that.

ty_1_02-17-2026_163430 56:22

Okay. Okay.

damon_1_02-17-2026_183430 56:23

we, we, we sliced it the whole way through and

ty_1_02-17-2026_163430 56:26

Yeah.

damon_1_02-17-2026_183430 56:26

pulled it over. So we detach it in the anterior and then pull it, buckle,

ty_1_02-17-2026_163430 56:31

Got it. Okay. Understood. And there, and there's like a os suture that's fixating that anterior.

damon_1_02-17-2026_183430 56:36

osseous, suture, fixating that. Yep. Yep. So, you know. It kind of, we'll, we'll talk about buccal fat pad grafts versus scarf grafts as, as, as we go on. you know, generally, uh, if you have to pull a buccal fat the second time, you're not gonna get much. So I prefer to use connective tissue, uh, a because it's going to reestablish itself. if you ever need to get more, uh, palatal connective tissue, you always can. the, the buccal fat doesn't necessarily, uh, re lobate and, uh, regrow. So sometimes once you pull it, you just kind of pull, pull the lobe and it stays there and it doesn't, doesn't regrow back in the fossa. So I, I prefer to keep and, and hold the, uh, buccal fat for a rainy day.

ty_1_02-17-2026_163430 57:32

Very nice.

damon_1_02-17-2026_183430 57:36

And there's, there's our final, so

ty_1_02-17-2026_163430 57:39

Gorgeous. Yeah, that's good.

damon_1_02-17-2026_183430 57:41

you can see the anterior implant there. So he wound up getting seven implants, in his maxilla.

ty_1_02-17-2026_163430 57:48

Yeah. Well, I, I wouldn't say that's over-engineering by any stretch, given what he is been through, So

damon_1_02-17-2026_183430 57:54

Yeah.