The PATZI Protocol in Maxillary Full Arch Rehabilitation

Full-arch implant rehabilitation is achieved with a stable configuration of implants supporting a fixed implant-supported prosthesisFull arch implant rehabilitationfixed implant-supported prosthesis. However, vast variability exists in this procedure regarding prosthetic success outcomes. The disconnect between surgical and prosthetic success is a pitfall many young surgeons or surgical residents are prone to. This is primarily due to the disconnect between the dedicated surgical and restorative proceduresFull arch implant rehabilitationsurgical and restorative procedures involved with the treatment. In the traditional “all on four” configuration, the surgeon may deem the surgery to be successful simply by being able to place four maxillary implants with appropriate primary stability and insertion torque for immediate loading. However, this definition of surgical success does not necessarily equate to equivalent prosthesis success or address the restorative nuances required of the final prosthesis design for optimal performance. It is important for the surgeon to analyze such prosthetic outcomes and nuances as a direct result of secondary outcomes of the surgery performed, such as prosthetic arch lengthFull arch implant rehabilitationprosthetic arch length, antero-posterior (AP) spreadFull arch implant rehabilitationantero-posterior (AP) spread, length of distal extension cantileversFull arch implant rehabilitationdistal extension cantilevers, bucco-palatal screwFull arch implant rehabilitationbucco-palatal screw access hole positions, and restorative material thicknessFull arch implant rehabilitationrestorative material thickness. These prosthetic design outcomes are affected directly by surgical implant platform position and configuration and are critical to long-term prosthetic success. Oftentimes, due to maxillary sinus pneumatizationMaxillary sinus pneumatization, lack of alveolar bone height or width, or poor quality of bone for immediate loading of implants may indicate the necessity to place extra-alveolar implants. Where if extra-alveolar fixationFull arch implant rehabilitationextra-alveolar fixation were not utilized in such a situation, would significant prosthetic pitfalls occur, such as failing to achieve the successful prosthetic outcomes previously mentioned. The authors use the PATZI protocolPATZI (Posterior, Anterior, Tilted, Zygomatic implant) protocol when planning and performing full-arch implant rehabilitation as a systematic surgical protocol to help achieve ideal prosthetic results while utilizing various surgical techniques, prioritizing traditional implant placement over extra-alveolar fixation, and accounting for strategic backup plans for potential future salvage procedures—the purpose of this chapter to discuss the PATZI protocol for planning and performing full-arch implant rehabilitation.