Dr. Eduardo Nicolaievsky, Speaker at Edentulism2023
Episode summary
In this Edentulism2023 preview, Dr. Eduardo Nicolaievsky, an oral and maxillofacial surgeon in Miami and Chief of Oral & Maxillofacial Surgery at Mount Sinai Medical Center in Miami Beach, discusses how to define terminal dentition and the point of no return. Reviewing 27 years of cases, he concludes that terminality is a global, systemic diagnosis, not an isolated single-tooth verdict: the same tooth may be terminal in a medically compromised patient yet salvageable with endodontics in a healthy one. He argues the profession created maxillofacial deformities by removing large amounts of bone for early all-on-four cases, and advocates a treatment pyramid in which zygomatic implants are a last resort. He now favors bone-preserving, digitally planned full-arch surgery using FP1 prostheses, dynamic navigation, and photogrammetry to confirm implant stability.
Key takeaways
- Dr. Eduardo Nicolaievsky is an oral and maxillofacial surgeon in Miami, Florida, and was a keynote speaker at Edentulism2023, presenting on terminal dentition and the point of no return.
- He argues terminal dentition is a global diagnosis rather than an isolated tooth complex; the same tooth can be terminal in a medically compromised patient yet, in a healthy patient without infection or airway involvement, be referred to an endodontist and restored with a crown.
- Dentistry lacks the objective criteria medicine uses to declare an organ terminal (such as cardiac parameters for heart failure and transplant), so he developed his own bullet points and algorithms to define the point of no return case by case.
- He contends the profession, following early-2000s all-on-four papers that removed significant bone to create restorative space, created bony deficiencies and maxillofacial deformities that zygomatic implants and the ZAGA concept now help restore.
- Zygomatic implants should be applied only when conventional surgical techniques cannot be used, following a treatment pyramid rather than jumping straight to quad zygoma or pterygoid-plus-zygoma; existing single implants should be considered part of the comprehensive plan and can be preserved, submerged, or expanded.
- He preserves bone whenever possible, placing FP1 prostheses that emerge from the gingival contour and routinely using 18mm and 15mm implants rather than eliminating bone, to gain primary stability, greater bone-to-implant contact, and case longevity.
- He plans zygomatic cases digitally with dynamic navigation and uses photogrammetry to detect mobility at the distal portion of the implant, requiring full contact and stability of the maxillary portion where the prosthetic connection is made.
What you'll learn
- Why terminal dentition is a global, systemic diagnosis rather than an isolated single-tooth complex
- Building bullet points and an algorithm to decide when a dentition has reached the point of no return
- Following a treatment pyramid so zygomatic implants are reserved for when conventional techniques cannot be applied
- Bone-preserving full-arch technique: FP1 prostheses emerging from the gingival contour and routine 18mm/15mm implants instead of removing bone
- Digitally planned zygomatic surgery with dynamic navigation and photogrammetry to verify maxillary stability of the implant
About the guest
Dr. Eduardo Nicolaievsky
Dr. Eduardo Nicolaievsky is an oral and maxillofacial surgeon practicing in Miami, Florida, at Blum-Nico Oral Surgery Associates, a certified ZAGA Center in Miami. He completed his training in Dental Anesthesiology and Oral & Maxillofacial Surgery at the University of Miami / Jackson Memorial Medical Center and serves as Chief of the Oral and Maxillofacial division at Mount Sinai Medical Center in Miami Beach. He focuses on zygomatic implants and complex full-mouth rehabilitation, and joined ZAGA Centers as a keynote speaker at Edentulism2023.
Credentials: Oral & maxillofacial surgeon, Blum-Nico Oral Surgery Associates (ZAGA Center Miami); Chief of Oral & Maxillofacial Surgery, Mount Sinai Medical Center, Miami Beach; Diplomate, American Board of Oral & Maxillofacial Surgery
ZAGA profile · blumnico.com · LinkedIn
