The Full Mouth Falcon

Zurich — 04:30 AM

I am in Switzerland, in Zurich.

I am in my hotel room. It’s 4:30 in the morning.

I have a fantastic view over Lake Zurich, but dinner was quite heavy, so I can’t sleep.

That’s why I decided to write these lines.

On Tuesday, we had a very interesting case.

It was a bimaxillary case, a full implant-supported rehabilitation, using Falcon navigation.

It was a team case — once again — involving Fátima. It allowed us to calibrate the team, the surgery, and many aspects of the workflow.

We had the opportunity to have Jean-Marc Ducommun from Straumann in Lisbon, who is the global product leader for Falcon. He came to discuss the future of Falcon and showed us fantastic technological innovations, as well as very impressive software updates.

The truth is that we selected this case in order to perform the surgery using this system.

It consisted of a full lower and upper rehabilitation.

We started with the lower jaw.

The lower jaw had relatively abundant bone, where we placed four BLX implants, 3.75 × 12 mm, in the interforaminal region, and two BLX implants, 4 × 8 mm, in the posterior areas, in order to achieve a good AP spread without cantilevers, allowing us to truly test a six-implant configuration in the arch.

The first phase is quite different because, in a full rehabilitation, we do not have dental references.

Therefore, Falcon requires mini-screws, similar to transitional anchorage devices used in orthodontics, so that it can accurately identify the position in the software and CBCT.

We performed this calibration by placing three mini-screws. Falcon recognized these markers very quickly, and calibration was done efficiently.

The calibration process also involves placing a marker, which is fixed using healing screws or orthodontic screws.

At this stage, we encountered very dense bone, and while placing the screw, I fractured it.

I lost approximately 10 minutes removing it.

These 10 minutes have an impact, because we had already administered anesthesia — four carpules of articaine — and we cannot afford to lose time, as anesthetic overdose is a real concern.

Once the marker was placed, the most challenging part of Falcon began.

The osteotomy position is somewhat different from the usual.

We constantly need to move between the left and right hand so that the light properly reaches the marker and Falcon does not lose tracking.

I believe this part could be optimized, as some time is lost here due to positioning.

However, it is a completely different experience when we can actually see where we are drilling, whether we are on target, and whether the angulation is correct.

We placed implants in positions 42 and 32, then 44 and 34, and finally the posterior implants.

Everything went well, and we also performed, for the first time, the calibration of the implant itself, which allowed us to visualize the implant reaching the end of the osteotomy.

This was fantastic.

We took a radiograph, everything was fine, and we made some minor torque adjustments in the apico-coronal direction to position the implant correctly.

Overall, everything went more or less as expected.

The entire surgery took 50 minutes, which I do not consider excessive.

We may be faster with manual surgery, but the level of precision is completely different.

One of the main difficulties of this technique is that we must avoid the mini-screws that are placed, meaning we cannot touch them.

This makes it difficult to raise a mucoperiosteal flap without interfering with them.

On the other hand, one of the major advantages is that we use the same set of drills.

We do not need specialized guided surgery drills — the system recognizes which drill we are using, which makes the procedure more efficient.

At the same time, both in the mandible and in the maxilla, when performing Falcon surgery, although the drills belong to the same surgical kit and this is an advantage — using fewer drills and a very reduced system — attention must be given to the calibration process.

Sometimes, drill calibration takes time because the software does not always recognize the drill automatically.

For example, the lance drill needs to be calibrated on one side, while the regular drills, whether short or long, need to be calibrated in different positions on the calibrator.

During surgery, this calibration process can cause us to divert our attention away from the surgical field for extended periods, as we focus on calibrating the drill.

Therefore, in terms of team calibration, it makes sense for a dedicated team member to handle this process for the clinician — placing the drills in the handpiece, calibrating them, and selecting them in the software.

It is important to highlight that when placing 12 implants, the calibration of multiple drills can result in excessive time consumption.

This is not critical in partial or single-unit rehabilitations, but it becomes critical in full-arch rehabilitations.

This is also something that must be taken into account.

We have full visualization of the angulation, and overall everything progressed within normal expectations.

We then performed suturing, placed the SRA abutments, and positioned the healing caps.

After approximately one hour, we moved to the upper jaw.

For the upper jaw, we decided to perform the surgery flapless.

This was particularly impressive, as the marker fixation was done directly on the gingiva using two orthodontic screws.

It was similar to placing screws for orthodontic traction.

We fixed the marker in the maxilla in this way.

It is important to note that in the maxilla things become easier, as there are no concerns regarding the inferior alveolar nerve.

We can work with more confidence and focus more on the marker.

I decided to proceed by quadrants — completing one quadrant first and then the other — to avoid constant recalibration of the light, as the angulation remains similar.

This allowed Falcon to track the marker more efficiently.

The main difficulty in this case was related to angulated implants.

When the handpiece is significantly inclined mesially or distally, the marker reading becomes more difficult.

However, with some experience and persistence, we were able to place the implant in position 16 (13.5 × 12 mm), avoiding the maxillary sinus, and also in position 14, anchoring between the nasal wall and the anterior wall of the sinus.

This was particularly impressive, as what we see on the screen corresponds exactly to what we feel clinically.

We were able to place implants in extremely challenging positions with very high precision.

We then placed the implant in position 12, which achieved excellent torque.

We had some difficulty in positions 11, 12, and 22, as the marker was positioned in a way that prevented full drill progression.

This is a limitation of the system.

As a result, the final 2–3 mm of the osteotomies had to be completed freehand.

This is not a major issue, but during implant placement we noticed that we had to apply additional rotations, which resulted in loss of primary stability in implant 11.

We then moved to the second quadrant and repeated the same procedure.

We were able to complete everything flapless, despite the difficulty due to excess gingival tissue.

There was some bleeding, but it was manageable.

We successfully placed all six implants using Falcon technology.

We then proceeded with the scan body acquisition.

This part did not go as well, as we were missing some transmucosal components, which limited the workflow.

At the end of the surgery, we placed the screw-retained templates on the two anterior SRA abutments so that we could perform a reading using the Straumann Smart Links and the Exact scan bodies.

We completed this step, and Sofia milled two provisional structures to be delivered the day after surgery under immediate loading.

During the reading of the Exact scan bodies and the SmartLinks with the Sirius intraoral scanner, we encountered some difficulties, as the patient had some bleeding, which created challenges during the scanning process.

As you can see in the radiograph, there is one of the lower implants that is not passive. I believe this is due to the intraoral scanning reading.

It is also important to note that in implant 34 there appears to be a mesial deviation. One of the major limitations of Falcon is that you become very focused on the unit itself, and in full-arch rehabilitations you often lose the reference of parallelism with the other implants. This can have implications for the prosthesis.

In this case, we can see that the implants are somewhat close to each other, but the issue is not even the proximity — it is the angulation of implant 34 that will prevent, for example, the use of SmartLink scan bodies, because both components do not fit simultaneously.

This is not a limitation in the analog workflow, but it can become a limitation in the digital workflow.

For me, the main limitations of this Falcon technology were related to the marker.

I believe the marker itself can be improved.

Also, the way Falcon reads the marker could be improved.

A significant amount of time is lost adjusting the position so that the system can properly detect and track the marker.

For me, another important point is the working position, which is different from what we are used to.

The left hand becomes much more involved, which is not usually the case when placing implants.

The position of the dental assistant also changes slightly.

The way suction is performed also needs to be adapted to ensure that the marker remains constantly visible.

I also believe that, at the level of the central implant positions, because the marker is placed in that area, it can interfere with the procedure.

In our case, both in the maxilla and in the mandible, it did interfere with the workflow.

Therefore, one of the limitations of Falcon, in my opinion, is the loss of global control, especially in full-arch rehabilitations.

Falcon — What it gives

Real-time precision

• Continuous control of angulation and depth

• Immediate confirmation of the target

• Strong correlation between what you see and what you feel

→ Especially evident in critical zones (e.g. 16, 14 — sinus avoidance)

Ability to execute complex cases

• Enables implant placement in highly demanding positions

• Increases confidence in borderline anatomy

• Reduces uncertainty in critical decisions

Implant calibration (not just drills)

• Real-time visualization of implant insertion

• Finer control of final positioning

→ A true differentiator

Same surgical kit

• No need for dedicated guided surgery drills

• System recognition of instruments

→ Logistically simple

Strong performance in the maxilla

• Smoother workflow

• Greater confidence

• Better tracking

Effective in single and partial cases

• Ready for daily use

• Integrates easily into practice

Falcon — What it takes away

The marker

• Interferes with the surgical field

• Blocks access

• Limits execution

Tracking

• Unstable at times

• Dependent on light and angulation

• Requires constant adjustment

Ergonomics

• Forces new working positions

• Increased use of left hand

• Breaks natural flow

Team dependency

• Requires coordination

• Assistant positioning is critical

• Not plug & play

Mini-screws

• Limit movement

• Complicate flap management

Angulated implants

• Loss of tracking

• Reduced precision

Loss of global control

• Focus on the unit

• Loss of parallelism

→ Prosthetic consequences

Digital workflow limitations

• Scanning difficulties

• Component incompatibility due to angulation

Time

• Not faster than freehand

• Time lost in calibration and tracking

Final Thought

Falcon does not simplify surgery.

It gives you control —

but it also demands more.

It improves where you are looking —

but it may blind you to everything else.