Anesthesia for All-on-X and full-arch surgery, in your office.
General anesthesia or IV sedation, matched to your case and your preference, delivered by physician anesthesiologists with hospital-grade equipment. Better conditions for your surgery, and a smoother recovery for your patient.
Full-arch surgery is a long, demanding day for everyone in the room.
Extractions, bone reduction, implant placement and a same-day prosthesis often add up to several hours in the chair, with constant irrigation, bleeding and debris in the mouth.
Most patients can't comfortably stay still and calm through that awake or under light sedation. When the anesthesia is handled by a dedicated physician, the surgeon can focus entirely on the surgery, and the patient wakes up with the hard part behind them.
TIVA and ERAS: built for great surgical conditions and an easy recovery.
We combine two approaches used in leading hospitals and surgery centers, adapted for full-arch surgery in your office.
Total intravenous anesthesia
The patient is kept asleep entirely with precisely dosed IV medications delivered by infusion pump, instead of anesthetic gas.
- Much less post-op nausea and vomiting
- A smooth, clear-headed wake-up
- Steady, finely adjustable depth of anesthesia for a still patient throughout
Enhanced recovery after surgery
A protocol that plans recovery before surgery starts, so patients go home sooner and feel better once they're there.
- Multimodal pain control that reduces the need for opioids
- Nausea prevention built into every anesthetic
- Careful fluid management and an efficient, comfortable discharge
What the surgeon gets
A still, stable patient with steady blood pressure, which helps keep the surgical field clear, and a protected airway for the whole case.
What the patient gets
No memory of surgery, less nausea and pain afterward, and a faster return to feeling like themselves. That's what they tell their friends about.
A secured airway, through the nose, for the whole case.
In a long full-arch case, the surgeon and the anesthesiologist share the same airway, with bleeding and irrigation in the mouth for hours. Sedation works well for many cases. For the longest and most involved ones, general anesthesia with a nasal breathing tube adds a protected airway, without taking any access away from the surgeon.
The whole mouth is yours
No tube in the way of either arch. Work upper and lower without repositioning around an oral airway.
The patient can bite
With the tube out of the mouth, the jaws can close normally for bite checks and prosthesis try-in during the case.
Controlled breathing
We control and monitor every breath for the full length of the surgery, however long it runs, instead of relying on the patient's own breathing.
Protection from aspiration
Water, blood, secretions and dental material can't be inhaled into the lungs.
Choosing between general anesthesia and IV sedation
| General anesthesia, nasal intubation | Deep IV sedation | |
|---|---|---|
| Patient experience | Fully asleep, no memory of surgery | Deeply asleep, little or no memory |
| Airway | Secured with a nasal tube | Patient breathes on their own |
| Medications | TIVA by infusion pump, with an ERAS recovery protocol | IV sedation medications |
| Protection from aspiration | Yes | Relies on suction and positioning |
| Best for | Double arch, long cases, heavy bleeding or irrigation | Single arch, shorter or simpler cases |
For most full-arch cases we recommend general anesthesia, and we're glad to provide IV sedation when you prefer it. Either way, a physician is at the head of the chair with the same equipment. We review every case with you ahead of time and agree on the right approach for that patient.
Surgery-center equipment, in your operatory.
Your office provides oxygen and suction. We bring everything else to every case.
- Anesthesia machineFor general anesthesia cases
- Full monitoringASA standards, including end-tidal CO2
- SCDs on every caseClot prevention during long surgeries
- Video laryngoscopePlus backup airway equipment
- Infusion pumpsPrecise, steady medication delivery
- Medications and AEDAll anesthesia and emergency drugs on hand
From the first call to the ride home.
Before surgery
We review the patient's health history, request medical clearance when it's needed, and give the patient clear fasting and arrival instructions. We confirm the anesthesia plan with you.
Surgery day
We arrive and set up before the patient does. A physician anesthesiologist stays at the head of the chair for the entire case, running TIVA by infusion pump and the ERAS protocol for fluids, nausea prevention and pain control.
Recovery
We monitor the patient in recovery until they're awake, comfortable and safe to leave with their escort, then hand off with clear post-op instructions.
All-on-X anesthesia FAQ
What does my office need to provide?
Oxygen and suction. We bring the anesthesia machine, monitors, infusion pumps, SCDs, airway equipment, medications and AED.
Is general anesthesia safe in a dental office?
With careful patient selection, a physician anesthesiologist and surgery-center equipment, yes. We screen every patient beforehand and will tell you honestly if a case belongs in a surgery center instead.
Why a nasal tube instead of an oral one?
An oral tube sits in your surgical field and keeps the jaws apart. A nasal tube leaves the whole mouth open and lets the patient bite down for occlusion checks, while still protecting the airway.
What are TIVA and ERAS?
TIVA (total intravenous anesthesia) keeps the patient asleep with IV medications instead of anesthetic gas, which means less nausea and a clearer wake-up. ERAS (enhanced recovery after surgery) is a protocol for pain control, nausea prevention and fluids that helps patients recover faster with fewer opioids. Together they give you steady surgical conditions and give your patient a better experience afterward.
Do patients need medical clearance?
Not always. We review every health history, and for patients with significant medical conditions we'll request clearance from their physician before surgery day.
Your full-arch anesthesiologists
More than 50 years of combined anesthesia experience between them.
Ramtin A. Cohanim, MD
Founder and Managing Partner. Former instructor to dental anesthesia residents at Stony Brook University Hospital.
Charles Neal, MD
Founding Member. 36+ years of anesthesia, former department head and medical director.
Planning a full-arch case?
Send us the date and a few details, and we'll confirm availability and an anesthesia plan.