Who or what is in the driver’s seat?

It is no surprise that the market for implant dentistry
continues to grow impressively as the result of advances in science and
technology and from the purchasing power of the most affluent older
generation in U.S. history – the baby boomers.

First, let’s
acknowledge the tremendous impact of evidence-based research in making
dental implants the most predictable procedure – from an outcomes
perspective – in dentistry today. We’ve evolved from the development of
the first commercial titanium screw implants in the 1980s to a plethora
of new implant products and systems which have been fueled by rising
consumer demand. Companies are investing millions in implant technology
because aging baby boomers with periodontal disease and other dental
problems don’t want to bother with clumsy and uncomfortable bridgework.
Folks who prefer driving BMWs to Fords want the best when it comes to
dental care … and many are willing to dig deep in their pockets to pay
for it.

Implants aren’t new, they’re just better

People
have been losing teeth since Adam met Eve, and through the ages
procedures have been used to replace missing teeth with permanent,
anchored implants. Some archeological findings have shown that the
ancient Egyptians and Mayan Indians in South America tried to re-implant
lost teeth with substitutes made of wood or ivory. Believe it or not,
the first effort for human transplantation occurred in the 18th century
when lost teeth sometimes were replaced by teeth from donors. Given the
lack of knowledge about immune system responses and tissue rejection,
it’s unlikely many of those crude procedures were successful.

Advances in metallurgy led to pioneering work in the late
1800s to implant anchors made from gold, platinum, and even porcelain in
the jawbone. However, the seminal breakthrough occurred
serendipitously, as often happens in science. In 1952, a Swedish
orthopedic surgeon named Per-Ingvar Branemark accidentally discovered
that his bone-anchored titanium microscope had bonded permanently to
bone tissue. Annoyed,but curious,he pursued further investigation of
this phenomenon and proved that titanium could be fused with living bone
with great predictability and without inflammation or significant
rejection risk. He first implanted titanium cylinders and fused them to
the hipbones of rabbits. Additional studies included use of titanium
screws as dental implants, and the science of osseointegration was born.
The first practical application occurred in 1965 when titanium implants
were given to an edentulous patient. However, it wasn’t until 1985 that
the technique became accepted in dentistry. The implant systems we use
today are based on Dr. Branemark’s original research.

With
the knowledge and confidence that titanium fosters osseointegration,
many improvements occurred in our field in surgical techniques, medical
imaging enhancements, bone grafting advances, and the continual
development of new implant products. With solid research and technology
making implants safer and more long-lasting and predictable than ever,
the market is booming today. But let’s also give due credit to the huge
patient base comprised of adults who were born following World War II.

It’s
a boomer market … for now

At the risk of
overstating the point, technology and discretionary spending by the baby
boomers are responsible for the remarkable growth of implant dentistry
in the last 10 years. Baby boomers will be the richest senior-citizen
generation in our history, and those of us in the implant business know
our field is being driven by their dollars. While demand for implants is
surging, let’s not delude ourselves into thinking this trend will
continue forever. The market will adjust and we must be ready to adapt
our practices to future trends. I strongly believe that very few, if
any, of us in 10 years will be able to maintain a practice just doing
implants.

By 2017, many of the baby boomers will have
died. It will be impossible to replace their business due to the size of
this population group and its high per-capita wealth. It is my opinion
that the next generation, born in the late ’60s through ’70s, has
benefited from better pediatric dental care, so the overall incidence of
periodontal disease and tooth loss should be lower. Also, this group
and subsequent generations might not be able to spend as lavishly as the
baby boomers did. Clearly, the long-term future of implant dentistry
depends on its becoming a regular service in the general dentist’s
office. The mainstream implant market will be dominated by one- or
two-at-a-time replacements precipitated mainly by accidents and
injuries.

Though the overall market for implants will shrink, the
core demand will not. Implants are now widely accepted by dental
practitioners and patients as superior to bridgework and other
procedures to replace missing teeth. As a result, the investment in new
technologies and products will continue by implant companies.

Implants
going mainstream

As dental implants become mainstream, more
general dentists will include implants as a core service. This will make
their patients happy because they want to be able to rely on their
family dentists to provide a wide range of services, including implants.
There won’t be huge numbers of implants performed in the average
practice, but implants will be a viable part of a family
dentist’s practice, especially for single-tooth replacements.

While I contend the unique size and financial well-being of
the baby boomer generation have helped spur tremendous implant growth,
let’s not forget that the permanent esthetic benefits of implants are
very attractive to younger generations who are and will remain very
conscious of how they look. They are driving the current boom in plastic
surgery and cosmetic dentistry. More and more women and men in their
30s and 40s are undergoing facelifts and other cosmetic procedures. For
many, part of the makeover involves getting veneers or implants to
achieve that near perfect smile.

Implant dentists today are
part oral-health professional and part cosmetic-solutions provider.
It’s wrong to think our patients are coming in for partial or full-mouth
implants strictly to achieve better functionality. Yes, many patients
are better able to chew certain foods and enjoy a better quality of life
thanks to dental implants. So, it’s good riddance to that bridge that
never fit right and the discomfort and embarrassment it may have caused.
For these patients and others, implants represent a discretionary
spending decision. We are not competing for the health-care dollar.
Vanity and convenience are the prime motivators.

We are not the
local cardiologist whose decisions could have life or death
implications. For example, I had heart bypass surgery four years ago and
there was no choice. I had to undergo this procedure or risk having a
heart attack. Let’s not assume that our patients see our services as
essential health-care expenditures. What we do most of the time is offer
noncritical care that helps patients keep their natural teeth, fix
acute problems, and provide restorative or cosmetic improvements that
support lifestyle preferences.

Today, the dental
implant market benefits from the increased success rates of implants,
particularly when compared to root canals. The single-tooth implant,
rather than a three-tooth bridge, is recognized as the best treatment
for replacing a tooth. Many candidates for root canals today would
rather take the tooth out and get an implant. The Internet educates
patients about the pros and cons of various dental procedures. The more
they learn about the advantages of implants, the more they want them.
After learning that implants don’t require cutting down healthy teeth,
patients opt for them more frequently than for three-unit bridges.

Demand
for one-stop dentistry

Many of us spend
considerable time and money recruiting patients and making sure we keep
them. Sometimes marketing is a very effective way to attract new
patients, as is accepting patients’ dental insurance plans. I’m also
finding that the best way for many dentists to keep patients in their
practices is to offer a wide range of services instead of routinely
referring to specialists. Patients want to stay in the offices they grew
up in whenever possible, so why not make it easy for them by performing
implants and other procedures?

Dental implant companies
are responding to this trend by offering courses and other training
tools to help general dentists become familiar with implant products and
procedures. However, general dentists interested in adding implants to
their practices are advised to get expert, comprehensive, professional
training offered by the American Academy of Implant Dentistry
(www.aaid.com).

While the future still looks rosy
for dental implants, I’m concerned that the technology, especially in
the area of increasingly sophisticated digital imaging, might be
outpacing its overall value to the public. While digital imaging has
been instrumental in helping fuel acceptance of and demand for implants,
how far should it go?

I believe we should focus on
keeping implant fees about the same as what commonly is charged for a
three-unit bridge. We don’t want too much of a technology-driven price
gap and negatively influence patient demand for implants, despite their
advantages compared to bridges and root canals.

Implants
belong in the general dentist’s practice. The tough cases always will
be referred to the dentist with the correct experience to address the
problem. But patients needing single-tooth implants will want them
performed by family dentists as part of their ongoing oral health care.

The future for implants is bright, although the economics will
change as the modality becomes more tightly linked with mainstream
dental practice. This is a very strong and positive trend that should
outlast those free-spending baby boomers for the next several decades.

by Craig Cooper, DDS, practices
implant dentistry in Indianapolis. He is past president of the American
Academy of Implant Dentistry, and teaches courses on implant dentistry.
Contact him by e-mail at implantdds@worldnet.att.net.