August 1, 2007
by Blake Nicolucci, BSc., DDS
In May of 2008, there is going to be a symposium at the University of Toronto on ‘Osseointegration’. This will be the first time in some twenty five years that the major researchers involved in implant dentistry have regrouped to consider the History of Implant Dentistry and decide the direction that Implant Dentistry will take in the future. There are certainly going to be some variation on opinion with respect to how to separate the ‘Good’ from the ‘Bad and the Ugly’. Each company has its own version of what is required to make an implant ‘successful.’
Probably the most intriguing moments of the symposium will be the analysis of years gone by: what was successful — what was not; what should have been done — what was not; what could have been done — what was not; coated surfaces vs. machined surfaces; screw retained vs. cement retained prosthetics; specialist vs. generalist; permanent cement vs. temporary cement; bullet shaped implant vs. threaded implant; fixture thread vs. buttress thread; smooth collar vs. textured collar; long necks vs. short necks; platform switching vs. flush fits; pure titanium vs. titanium alloy; short vs. long implant bodies; wide vs. narrow implant bodies… and the list goes on.
In one of the first editorials I was privileged to be able to write for Oral Health Magazine back in 1998, I mentioned that ‘a bone cell can’t tell the manufacturer of an implant’. Most of the time, an implants success or failure is the result of some external factor — like Force. Not all implants are created equal — just as all areas of the mouth don’t have the same quality of bone. It still amazes me that back in the 80s, there was an understanding that there was different rates of success in different areas of the mouth. These success rates co-related directly with a bone quality scale that was discussed openly and freely amongst leaders of the field at that time. And yet, to this day, there has been little attempt by the major companies to correct this situation. Biomechanics, physics, and physiology all inter-relate to cause this change in success rate. Everyone must still think that a success rate of 78% in the posterior maxilla is acceptable or they would have developed a protocol to increase this particular success rate.
The other problem I have is that most so called ‘implant dentists’ — be they generalist or specialist — are still placing implants where there is sufficient bone — not where the prosthetic design indicates an implant should be placed. Everyone doing implants at this time in the evolution of implant dentistry should be aware of the fact that the prosthetic design dictates the position of the implants (and not the reverse). Where bone grafting has provided inadequate bone for implant placement, another graft must be performed. This will definitely affect the bottom line for the dentist, but is definitely in the interest of the patient in so far as proper placement of the implants, and longevity of the prosthesis is concerned.
If treatment is rendered properly from the beginning, it will eliminate the need to ‘babysit’ the patient for years to come — but again, I digress.
I am anxious to see the outcome of this symposium, and some of the new ideas that will be laid down as ‘rules to follow’ in implant dentistry. The years of ‘trial and error’ are gone. The errors have been made, and some basic laws have been established. It will be interesting to see what direction each of our ‘leaders’ has taken, and what will be the end result of each new trek.