Oral Health Group
Feature

Implantology: How to Integrate Implant Dentistry in General Practice

February 1, 2003
by Milan Somborac, DDS


It is interesting to note that a search using the Internet engine www.google.ca using the terms “dental implants” will produce more citations than the terms “cosmetic dentistry” or the terms “tooth bleaching” and “tooth whitening” combined! This search engine is the layman’s medium. It is not a peer-reviewed journal. The public is interested.

To assess effective demand for implant treatment we need to examine:

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1. the absolute numbers of potential implant candidates

2. their capacity to buy treatment.

Looking at the first point we can note that a National Institute of Dental and Craniofacial Research study shows that 69.5% of adults 18+ years of age in the US are missing one or more teeth.1 The same study shows that 10.5% of the US population is edentulous. If we extrapolate that to Canada’s population of 32 million, we find that there are 22.4 million people missing some teeth and that 3.36 million are fully edentulous. Further, given North American demographic trends, ever-increasing numbers of people are entering older age groups and experiencing age-related tooth loss.

Looking at the second point, today’s North American society is the wealthiest in history. Without doubt, significant effective demand is present.

Would we be placing patients at risk by enthusiastically promoting implant treatment ahead of traditional treatment with its much longer history? Let us compare long-term success/failure rates of implant-supported dentistry relative to these traditional methods.

For single tooth replacements, success rates of 97% have been reported for implant supported prostheses. For implant-supported fixed partial dentures, success rates are 94%.2-6

By comparison, long-term failure rates of traditional dentistry are 10% for fixed partial dentures,7 13% for hemisections and root resections,8 15% for endodontic therapy,9 19% for resin bonded bridges10 and 34% for endodontic re-treatment.11 From these data it appears that the seemingly more radical implant treatment is actually more conservative. Today’s standard of care, as well as ethical considerations dictate that our patients be made aware of these comparisons. Even dentists who don’t place or restore implants need to inform patients of treatment risks, benefits and alternatives.

THE SUPPLY SIDE

How many clinicians are there in Canada to meet this effective demand?

Almost all of Canada’s 285 periodontists and 320 oral surgeons are involved in the first step of treatment, the actual placement of implants. There are about 16,000 licensed dentists in the country, and about 2000 (+/- 5%) are part time, in academia, public health or administration. Of the 14,000 in full time general clinical practice 6% perform implant surgery according to a CRA survey of a random selection of 3865 of its subscribers, including Canadians.12 About 60% of the dentists surveyed complete the prosthetic phase of treatment.

So, 6% of 14,000 = 840 plus the 605 surgical specialists gives us a figure of about 1,450 clinicians who can initiate implant treatment for 22.4 million potential patients.

Clearly, they cannot meet the effective demand. The question then is, how is the effective demand being satisfied?

To a small extent, some of it is met by surgical specialists (oral surgeons, periodontists and some endodontists) doing implant surgery and general practitioners, or prosthodontists looking after the prosthetic aspects of treatment.

The shortfall is largely being met through the use of the less reliable traditional methods described above. More general practitioners need to add both implant surgery and prosthetics to their clinical repertoire.

Clearly, it will raise the standard of care. Clinicians need to acquire appropriate training and learn which cases need specialist attention.

CLINICAL EXAMPLES

(All cases treated by Canadian general practitioners)

1. Overdenture retention

In May 2002, a conference of leading implant dentists meeting at McGill University concluded…” that there is now overwhelming evidence that a two implant overdenture should become the first choice of treatment for the edentulous mandible.”13 Indeed, the largest number of implants are used in this application. It is relatively straightforward with a strong positive impact on patients’ lives (Figs. 1-3).

2. Single tooth replacement

This is the most commonly performed implant procedure. If the site is accessible, and the bone has good residual shape and quality, this procedure is also relatively straightforward. If the bone has poor residual shape and/or quality, a specialist should be consulted (Figs. 4-6).

3. Other Examples (Figs. 7-12).

GETTING STARTED

For reasons beyond the scope of discussion in this article, little implant science is taught in undergraduate programs at our dental schools.

All courses taught in Canada today, and indeed, anywhere, have a manufacturer’s bias connected with them, either overtly or subtly. The clinician needs to make science-based judgment in order to separate commercial hype from biologically sound claims. Both are always present.

A low cost way of getting started is to study manufacturers’ web sites. The alphabetical list shown in Table 1 is not comprehensive but includes most implant companies offering implants that have regulatory clearance in Canada. Some companies offer several distinctly different implant systems. (Omissions are accidental.)

Implant component catalogs are often shown on the web sites and all manufacturers will gladly send a hard copy catalog with pricing. Published papers are often quoted and are worth examining.

There are study clubs, lectures and seminars that the interested clinician should look into, keeping in mind that sponsors have their private agendas.

Ultimately, the clinician needs to take a hands-on, live surgery and prosthetics course. These typically have six or more all-day sessions and require a significant commitment of time and money including a high level of on-going study. Careful investigation will ensure the right choice.

Those who make a commitment invariably find the inclusion of complete implant treatment in their practices very cost effective. The satisfaction is enormous. It grows as the clinician gains experience and undertakes increasingly more difficult cases to improve patients’ quality of life.OH

Oral Health welcomes this original article.

Note: All implants used in this article were manufactured by Tenax Implant Inc. of Collingwood, ON, Canada. Dr. Somborac is in private practice and is a shareholder in Tenax Implant Inc.

REFERENCES

1.Marcus SE, Drury TF, Brown LJ, Zion GR. Tooth Retention and Tooth Loss in the Permanent Dentition of Adults: United States, 1988-1991. J Dent Res 75(Special Iss): 684-695 Feb. 1996.

2.Henry PJ et al, Osseointegrated implants for single-tooth replacement: a prospective 5-year multicenter study. Int J Oral Maxillofac Implants. 1996 Jul-Aug;11(4):450-5.

3.Van Steenberge D et al, Applicability of osseointegrated oral implants in the rehabilitation of partial edentulism: a prospective multicenter study on 558 fixtures. Int J Oral Maxillofac Implants. 1990 Fall;5(3):272-81.

4.Zarb GA, Schmitt A., The longitudinal clinical effectiveness of osseointegrated dental implants in posterior partially edentulous patients. Int J Prosthodont. 1993 Mar-Apr;6(2):189-96.

5.Lindh T, Gunne J, Tillberg A, Molin M. A meta-analysis of implants in partial edentulism. Clin Oral Implants Res. 1998 Apr;9(2):80-90.

6.Jemt T, Pettersson P. A 3-year follow-up study on single implant treatment. J Dent. 1993 Aug;21(4):203-8.

7.Samama Y, Fixed bonded prosthodontics: a 10-year follow-up report. Part II. Clinical assessment. Int J Periodontics Restorative Dent. 1996 Feb;16(1):52-9.

8.Buhler H, Survival rates of hemisected teeth: an attempt to compare them with survival rates of alloplastic implants. Int J Periodontics Restorative Dent. 1994 Dec;14(6):536-43. Review.

9.Peak JD, The success of endodontic treatment in general dental practice: a retrospective clinical and radiographic study. Prim Dent Care. 1994 Sep;1(1):9-13.

10.Corrente G, Vergnano L, et al, Resin-bonded fixed partial dentures and splints in periodontally compromised patients: a 10-year follow-up. Int J Periodontics Restorative Dent. 2000 Dec;20(6):628-36.

11.Allen RK, Newton CW, Brown CE Jr, A statistical analysis of surgical and nonsurgical endodontic retreatment cases. J Endod. 1989 Jun;15(6):261-6.

12.CRA Newsletter, Vol. 25, Issue 12.

13.Feine JS, Carlsson GE, Awad MA, et al, Mandibular Two-Implant Overentures as First-Choice Standard of Care for Edentulous Patients. Report on McGill Consensus Statement on Overdentures. Int J Oral Maxillofac Implants. 2002; July/August (4): 601-602.

Table 1

Implant System Manufacturer’s Website
Bicon www.bicon.com/
BioHorizons www.biohorizons.com/
Endopore www.innovatechcorp.com/
Friadent www.friadentna.com
Implant Innovations Inc. www.3implant.com/
Nobel Biocare, formerly Brnemark www.nobelbiocare.se and Steri-Oss
Straumann (ITI) www.straumann.com/
Sulzer, formerly Paragon, formerly www.centerpulse-dental.com Dentsply Implant, formerly Core-Vent
Tenax www.tenaximplant.com


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