August 1, 2005
by Blake Nicolucci, BSc., DDS
Well, it’s that time of year again. It seems like yesterday that I wrote about the lack of enthusiasm of the insurance companies (and employers) to support implants as a viable treatment option for our patients. I have heard from numerous colleagues since that editorial, all of whom are of the same opinion as the one I shared with you at that time. It was wonderful to hear from some of you for two reasons. One–it let me know that people were actually reading what I had written; and two–it ‘struck a chord’ with those of you who had been unfortunate enough to be in the same situation I had described.
I’m not saying that implant dentistry is the ‘be-all’ and ‘end-all’ of the new millennium. Many other areas of dentistry are growing by leaps and bounds as well. I just happen to be infatuated with little metal screws.
Take cosmetic dentistry, for example. There are more materials out there now than was ever fathomable when I graduated. The ‘dental material science’ professor could dedicate a full year on this particular subject for the undergrads, and they would still only be scratching the surface. When I graduated there was no ‘buccal corridor’, ‘biologic width’ or ‘golden proportion’. The ‘science and clinical research’ area of dentistry has been growing exponentially. It is impossible to separate all of the different disciplines of dentistry into their own individual compartments as we once did. Implant dentistry seems to have melded with most specialties in a very subtle manner. The crossover from oral surgery, orthodontics, periodontics, prosthetics, cosmetic dentistry and implant dentistry is very apparent–and very common.
The expertise of oral surgery is used to place implants, and repair ailing–failing implants. Bone can be placed where necessary. It is also removed when required. Knowledge in oral surgery is necessary to insert implants for both the specialist and generalist alike. The implant dentist should have the expertise and anatomical knowledge to remove implants and associated pathology where indicated.
In orthodontics, dental implants are used as anchors to move teeth during fixed straight wire treatment. Orthodontics is used to move natural teeth to make room for implants. Bodily movement of teeth (as opposed to tipping teeth) can become a very time consuming and daunting task in this area of dentistry–but a very necessary one. Placing an implant into an adjacent natural tooth root is not an uncommon complication for the novice implant dentist. Orthodontics can help us avoid this pitfall.
Periodontic expertise is required to place, repair and maintain dental implants. Repairs can involve both the hard and soft intra-oral tissues. Connective tissue grafting to save implants with poor, or less than ideal surrounding tissues is now commonplace. Periodontic evaluation is used when placing implants to replace periodontally involved teeth. These teeth would be evaluated as being or have become hopeless and unsalvageable.
The knowledge used in prosthodontics allows us to restore and repair dental implants. Implants are used as abutments in prosthetics, especially in complete mouth rehabilitation–where spans on bridges might be considered excessive. Prosthetic protocols limit the length of these spans. If there is no abutment tooth present, implants can be a feasible and desirable option when fixed or removable prosthetics is desired.
As suggested earlier, cosmetic implant dentistry has evolved as the major area of concentration for the modern implant dentist. Long gone are the days of ‘high and dry’ prosthetics for ease of cleaning dental implants by the patient. Historically, it was more important to keep an implant in function for an extended period of time than to worry about the final prosthetic result. Now that implants have passed the ‘testing’ stage, and have become a dependable modality of treatment, the cosmetic end result has become the target. Even though it can be very difficult (and almost impossible under some circumstances), the modern patient is more concerned about an ideal cosmetic result than at any other time in dental history. Unfortunately, our present litigious society shows support for this statement. Some television programs have a theme that is completely dominated by cosmetic overhauls. Dentistry plays a major part in this overhaul.
No, implant dentistry is not a specialty–at least not at present. But it does become an adjunct to all other facets of dentistry. Implants have become a dependable tool in the dentists’ armamentarium–a tool that all dentists should be able to offer as a service option to their patients. Both specialist and generalist alike have the responsibility to present implants as a treatment option. Are you up to the challenge?