The incorporation of dental implants into the general dentistry practice is certainly on the rise, as it should be. Many organizations have done surveys which have yielded results showing somewhere between 10% and 15% of dentists in the United States place and restore their own implants.1 Many of those clinicians discovered that they should not be afraid to place them and that implants can be very successful, thus provoking thoughts of creating an implant-centered practice (Figure 1).
WHERE DOES ONE BEGIN?
Like anything we do in life, we must first learn, then do over and over until we get it right; this is no different than learning to ride a bike. The same is true with implant dentistry. Until recently, all implant education was post-dental school, and, even today, the education is limited at dental schools to those students who are ahead or have extra time (Figure 2). There are now many ways to gain the knowledge required to place implants. Some start with a weekend course, while others choose a more formal route, such as a specialty residency, advanced education in general dentistry (AEGD), or a general practice residency (GPR).2 However one gets started, it is important to remember that this is a multidisciplinary modality that requires time and thought. Implant dentistry is a concert made up of an oral surgery section, a periodontal section, and a prosthetic section all in harmony with the patient. I started my implant path with a weekend course presented by a manufacturer of implants. Once home and situated with my new expensive gadgets and toys, I quickly found out that I had a lot more to learn.
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| Figure 1. The physical markings of a practice that is dedicated to dental implant treatment. | Figure 2. Dr. Moody providing hands-on mentorship to a dentist at the Brighter Way Dental Clinic (Phoenix, Ariz). Comradery is important to learning and sharing during one’s journey on the implant pathway. |
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| Figure 3. Dr. Moody and one of his mentors, the late Dr. Carl Misch. | Figure 4. CBCT (Carestream Dental 8100) and the accompanying treatment planning software are musts for the accurate placement of dental implants. |
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| Figure 5. Upper full-arch zirconia fixed-removable prosthesis on multi-unit abutments (ProSmiles Dental Studio [Rapid City, SD]). | Figure 6. Lower full-arch zirconia fixed-removable prosthesis on multi-unit abutments (ProSmiles Dental Studio). |
I was lucky enough to have had an amazing mentor in Dr. Roger Plooster; he insisted that I jump on a plane to go and start learning from Dr. Carl Misch (Figure 3).3 On that flight, I ended up sitting next to a dentist who was also headed to the same place. After just a few minutes of conversation, I learned that not only was Dr. Plooster his mentor as well, but also his cousin. As I was piecing together all this information, I discovered that my new friend and I had some very close ties. Not only were his parents from my hometown but, in fact, my practice was once owned by his grandfather! From that moment on, Dr. Mike Freimuth and I were partners in this implant journey. We were hungry for the knowledge to marry the disciplines of implant dentistry so that our patients could get the absolute best treatment. I would encourage anyone looking to walk this path to find a friend to go on the journey with them. Having someone to call and share cases, problems, and awesome outcomes with is such a comfort. We crossed the country for many years going to places like Atlanta for the American Academy of Implant Dentistry maxi-course and to the Kois Center in Seattle, culminating years later in Boston where we both received Diplomate status in the American Board of Oral Implantology.
The Technology Needed to Support Implant Dentistry
Cone beam computed tomography (CBCT) was not available when I began to learn about implants. The best option anyone had was a hospital grade “lay-down” machine with no dental software and a lot of radiation. Times were different; we learned to be more aggressive with flaps and avoided many of the anatomical landmarks or pitfalls altogether. When I purchased my first CBCT unit in 2006, I was still in my hometown of Crawford, Neb (population 1,109). Many probably wondered, “How can Dr. Moody afford that high-tech equipment in such a remote rural town?” It was the springboard to my implant practice, because knowing more information about my patients made it safer for them and less stressful for me. Being able to visualize the anatomical concerns while virtually treatment planning the case using today’s software has kept me energized and loving my job.4 Is CBCT the new standard of care? That is not for me to decide, but I will tell you that CBCT is the gold standard in my practice (Figure 4).5
No Dentures, Removable Partials, or Fixed Partial Bridge Dentures
Confidence in your ability to deliver the very best in implant dentistry is the backbone for putting implants at the front of your practice. You must also believe in your heart and have the sincere conviction that tooth replacement with a dental implant is the best and right treatment option for your patients. This is the motto in all my offices: “No dentures, partials, or bridges,” and we live by it. Discussions about bone loss prior to tooth extractions is also a must. Educating your existing denture patients on why their dentures do not fit and how such appliances by themselves are not true tooth replacements should always be done (Figures 5 to 7). Knowing that the 3-unit fixed partial denture (FPD) may only have a mean life span of 9.6 years6 while the single implant demonstrated a survival rate of 97% or greater7 in studies of more than 10 years makes the case for implants compelling, to say the least. An implant must be considered when a patient needs a tooth replacement. Your team must also have total and complete buy-in if there is to be an implant practice in your office. Every one of your team members must believe that implant care is the absolute best solution and, if they were placed in that same situation, they too would want implants done by their dentists.
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| Figure 7. Before and after collage of a full-mouth reconstruction used to educate and market Dr. Moody’s practice. | Figure 8. Proper management of soft-tissue is extremely important for excellent aesthetics. |
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| Figure 9. Proper placement and emergence profiles for posterior restorations are made easier using platform-shifted internal Tapered PLUS Implants (BioHorizons). | Figure 10. Screw-retained zirconia crown on a BioHorizons Ti-Base (ProSmiles Dental Studio). |
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| Figure 11. Patient education materials. | Figure 12. Crestal bone maintenance using the Tapered PLUS implant, custom titanium abutment, and layered zirconium crown (ProSmiles Dental Studio). |
Procedures
To be an implant practice, you must think like you are part of an implant practice, consistently talking with patients who need implant treatment. Prejudging your patients is the downfall of your own abilities. The doctor and the team should present treatment options that they would have done on themselves if put in the same situation. One must become comfortable with or have knowledge of all common implant procedures, whether done in the practice or referred out of the practice to another clinician. The implant procedures are as follows:
- Single implants
- Multiple implants
- Immediate (both load and unloaded) implants
- Socket grafting and ridge preservation
- Implant-secured overdentures
- Fixed edentulous restorations.
One of the most important pieces in my own experience is using immediate implants when the tooth is (or teeth are) terminal. Our ability to be spontaneous and not wait to begin treatment increases the number of implants the clinic does as well as provides us many of the clinical benefits such as soft-tissue maintenance (Figures 8 to 10). It will also increase your patients’ satisfaction index as they do not want to wait or be referred out to another clinician.
Patient Education and Marketing
Patients only know what they have been told or what they have heard. You must make the effort to talk to each one of them and to educate them about their dental condition and the benefits of implants as an option to replace teeth.8 Visual stimulation is the easiest and, perhaps, the most effective way to educate our patients. In our practices, we have modules such as implant magazines, brochures, models, posters, and videos all designed to initially educate patients about implants (Figure 11). Although the use of visual aids is good, it doesn’t make up for the verbal skills you must possess to present your treatment plans with confidence.9 If you truly believe in your treatment plan as the best option for care, then you will have gained the patient’s trust. This makes it easier for patients to follow your advice and to say “Yes!” to the best treatment option presented. Team confidence and knowledge are also key, as any messaging to your patients throughout the office must be done accurately and consistently. The best marketing will always be word of mouth, so it is important to find some happy patients within the practice to give you positive testimonials about your technical work and the delivery of services (Figure 12).
CLOSING COMMENTS
The goal is truly to return the patient to optimum oral health in a predictable fashion.10 Dental implants should be thought upon as the first choice for tooth replacement options in every patient. Through technology, education, and experience, you too can and will build your implant practice. I would strongly encourage you to begin your own journey down the implant pathway. Find a mentor, talk with a friend on the same path, inspire your team, and help your patients receive the very best in dental care.
References
- Agarwal T. The true cost of not doing implant dentistry. Dent Econ. 2013;103:52-53.
- Hamilton B. The benefits of a postgraduate dental program. Gap Medics. June 13, 2016. gapmedics.com/blog/2016/06/13/the-benefits-of-e-dental-program. Accessed January 6, 2017.
- Majors J. EncourageMentors: Sixteen Attitude Steps for Building Your Business, Family and Future. New York, NY: Morgan James Publishing; 2011.
- Ganz SD. Three-dimensional imaging and guided surgery for dental implants. Dent Clin North Am. 2015;59:265-290.
- Christensen GJ. Do you need cone beam radiography? Dent Econ. 2012;102:26-31.
- Walton JN, Gardner FM, Agar JR. A survey of crown and fixed partial denture failures: length of service and reasons for replacement. J Prosthet Dent. 1986;56:416-421.
- Fugazzotto PA. Success and failure rates of osseointegrated implants in function in regenerated bone for 72 to 133 months. Int J Oral Maxillofac Implants. 2005;20:77-83.
- Hines M. Marketing Implant Dentistry. Hoboken, NJ: John Wiley & Sons; 2016.
- Majors J. Open the Door to Your Purpose in Implant Dentistry. Bryan, TX: Dentistry by Choice; 2006.
- Misch CE. Contemporary Implant Dentistry. 3rd ed. St. Louis, MO: Mosby Elsevier; 2008.
Dr. Moody is a 1997 graduate of the University of Oklahoma College of Dentistry. He has been a general dentist for nearly 19 years, and, since 2008, his practice has been limited to dental implants in Rapid City, SD. He is a Diplomate of the American Board of Oral Implantology/Implant Dentistry and the International Congress of Oral Implantologists and a Fellow/Associate Fellow of the American Academy of Implant Dentistry. An adjunct professor at the University of Nebraska Medical Center, he is also a mentor at the Kois Center in Seattle. He can be reached at (605) 716-5622 or via the email address: justin@justinmoodydds.com.
Disclosure: Dr. Moody is a paid consultant for BioHorizons Dental Implant Systems, ProSmiles Dental Studio, and Carestream Dental.
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