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| Michael A. Pikos, DDS |
Dentistry Today’s implant editor, Dr. Michael Tischler, interviews Michael A. Pikos, DDS
What are your thoughts regarding continued global dental implant market growth?
Dr. Pikos: A definite trend that we have been seeing involves continued global dental implant market growth as a direct result of increased patient demand for implant treatment, in addition to the increased number of restorative-based clinicians offering surgical as well as restorative implant services. These clinicians will need to seek out implant-based continuing education courses that will provide adequate surgical training to allow for safe patient treatment and predictable long-term results with minimal complications. Another driving force for increased revenue growth will be the advent of new dental implant technologies that will command higher prices. Finally, the largest demographic group—the baby boomers (born between 1946 and 1964)—is moving into middle age and later middle age. This group has been very instrumental in developing a youth-based culture, and now have a desire to maintain that youth.
According to the US Census Bureau, the United States alone has approximately 78 million baby boomers, which means that each year, more than 4 million Americans turn 60 years old. That’s 11,000 people each day, more than 450 every hour, and 100 every 13 minutes, every hour of the day until 2024. As a result, the market trend shows continued double-digit growth in the implant market.
Do you see a continuing demand for immediate full-arch fixed restorations?
Dr. Pikos: There is an increased public awareness now of the availability of full-arch immediate fixed restorations. Of course, these are provisional restorations to be followed by the final prosthesis some 4 to 6 months later. The 2 population groups that this treatment modality addresses involves both the edentulous arch patient, as well as the terminal dentition patient, many of which are true dental phobics who have not been to a dentist in a number of years.
There are many technological advances that have contributed to the predictability of these fixed full-arch immediate implant-supported restorations. These include advances in implant surface technology and aggressive thread design that accelerate healing times, in addition to abutment design and nature of the restorative material. Finally, the use of CBCT with third-party software allows for virtual treatment planning, as well as for the application of a fully guided surgical approach that includes the fabrication of a monolithic polymethyl methacrylate bar-supported hybrid prosthesis in advance of the surgical procedure to be used as a provisional prosthesis.
What advances in bone grafting do you see shaping the future of implant dentistry?
Dr. Pikos: Bone grafting in implant dentistry is critical to provide adequate 3-D bone volume for implant placement and long-term success of the implant abutment crown complex. That said, autogenous bone grafts remain the proverbial “gold standard” for bone regeneration as they provide osteogenic cells, osteoinductive growth factors, and an osteoconductive scaffold; all essential for new bone growth. However, autografts carry the limitations of harvest site morbidity and limited availability. As a result, tissue engineering has emerged as a technology to manage bone loss.
I have utilized rhBMP-2/ACS and rhPDGF-BB for the past 9 years with stable and predictable bone volume maintenance after loading. We will continue to see advances in tissue engineering and biomaterials that will provide appropriate tools to promote the migration, proliferation, and differentiation of bone cells, and to enhance bone graft healing. New strategies such as gene therapy, polytherapy by using scaffolds, growth factors, and stem cells along with the use of 3-D printing may offer new exciting options in the near future.
Do you see a trend toward increased training in virtual reality?
Dr. Pikos: The impact of virtual reality for the dental implant surgeon and his or her patient will be unprecedented in the near future. We are entering a world that will provide real-time, 3-D anatomic situational awareness with simultaneous interfacing with surgical planning, 3-D imaging, and technical/educational databases. The surgeon will be able to efficiently optimize real-time anatomical findings during surgery. As more advanced imaging technologies come online, interactive artificial intelligence programs will combine to monitor, direct, and assess operative progress and ultimately direct robotic surgical implantology applications.
The implications for surgical implant training are limitless. Quality control and 3-D visualization of the anatomic soft- and hard-tissue architecture as it relates to an optimal implant or regeneration protocol can allow repetitive virtual experience prior to actual patient surgery. Virtual surgical implant simulation, as in, “fly the mission before you actually perform the case” will become reality. Our new generation of experienced 3-D enthusiasts will be the dental surgeons of the future.
Do you see guided surgeries being used more as we head toward the future?
Dr. Pikos: I do see digital diagnostics, treatment planning, and guided surgery becoming the future standard instead of the present options. Indeed, sophisticated and successful full-arch prosthetic outcomes depend on careful computer-driven treatment planning and implant placement. This means that guides will be the norm. A full-arch implant-supported prosthesis, for example, is expected to be functional, extremely aesthetic, and hygienic. Anything less than precise preplanning and equally precise implant placement may result in a compromised final prosthesis. The smile-line, midline, and incisal edge positions must be correct. Screw access holes must emerge in the proper locations, especially in conjunction with tilted implants and multiunit abutments. Cantilevers and hygienic intaglio surfaces must be by design. There is simply no guarantee that a “freehand” placement of implants will allow for a predictable final prosthetic outcome, especially with full-arch immediate load prostheses.
Dr. Pikos graduated summa cum laude and Phi Beta Kappa from The Ohio State University (OSU), where he also graduated with honors from the OSU College of Dentistry. He completed an internship at Miami Valley Hospital and residency training in oral and maxillofacial surgery at the University of Pittsburgh, Montefiore Hospital. He is an adjunct assistant professor, department of oral and maxillofacial surgery at the OSU College of Dentistry and Nova Southeastern University College of Dental Medicine, and is a courtesy clinical associate professor in the departments of periodontology and prosthodontics at the University of Florida College of Dentistry. He is an active member and frequent lecturer for the American Association of Oral and Maxillofacial Surgeons, the American Academy of Periodontics, the Academy of Osseointegration, the American Academy of Implant Dentistry (AAID), and the International Congress of Implantology. He is the scientific advisor on implants for the Kois Center and is the recipient of the AAID’s 2006 Aaron Gershkoff Memorial Award. Dr. Pikos is founder and CEO of the Pikos Institute. Since 1990, he has been teaching advanced bone and soft-tissue grafting courses with alumni that now number more than 3,000 from all 50 states and 32 countries. Dr. Pikos maintains a private practice, which is limited exclusively to implant surgical reconstruction in Palm Harbor, Fla. He is a well-published author who has lectured extensively on dental implants in North and South America, Europe, Asia, and the Middle East. He can be reached via email at learn@pikosinstitute.com or via the website pikosinstitute.com.
Disclosure: Dr. Pikos reports no disclosures.
