As technology improves, there are often questions on to how to best treat our patients who present with significant decay in their teeth. This issue of Dentistry Today focuses on endodontics as a reliable method to help our patients retain their natural dentition.
Often, the cost of treatment to our patients for root canal treatment of an infected tooth and the subsequent restoration is equal to or less than our dental implant therapy. However, when indicated, dental implant therapy is becoming an extremely popular option of restoring form and function.
In this issue, Dr. Stephanie Tilley describes how to do simple maxillary sinus tenting with dental implant placement. Losing teeth can result in some serious dental concerns, especially in the posterior maxilla. Teeth roots act like tent poles holding up a circus tent, but when the poles are removed, the circus tent collapses. This common result often inhibits dental implant placement without more invasive surgical procedures, which are expensive and time consuming. So, when possible, is it better to retain teeth via endodontic therapy or to simply remove the damaged teeth and place dental implants? That is a question that the dental professional needs to consider carefully.
Also in this issue, Drs. Richard Miron, Michael Pikos, and Mark Bishara write about how vitamin D and antioxidant deficiencies in our patients can result in poor prognoses. Restoring edentulous spaces to function and aesthetics is much more than anesthetizing, reflecting, drilling into hard tissue, and placing titanium screws into jawbones. Proper diagnosing and a thorough evaluation of the patient’s general health is just as important as our clinical skills in surgical placement. Conventional root canal therapy is a viable alternative to extraction and implant placement. However, there are times when dental implant therapy may be a better solution. Educating and instructing our patients as to the benefits and risks of treatment should be above “selling” a procedure.
Over the years, Dentistry Today has been an awesome source of information to stimulate dentists to investigate the newest protocols and their possible implementations in the practice. Of course, these decisions should be made after undertaking further research and additional education.
Dentists of all experience levels need to know that some of the procedures presented are complicated and require a full understanding of the techniques involved.
For example, Dr. Todd Engel’s article in this issue provides a step-by-step discussion of one of the most publically advertised dental implant treatments: edentulous arches. This type of therapy seems simple enough, but there is a lot of thought and preparation that goes into the process prior to any surgical intervention. CBCT analysis allows us to virtually determine the position of dental implants to support a fixed or fixed/detachable prosthesis. It is imperative that doctors understand the specific rules to follow to create such an appliance before any placement of implants. There needs to be a certain amount of inter-occlusal space per arch provided, and this can mean removing valuable bone to accommodate the implant-retained bridgework. Precise surgical guides must be fabricated.
In his article, Dr. Engel describes a reduction guide to level the available hard tissue, then an implant placement guide allowing for specific positioning of the supporting dental implants. Once the implants were initially stabilized, a prefabricated screw-retained transitional appliance was delivered. Please be aware that this step is critical to the long-term success of the case. When immediate loading of implants is required, the prosthetic architectural design is important for initial stabilization and integration. Any discrepancy in the evaluation, virtual design of the surgical guides, surgical placement, and/or immediate positioning of the transitional appliance can result in retreatment. It is crucial that clinicians who want to provide this often-requested therapy be well educated and skilled.
Each passing year brings technological advancements to dentistry that potentially improve proficiency, efficiency, and profitability. Continuing education is vital for clinicians wishing to provide high-quality implant dentistry. Keeping updated via clinical case report articles assists in providing you, our readers, with the proper tools. In this issue, Dr. Brady Frank demonstrates how 3-D printing technology is changing how we can create clear aligners for orthodontic treatment and fabricate immediate and cost-effective surgical guides using CBCT analysis and planning software. These 2 applications of technology will soon become mainstream. I am presenting a case report that outlines the retreatment of a patient who had significant full-arch reconstruction just 8 years ago. A traumatic accident resulted in loss of the implants and prosthesis. The retreatment of this complicated case involved implementing modern diagnosis and planning protocols to simplify the process and to make it very affordable for the patient.
Being able to visualize a finished case prior to any treatment intervention is an art that may take years to master. However, with proper didactic and clinical training, it becomes possible to provide outstanding clinical outcomes. The ability to properly diagnose and treatment plan a case is the most important skill we must learn and appreciate, especially in complex prosthetic constructions. Advances and techniques, as represented in articles herein, should stimulate your thought process and provide a focus toward exceptional and predictable care.
The age of the “super dentist” is upon us. I hope you enjoy the submissions presented and take this knowledge to expand your patient care. Aesthetics, function, improved speech, and quality of life are the fruits of our labor. This certainly makes dentistry an exciting profession as we are truly making a difference in people’s health and well-being.
It is a tremendous honor for me that the publishers and editorial team of Dentistry Today asked me to take the helm of Implants Today!
My training in implant dentistry began in 1984 during my residency at Miami Valley Hospital in Dayton, Ohio, Therefore, I began placing our modern endosseous implants soon after their introduction to the profession. I did start out in my career with subperiosteal implants and blade implants though, but quickly evolved to using the IMZ system followed by becoming a key opinion leader with several of the prominent implant companies.
I often mention that I have been blessed with great mentors throughout my professional career, including legends like Drs. Paul Mentag and Frank Bustillo. My education has continued in earnest, and I am now involved in learning new treatment concepts and techniques from new mentors such as Dr. Todd Engel at the Engel Institute in Charlotte, NC. At this stage of life, I am really enjoying mentoring others as well, including many dear friends and colleagues. Education is the key to success with implant dentistry!
There is much to understand, including vital anatomy and ideal placement, which is dictated by a “tooth up or down approach.” Simply placing implants in available bone is no longer acceptable, and we now consider emergence profile and smile design to be of utmost importance to both the clinician and the patient. Patients continue to investigate this exciting dental procedure using the Internet whenever they perceive a problem, such as hurting or missing teeth or unhappiness with their existing full or partial dentures.
We will continue to provide you quality implant and implant-related articles, like those in this issue, that will stimulate your thoughts and assist you in your goals to both learn and excel in the practice of implant dentistry. I appreciate the expressed confidence of the editor-in-chief, Dr. Damon Adams, in naming me as the editor of Implants Today and look forward to your comments and feedback as we strive to continually provide both practical and cutting-edge clinical content for your review.
For the past 3 years, as implant editor of Dentistry Today, I have had the honor and privilege to be a part of the editorial team in reviewing many articles and to work with wonderful and dedicated clinical authors. The Implants Today section has an incredible advisory board, consisting of some of the top implant dentists in the country; Dr. Damon Adams and I have worked with these board members (many of whom have contributed excellent content for publication over the years) and wish to thank them for their time and effort. The editorial team at Dentistry Today, and Dr. Adams especially, have been amazing to work with and supportive of all my efforts in my position as the implant editor. Unfortunately, due to time constraints and changes in my professional life and schedule, this will be my last introduction as the implant editor. It has been an honor.
Over the past 36 issues, so many areas of implant treatment have been covered. The topics have ranged from surgical and prosthetic techniques to treatment planning and implant practice principles. Looking back, the most surprising thing for me is how diversified and interesting implant dentistry can be. As a clinician who is very involved in implant dentistry, I know that this arena must encompass knowledge in every aspect of dentistry for treatment success.
Also, as an author, I can appreciate how much time it takes to write an article and have it reviewed and considered for publication in Dentistry Today! Writing a clinical article takes passion, organization, and a commitment to share with others. In the spirit of the season, this is a form of giving back to the profession, and I want to take this opportunity to encourage others to share their knowledge and talents by writing and submitting articles to Dentistry Today and other publications.
This month continues to reflect a variety in topics with 3 great articles that cover different aspects of implant dentistry: Drs. Tim Kosinski and Stephanie Tilley share a case report dealing with a patient who, like so many others, wanted to move from a removable to an implant-supported prosthesis; Dr. Calvin Bessonet et al present an article about innovations in extraction techniques and implant design; and Dr. Justin Chi talks about basic implant dentistry with the GP in mind.
This month, in our introduction to Implants Today, let’s briefly discuss the many variations that exist in implant applications as we consider implant treatment for our patients. As the dental implant industry has grown over the past 10 years, so has the variety of options to choose from among dental implant fixtures, prosthetic components, and materials. The benefit of this variety is being able to offer our patients the best choices specific to the applications needed.
This month, we have 2 excellent articles that exemplify the diversity of implant applications. Dr. Todd Shatkin shares information based upon his many years of experience with placing mini dental implants, and Dr. Ara Nazarian presents a combination case involving standard-sized dental implants. These articles demonstrate how replacing missing teeth can be done with different size dental implants and different components.
The choice in every aspect of dental implant treatment starts with a definitive treatment plan. The treatment plan chosen between a doctor and the patient is based on many considerations. These considerations are cost, treatment time, aesthetic result, material longevity, and more. Through having the availability of different implant sizes and prosthetic components, many variations of final implant prosthetics can be achieved. The choices a clinician makes when selecting a dental implant fixture for a specific clinical situation is dependent on several factors and can include bone quality, bone length and width, adjacent tooth space, and the available prosthetic space. An additional consideration in implant fixture choice is the prosthetic attachment type. The prosthetic attachment to an implant fixture has an effect on abutment angulation choices, removable attachment options, interim provisionalization options, and more. All of this shows how treatment plans must be supported by the correct implant fixture, which in turn must be able to support the chosen prosthetic result.
The final prosthetic result often requires components that support the provisional aspects of treatment. The discipline of implant dental treatment has many variations of component choices, including implant fixtures. In the end, it is up to the clinician to become fully educated in these matters and to properly choose among the many options available to realize a successful final outcome for the patient.
This month in the Implants Today section, we are focused on dental implant-adjacent soft-tissue considerations. The first thing most clinicians consider for dental implant treatment plans is the bone that is required for support of the dental implant(s). While that is logically the first consideration, the biological interrelationship between the hard and soft tissues that support a dental implant must be considered with any dental implant treatment plan. The vascularity associated with a dental implant is connected and nurturing to both the hard and soft tissue. The health of both hard- and soft-tissue cellular structures supports a dental implant.
The soft tissue around a dental implant can help protect a dental implant from debris and bacteria entering the sulcus around it. The degree of protection that the soft tissue offers is related to the amount of keratinized tissue content present. It is important to note the amount of keratinized tissue available at the surgical site during the treatment planning phase appointment. If there is inadequate keratinized tissue noted, the treatment plan can then include surgical treatment to either augment the tissue with grafting and/or utilize surgical repositioning procedures. These steps should be predetermined so that the patient is apprised of the planned treatment from both the informed consent and financial perspectives.
Besides protection of a dental implant, soft issue has an important role in the aesthetics around an implant, especially in the anterior region. Once again, treatment planning considerations must be made to address any grafting or surgical manipulation that could increase aesthetic results. It is also important to consider that, no matter how attentive a clinician is, post-surgical soft-tissue complications can happen. This could be related to patient host factors and habits, dental implant design-related issues, and more.
This month, Jonathan Waasdorp, DMD, MS, has an excellent article, “Management of Retrograde Peri-implantitis: The Minimally Invasive Tunnel Approach.” This article addresses how to deal with this soft tissue complication. Also, Joseph Massad, DDS; Mahesh Verma, MDS, MBA, PhD; and Swati Ahuja, BDS, MDS, have contributed yet another informative article on the importance of recommending the use of an electric toothbrush to maintain soft-tissue health around dental implants.
This month’s Implants Today section is focused on guided full-arch implant surgery. We are fortunate to have an article by our Implants Today advisory board member Dr. Scott Ganz and his colleague Dr. Isaac Tawil on this very topic. Their excellent article entitled “Full-Arch Implant Surgical and Restorative Considerations,” is the first article of 2 planned on this topic. (The second article is scheduled to be published sometime in 2020.)
This month in Implants Today, we focus on complications related to dental implant treatment. Whenever a complex task is being performed, complications are often inevitable. The task of replacing a tooth or teeth as an implant dentist is a formidable task, as there are many variables involved for success.
This month in Implants Today, we have 2 unique articles written from 2 different perspectives. The first is a retrospective article written by arguably one of the most recognized and respected clinicians in dentistry, Dr. Gordon Christensen. In his article that was requested via a special invitation from our editor-in-chief, Dr. Damon Adams, Dr. Christensen shares some amazing insights gained from his many years of experience in placing and restoring dental implants. The second article is a unique consensus summary from multiple clinicians, Dr. Steven Williams et al, on various aspects of implant treatment.
This month’s Implants Today column focuses on implant placement strategies. In light of that topic, we have an excellent article by one of our Implants Today advisory board members, Dr. Craig Misch. Craig offers the unique perspective of having dual specialties in oral surgery and prosthetics. In his article, entitled “A ‘Graft Less’ Approach to Posterior Implant Sites,” he discusses how older paradigms of relying on bone grafts to place dental implants can now be avoided in many circumstances by utilizing shorter implants. This is a strategy that was not available just a few years ago, and because of the advancement of materials and implant design, it is now a reality backed by studies showing success. It represents a strategy change as an implant surgeon. Dr. Misch’s article is especially notable to me as a clinician practicing implant dentistry, as some previous paradigms that I had learned under the mentorship of his brother, the late Dr. Carl Misch, are now being challenged. I say this with total respect, as this is how it should be after pioneering concepts are created and introduced; it is called evolution.
When any strategy is formulated, it is based upon information that creates a plan to reach a goal. The goal for implant dentists is to restore form and function for the patient in the easiest, most predictable manner. In this month’s article, Dr. Misch gives an example of being able to place shorter implants, avoiding the need for sinus grafting. The rationale of obtaining proven results, with a less invasive procedure based on technology, is a strategy that makes sense as a practitioner.
Another paradigm we are seeing with a similar end result of less invasive surgery for our patients is utilizing a one-tooth cantilever for full-arch, implant-supported, screw-retained zirconia bridges. This is a proven alternative that involves fewer implants, more retrievability, less grafting, and shorter treatment times than a cement-retained implant bridge. The option of a cement-retained porcelain-fused-to-metal bridge does not offer reliable retrievability and often requires extensive bone grafting for the same result. When a strategy is created for a plan, the latest techniques and materials must be considered.