EMBRACING THE REWARDS OF IMPLANTS IN THE GENERAL PRACTICE
Advances in materials, digital technology, and techniques enable general practitioners to optimize their success with implant restorations
The tiny implant has changed more lives and given more long-lasting comfort than many a complicated prosthetic masterpiece—and may last to infinity and beyond,” said Robert Korwin, DMD, MAGD, MICOI, who has a general practice in Middletown, NJ. Indeed, from restoring a single tooth to providing edentulous patients with long-lost function, esthetics, and confidence, dental implant procedures can be extraordinarily gratifying for practitioners and virtually life-changing for patients.
With increasingly sophisticated healthcare consumers now expecting implants as a viable and accessible option, finding a clinician to provide safe, effective, and affordable implant services can be easier said than done. And the prospect of traveling between the specialist who places the implants and the dentist who performs the restoration can sometimes turn prospective patients off to implants altogether. As a general dentist who’s placing implants, you’re already ahead of the patient satisfaction game. While “one-stop shopping” is certainly more convenient, the benefits reaped by your patients extend beyond schedules and logistics. At least as important are the comfort and security of knowing a service will be provided in its entirety by a dentist the patient already knows and trusts—the kind of dentist the patient will recommend to their family and friends. For those in search of a new dentist, clinicians providing more comprehensive services in-house are likely to go to the top of the list.
To the clinician, some benefits are self-evident—namely, generating more revenue and losing less to referrals; keeping current patients and attracting new ones; and growing the practice with a needed and potentially lucrative service. But clinicians, too, can experience some less tangible benefits, including an enhanced reputation, greater professional satisfaction, and perhaps even a renewed sense of enthusiasm.
Tracking the Transformation
“We dentists are legion for creating a new idea translated into a usable tool or technique almost every day,” said Dr. Korwin. Today’s technology, he explained, enables proper insertion torque in any bone type, and the careful and exact gliding of paths of insertion into the desired trajectory while avoiding mandibular nerve canals and neighboring root apexes. “The scan abutment, the calibrated torque wrench, and the digital implant library have made the frustrating and time-consuming process of capturing and designing accuracy almost like child’s play.”
Of course, making high-tech wonders seem like “child’s play” requires a willingness to learn and embrace such advances, both today and as your implant services expand.
Driven by the need for optimal implant placement, the integration of cone beam computed tomography (CBCT) with virtual placement planning and digital surgical guides has become the standard of care for increasing predictability, decreasing risk, and improving outcomes. Considered by many as essential for implant surgery, CBCT enables 3D visualization and assessment of the structures, volumes, and relationships needed for accurate planning and to prevent complications such as soft-tissue insufficiency, implant failure, and paresthesia.
Intraoral scanning is touted to greatly improve workflow and the patient experience by providing accurate and rapid direct-image acquisition without the need for physical impressions. Portable laptop, tablet, and desktop cart configurations allow for easy room-to-room portability.
It’s hard to imagine a more state-of-the art technology than 3D printing, and even the most seasoned of techies are taken aback by the ability to create 3D products from what are essentially pools of resin. But with CBCT and intraoral scanning images, coupled with CAD/CAM treatment planning software, a small but intrepid group of dentists is now printing precise quadrant and full-arch bone-, tooth- and mucosa-supported digital surgical guides in-office.
With manufacturers producing dentistry-specific desktop units with the same precision and reliability as their industrial counterparts, we’ve only begun to see the potential of this exciting technology, which many believe will soon be used to print increasingly complex and multi-material products. A decrease in equipment costs, easier incorporation into clinical practice, improved software and resin material quality, and the promise of simple digital workflows with increased ROI on digital scanners and software are providing the impetus for more clinicians to bring this technology in-house.
Driving these digital technologies is software designed to optimize workflow with a focus on predictable prosthetic-driven implant planning—all while becoming increasingly intuitive, and easy to use and integrate into practice. Today’s advanced software provides tools for evaluating bone quality, viewing modes that alert the clinician if placement is too close to neighboring structures, and even “digital tooth removal” to eliminate the need for rescanning in patients who have undergone extraction. Workflow is getting a shot in the arm with software that offers viewing of all imaging data, photos, and intraoral scanning data in a single platform, surgical guide design modules, extensive implant libraries, and open integrations with the flexibility to change workflows or manufacturers.
Another advancing area is the augmentation and regeneration required to overcome the obstacles to predictable healing and long-term results posed by bone defects and deficiencies. Increasingly biocompatible graft, ceramic, and growth factor-based bone substitute materials (BSMs) and polymers are being used to replace autogenous bone and expand autogenous grafts before implant insertion and at the time of placement. Combining or even hybridizing different BSMs in formulations such as powders, granules, pastes, blocks, and custom-manufactured grafts is enabling a wide range of resorption rates.
"Embrace the rapid speed of technological advance... If you ride along with it, it will challenge and enthrall you."
Robert Korwin, DMD, MAGD, MICOI
Alloplastic graft materials range from incompletely resorbed calcium phosphate-based ceramics and completely resorbed tricalcium phosphates, to the more reactive, silica-ion-releasing bioactive glass, which doubles natural bone regeneration when fully absorbed and mixed with autogenous bone graft material. Meanwhile, the need for a matrix can often be eliminated with a newer alloplastic material that is syringed directly into the defect.
During healing, mechanical stresses on the graft are being counteracted with guided bone regeneration and collagen membranes, titanium mesh, bone screws, and other fixation devices, while barrier membranes exclude undesirable cell types, create and maintain space, provide clot stabilization, and allow tissue integration.
“Of all the amazing leaps in reliability and comfort that dentistry has made, the titanium implant has radically changed treatment plan thinking,” Dr. Korwin told DPS. Not surprisingly, those implants are undergoing their own evolution. Increasingly diverse heights, diameters, and configurations enable more stable and precise placement in more areas, while accommodating differences in bone type and anatomy. Of special interest are implant surfaces with chemistries and topographies that optimize early tissue integration and long-term stability, shorten bone healing time, and improve overall osseointegration.
Education: A Lifelong Pursuit
Many would argue that the best clinicians are those who view learning as a lifelong pursuit. Whether you’re currently working on the lower end of the implant technology spectrum or are already taking on more complex cases, the take-home message is a simple one: Implant services can be a lucrative and gratifying “win-win,” but only when the providing clinicians are properly trained and educated. “When I learned to integrate ortho, perio, surgery, and restorative principles into every plan, I found myself able to deliver the longest-lasting, bestfunctioning and most appreciated treatment options for my patients,” said Dr. Korwin.
Conventional wisdom would suggest beginning with and mastering the simpler cases, staying within your training as your experience grows, referring out for cases beyond your expertise, and then moving on in complexity—all the while carefully perusing the literature, honing your skills, upgrading your knowledge base, and using standard-of-care technology.
Continuing education is as much an opportunity as it is a requirement, and is as close as the nearest computer or smartphone. A visit to the websites of dental schools, professional associations, and manufacturers will reveal an array of educational opportunities, from online tutorials and discussion groups to live streaming of procedures—all from the comfort of your office or home.
This level of convenience notwithstanding, there’s no substitute for academically or professionally sponsored “real world” meetings, which offer lectures, hands-on workshops, and the unveiling of brand-new products—not to mention the opportunity to pick the minds of world-class experts, share ideas with your peers, and return home with a renewed sense of purpose and inspiration. “Even if you absorb only one item per course, the logarithmic increase in your skill is worth many hours of perhaps less useful repetition and questionable lecturer jokes,” said Dr. Korwin.
“Embrace the rapid speed of technological advance,” Dr. Korwin concluded. “If you fail to do so, it will overwhelm you. But if you ride along with it, it will challenge and enthrall you.”
Dental Implants Continuing Education Resources
When it comes to implant education, there are many options for those looking for training or to elevate their craft. In addition to the courses taught by manufacturers and universities, here are a few other training opportunities to check out:
American Academy of Implant Dentistry: The AAID’s MaxiCourses provide the 300+ hours of CE necessary to fulfill the CE requirement of the Associate Fellow Member process of the AAID, positioning participants to become proficient in all aspects of implant dentistry. Courses include lectures from experts as well as hands-on participation.
International Congress of Oral Implantologists: The ICOI directs members to select university-based and private courses that it reviews to ensure they are scientifically based, free of commercial conflict of interest, and meet a high-quality educational standard.
Misch International Implant Institute: Developed in 1984 to help set and elevate the standard of care in implant dentistry using a hands-on approach, the institute's goal is to remain at the forefront of implant dentistry through research, education, and its unique clinical applications.
Dental Learning: Dental Learning allows dental professionals to stay updated with the latest advances in treatment protocols, products, and the services available to them. Numerous online CE courses are available on topics such as "Building an Implant Practice" and "Dental Implants: What, Where and Why."