3D and BMP. Those in the know think that these two tools—cone-beam imaging for diagnosis/treatment planning and bone morphogenic protein for more reliable regeneration procedure—have made the biggest impact on the practice of implant dentistry in the past few years.
Three implant dentistry thought leaders answered a few general questions about the current and future state of dental implant treatment. All three—Raymond Choi, DDS, Gregory Sawyer, DDS, and Gary Henkel, DDS--are not only in the trenches providing comprehensive implant services in their own practices, but each is also an educator and trainer. Here are some of their observations.
DC: What do you see as the most significant advancement(s) in implant dentistry in the past five years, specifically in terms of diagnostic and treatment planning technologies?
Dr. Choi: The availability of cone-beam CT-scan guided software,which drastically reduces the treatment time and duration with utmost accuracy and safety.
Dr. Sawyer: Three-dimensional radiography has dramatically improved treatment planning for implant placement. I no longer raise a flap only to find inadequate bone for placing screw implants. It is much safer to know exactly where the important structures are during treatment planning. Computerized treatment planning is now possible using the DICOM files created by a CT scanner to create a virtual model of the patient's bone from which to create a reasonable accurate surgical guide.
Dr. Henkel: Number one would have to be guided surgery systems based on cone-beam tomography.
DC: What do you see as the most significant advancement(s) in implant dentistry in the past five years, specifically in terms of implant system design?
Dr. Sawyer: The conical abutment interface is becoming more widely used in new designs. Studies have shown that there is less micro-movement of the abutment on the implant fixture with the Morse taper connection. The new designs have removed the polished collars, surfacing the implant all the way to the top. The aggressive apical thread designs are making immediate and early load more predictable.
DC: What do you see as the greatest obstacle(s) to making implant treatment more widely available?
Dr. Choi:The biggest challenge is GPs' lack of participation, and that is due to inadequate training and, in many cases, relying on outdated traditional treatment options.
Dr. Sawyer: Implants have radically changed prosthetic dentistry treatment planning. But there are still many GPs who don't restore implants, so they don't recommend them to their patients. Additionally, the public is not well educated on what implants can do to improve their lives, so they don't pursue implant solutions to their problems as often as they would if they only knew what implants could do for them.
Dr. Henkel: I think the biggest obstacle is the cost of dental implant treatment relative to other alternatives.
DC: Do you see the need for the creation of a board certified specialty in implant dentistry? Why or why not?
Dr. Choi: No, I do not because there really is not one specialty that can adequately cover the whole spectrum of implant treatments.
Dr. Sawyer: I can't imagine an implant specialty ever happening. The turf wars over who should be placing implants is bad enough without a specialty board to decide who can belong to the club.
Dr. Henkel:I’d like to see it, but it has been tried multiple times without success. I do feel implantology has specific nuances that requires very specific training.
DC: What’s the “next big thing” in implant dentistry? What’s the focus of current R&D?
Dr. Choi: Definitely bone morphogenic protein. Further research is needed in order to make this technology available at more affordable cost.
Dr. Sawyer: Bone morphogenic proteins for implant site development is becoming more affordable. I would expect that dentists will find new and unique ways to use BMP. Also, CT scanners are becoming affordable for dentists to put into their offices. Their use will grow as they become more widespread in our offices.
Dr. Henkel: More applications for using CAD/CAM technology, specifically the marrying of cone-beam CT with prosthetics, allowing virtual design and then CAM manufacturing of bridges, crowns, bars, and other prosthetic devices.
Dr. Raymond Choi maintains a private dental implant practice in Tustin, Calif. He is a credentialed member of the American Academy of Implant Dentistry and a Fellow of the International Congress of Oral Implantologists. He lectures and trains dentists domestically and internationally on implant dentistry.
Dr. Gregory Sawyer is in private practice in Los Gatos, Calif. He is a member of the California Dental Association, the American Dental Association, the International Association of Computer Dentistry, the Sleep Disorders Dental Society, the Academy of Laser Dentistry, the International Congress of Oral Implantology, the Academy of Osseointegration, and is a Fellow in the World Congress of Minimally Invasive Dentistry. He is a registered continuing education provider.
Dr. Gary Henkel is owner of the Pine Run Dental & Implant Center in Horsham, Pa. Dr. Henkel lectures and consults nationally and internationally on dental implants, 3D imaging, endodontics, and bone and extraction socket preservation.