Part 1: The “Sense” of Implants for the General Practitioner
Mark A. Iacobelli, D.D.S.,
F.A.G.D., F.I.C.D., M.I.I.F.
Twenty years ago, when my exposure to
implantology was in its infancy, implants
were viewed as experimental at best. I was
constantly reminded that implants “don’t work” by my peers as
well as by patients. It is a constant amazement to me how,
through education and marketing, the pendulum has swung
into favoring dental implants. Currently implants are riding a
huge wave of acceptance not only in the dental community,
but also by the dental consumer. Patients are now routinely
inquiring about dental implants as a part of their desired
treatments.
At first glance, this good news of acceptance provides us better
alternatives for replacing missing teeth. Fortunately for
general dentists such as myself, it goes much deeper than that.
In order to understand the true benefits of this acceptance, one
must remember that potential implant patients fall into two
categories; those who are already missing teeth and those who
will be missing teeth!
For dentists who are considering becoming involved with
placing implants and for novice implantologists, some patients
who are already missing teeth present with unpredictable
implant sites and more difficult diagnoses (Is the maxillary
sinus too close? Is there enough bone to place the implant
above the inferior alveolar nerve? What happened to all of the
attached gingiva? Is the bone wide enough to accept the
implant?). This unpredictability is the main reason general
dentists might shy away from learning to place implants and
these are the same concerns of most new implantologists as
they move ahead in their education.
Complicated cases likely should still be referred to a trusted
specialist, but increased knowledge about the diagnosis and
treatment in planning these types of cases will remove many of
the uncertainties about implant dentistry to your patients.
This will lead to greater treatment acceptance for your general
practice.
Tooth #30 has been endodontically treated, hemisected,
and treated with individual crowns on each root.
Note the lingual fistula on the mesial root.
Conversely, let’s get back to the implant patients who will be
missing teeth. This is significant for all general practitioners
who have ever gotten the emergency patient call stating that
their crown has “come off.” Undoubtedly, the patient presents
(usually late on a Friday afternoon!) with the crown, buildup,
and probably some natural tooth in hand. Now comes your
moment of truth. Do you assume the role of “Super-Dentist”
trying to retrofit the crown over no remaining ferrule, while
hoping that the patient pays their bill and never returns to your
office for fear of the “crown falling off” again? Or, do you begin
the educational process, based upon science and predictable
results, to guide your patient through understanding the
problem that they have?
The education begins with showing the patient how the lack of
remaining tooth structure makes any dental heroics
unpredictable and economically unsound. We all need to
respect the fact that even in a perfectly balanced occlusion, the
prognosis of that “tired tooth” rebuilt with endodontic
treatment, posts, cores, pins and crowns, in the absence of
remaining natural tooth structure (ferrule), will in fact fail. It
is just a matter of time. Once the educated patient accepts the
futility of “the old standard of care,” they are now more open
to understanding the “new standard of care”-dental implants.
There is no better way to care for our
patients than by creating implant-ready
sites by treatment of a patient’s
emergent need.
As the primary dental care provider, the general dentist is
perfectly positioned to not only make the diagnosis, but to
educate and treat the patient to completion. Once the
treatment has been accepted, the hopeless root (with no ferrule)
is atraumatically extracted. If both the buccal and lingual
walls remain intact, simple socket preservation techniques can
be utilized so that in three to four months the general dentist
now has “created” an optimal implant site. If pathology or less
than traumatic extraction leaves you with a compromised
buccal or lingual boney plate, then socket augmentation is
performed, and an optimal implant site is available for implant
placement in four to five months.
There is no better way to care for our patients than by creating
implant-ready sites by treatment of a patient’s emergent need.
As patients in my Expanded Services Dental Practice have
found, dental implants now are a very realistic tooth
replacement option for them. Through my own education, as
well as the education of my Team and my patients, implants
have become not only a regular topic of discussion in my office,
but also a regular course of treatment for my patients.
In the next issue of Sidekick, you can read my article discussing
“The “Cents” of Implants for The General Practitioner,” i.e.,
the financial impact of the above-mentioned techniques on
your bottom line.
Quadrant after extraction of #30, socket
augmentation, and implant placement.
Mark A. Iacobelli, D.D.S., graduated from Case Western Reserve
University School of Dentistry in 1982. Since then, he has achieved
and maintained his Fellowship with the Academy of General
Dentistry by completing numerous hours of continuing education. This
continuing education has been highlighted by completing multi-year
programs in orthodontics, neuromuscular and TMD treatment for jaw
and head pain, esthetic and cosmetic dentistry, implant placement and
restoration, and a one-year program for conscious sedation (intravenous
anxiety control) with Advanced Cardiac Life Support. In addition to
being recognized by The Straight Wire Orthodontic Studies
Organization for his commitment to continuing education for
orthodontics, TMD treatment, and neuromuscular dentistry, he has
also received his Fellowship from the International College of Dentists
and The Midwest Implant Institute. Dr. Iacobelli is currently the
president of the Midwest Implant Institute Fellows, and maintains a
private practice in North Royalton, Ohio.
Learn more about the techniques discussed in this article by attending
an Introductory Implant course sponsored by Henry Schein and
Camlog. Dr. Iacobelli and other clinical educators offer courses
nationwide to increase your knowledge of Implantology. Contact your
Henry Schein Dental Field Sales Consultant for more information.
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