We've Come a Long Way
Dental implant therapy has come a long way since its inception. As a general practitioner, I've been fortunate to have been exposed to it since the beginning of my career. I remember watching my old partner, Paul Polydoran, DDS, place blade implants before they were being taught in dental school. The process involved creating a trough in the bone with a high-speed bur on an air-driven handpiece and then tapping them into place. When root-form implants came around, education for the GP was still hard to find. Fortunately, that is not the case today.
It's become a controversial issue for some, so let's address the elephant in the room: there is nothing inherently wrong with GPs placing implants if they are placing them to the same standards as a periodontist or an oral surgeon. Some of those blade implants that my partner placed are still functioning 40 years later. Although implant procedures have become more technology-driven, and we do things a lot differently now, he had success with those original protocols because he performed them correctly.
With the advent of CBCT, digital planning, and guided surgery, implant placement has become much more efficient and predictable, which some have translated into "easier," and therein lies the rub. Just because the protocols have become less technique-sensitive, doesn't mean that you need less training. These less technique-sensitive protocols involve more technology and actually require more complex knowledge to execute, which necessitates MORE education and training, not less. When dental implant science was still nascent, osseointegration was considered the endpoint for success. Today, implant success is determined by esthetics, and the treatment planning is driven by the restoration, top-down, so if you don't know it all-don't do it.
Now, that being said, the recent advances in implant therapy are almost too numerous to count, and there's more than one way to roof a house. When a patient is considering an implant, you might want a CBCT scan, bone grafting, a 3D-printed surgical guide, and immediate provisionalization; however, if the patient's finances are limited, you may have to adjust to accommodate. Printing surgical guides in-house can reduce costs, and the guide can be eliminated altogether in some situations, such as in an uncomplicated immediate extraction site or when the clinician employs navigated surgical techniques. Depending on the individual clinical scenario, there are many different protocols for implant delivery that the clinician can employ, as long as he or she is fully trained in the technique, including the potential complications, and properly manages the occlusal forces.
Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa
Department of Operative Dentistry
University of Iowa, Iowa City, Iowa