Jessica Maguire delves into implant dentistry, and explains what you need to know to get into the discipline.
Implant dentistry is a field that I never really imagined I would end up in. I couldn’t be happier that I did. At undergraduate level, implantology was not a topic that featured heavily, if at all, on the curriculum. My knowledge when I became a GDP was very minimal. I left university thinking substantial bone loss meant implants were not a treatment option for you. How wrong I was!
Implant dentistry – a brief history
Tooth loss as a result of disease, trauma, failure to develop and the adverse consequence of dentures is common. Implant dentistry has transformed the prosthodontic options available. Implants are now a recognised treatment for partially dentate or edentulous patients (Searson et al, 2005).
In the 1960s and 1970s, implant-supported prostheses based on subperiosteal or blade implants had a poor reputation. This was due to questionable clinical outcomes and lack of scientific documentation.
The change to a scientifically sound discipline was initiated by the two scientific pioneers of modern implant dentistry: Professor PI Brånemark from the University of Gothenburg in Sweden and Professor André Schroeder from the University of Bern in Switzerland.
They laid the foundation for the most significant development and paradigm shift in dental medicine.
Improvements
The development of bone-augmentation techniques, such as guided bone regeneration and sinus floor elevation to correct local bone defects at potential implant sites, has increased the indications for implant therapy.
The paradigm shift to moderately rough implant surfaces resulted in faster and enhanced bone integration. It led to improvements in various treatment protocols.
This included immediate and early implant placement in post-extraction sites. This has made various loading protocols possible – including immediate and early implant loading.
In the past 15 years, preoperative analysis and presurgical planning improved as a result of the introduction of three-dimensional imaging techniques (Buser, Sennerby and De Bruyn, 2017).
Implant dental treatment combines surgical, prosthetic, restorative and aesthetic skills to provide patients with a fixed solution for their missing teeth.
Hopefully, in the not-too-distant future, this will make dentures a thing of the past. The continued success of implants may challenge many more conventional approaches to dental care.
How I got started in implant dentistry
After a couple of years working as an associate, and having a particular interest in oral surgery, I decided to embark on an implant course. This was a year-long certificate course under the mentorship of Hilt Tatum, the pioneer of the sinus graft procedure.
Still to this day, at nearly 90 years of age, Hilt lives and breathes anything relating to implant dentistry. His passion and wealth of knowledge were incredibly inspiring and, after completing my certificate in 2014, I knew it was the area of dentistry that I wanted to work in.
I subsequently embarked on various other courses and seminars and loved the surgical aspect involved with implants. However, I learnt that surgical skills are secondary to prosthodontic and restorative knowledge.
In 2018, I visited Evodental to observe the team over the course of a day and my mind was well and truly blown. The company was using top of the range technologies, providing patients with fixed full jaw rehabilitation treatment all in one day as a result of being vertically integrated.
Full arch treatment is all that is carried out at Evodental – it doesn’t offer single or sectional work at all. It is constantly striving to be the best in this field. I instantly knew that I wanted to be a part of the Evo team so that I could provide this life-changing treatment to patients every day.
One year later, in 2019, I was fortunate enough to join the Evodental team. Even now, in 2021, I am still in awe of the multidisciplinary team that I work with; having lab technicians and a digital design team on site makes for a fantastic, collaborative environment.
How we do things at Evodental
Following a successful triage, our patients attend a comprehensive full clinical assessment. That includes a cone beam CT scan and thorough medical history check. If they are deemed to have a terminal dentition, and opt to go ahead with treatment, we then discuss their treatment plan. We discuss how we’ll carry this out using our digital workflow – in detail at our weekly multidisciplinary team meetings.
Insufficient bone is, of course, a factor that must be taken into account during this planning phase. However it is very rare that we would not be able to treat a patient due to this. If our traditional methods of placing implants in the premaxilla and pterygoids isn’t possible, then zygomatic implants would be our next choice.
Our patients attend early in the morning on the day of surgery and are taken to their own dedicated suite. It is at this point that patients have the opportunity to review their treatment plan. They can ask any final questions, ahead of treatment. Post-treatment, their dedicated suite is where they’ll recover following surgery and wait while their prostheses are milled.
If the patient is suitable and has opted for both jaws to be treated, this is done during the same visit. This involves extracting the patient’s hopeless dentition before carrying out thorough degranulation of the extraction sockets and alveoplasty, if required, to ensure sufficient prosthetic space.
Four to six implants are placed in the maxilla (to include pterygoids) and usually four implants are placed in the mandible. We always aim for our implants to be bicortically fixated to ensure great stability.
Review and Maintenance
While the patient is resting in their suite, the design and technical teams get to work. They create their first set of prostheses, which they will leave with that very same evening.
Six weeks after this is the patient’s first review, along with a soft tissue capture. This ensures that they’re healing as planned ahead of their advanced fit. This stage happens 12 weeks after their day of surgery fit. At this point we check to ensure the integration has gone as planned. That the patient has fully healed and is happy with their final prostheses.
We’ll then see the patient for maintenance appointment. The frequency of these is based on our risk assessment with one per year at minimum. We know that nothing lasts forever though. This is why we make it clear to patients ahead of treatment that revision surgeries or repairs may be required throughout their lifetime.
Getting started
So, how can you get started in implant dentistry? Firstly, time and effort reading books and research papers, or listening to lectures, will give you the knowledge of implantology that you need but without hands-on experience it is simply not enough.
Enrolling on a good quality, practical course that requires high levels of delegate participation is the best starting point. Going into this though, ensure that you have excellent knowledge of surgical anatomy and how to carefully manipulate soft tissues. Occlusion often gets overlooked. However, it’s a major risk factor for implant failure if not fully understood. Taking the time to improve your occlusal knowledge will stand you in good stead for all areas of dentistry, not just implantology. Remember though, even after you’ve attended your first course, this is only the start of your implant journey.
Invest in yourself to reap the rewards. Purchase the tools you will need to provide the best results. You will feel confident knowing you’re creating predictable outcomes for your patients.
Learning how to critically appraise any research papers to know which are providing you with gold standard evidence is a very useful tool to have. With rapid advances in this field, you want to know that you are investing in the right gadgets and materials with a strong evidence base behind them.
Practice makes perfect
Once you have mastered the basics of implant dentistry, I would then aim to place as many single implants as you can alongside a mentor. Implant dentistry is complex and treatment planning is key to success.
Having an experienced clinician provide you with the answers to your many questions and being there to guide you through the process from planning, to placing and then restoring, will help to build your confidence to eventually go solo.
I’d especially recommend doing what I did when I first started too by observing some of the experts in the field. This will help you to gain so many tips and tricks of the trade. Most experienced dentists will be happy to help.
At Evodental, we are always happy to have dentists observe for the day as part of our Evo Experience. This is free of charge and is a great way to dip your toes into implant dentistry.
References
Buser D, Sennerby L, De Bruyn H (2017) Modern implant dentistry based on osseointegration: 50 years of progress, current trends and open questions. Periodontol 2000 73(1): 7-21
Searson, Gough and Hemmings (2005) Implantology in General Dental Practice. Quintessentials of Dental Practice, Vol 4. Quintessence Publishing, UK
This article first appeared in Dentistry magazine. You can read the latest issue here.
