A systematic review was performed on studies investigating current issues in implant dentistry. The Journal of Dental Research and Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology were searched from 2004 to 2010 using ScienceDirect. Criteria for inclusion included: (1) studies of implant placement; (2) observations regarding permanent dentures; (3) data considering bone-to-implant healing; and (4) results of implant procedures in elderly patients. This electronic search of the literature yielded over 2,000 abstracts.
Recently published papers revealed the importance of significant bone-to-implant contact as well as positive implant surface roughness. Successful implant placement; that is to say, osseointegration, increases with the use of bone growth factors, as well as various surface treatments. The studies selected indicated that, among both patients and professionals, dental implants are often the preferred method of treatment. From replacing a single tooth to allowing the placement of full dentures, evidence-based research in implantology has led to both an ever increasing number of treatment options, and longer lasting results for dental patients. Introduction to Implant Dentistry As a profession, the practice of dentistry goes back as just as far as the practice of medicine. Dentistry itself can be thought of as a specialization of medicine – dealing primarily with the oral cavity, jaw, and neck in a manner similar to many medical specialists. The practice of implant dentistry, on the other hand, is rather new – and is based in a tremendous amount of evidence-based research. From an outcome perspective, implantology is the most predictable of dental procedures.
The usage of dental implants was performed in the US as early as 1950, but it was not until the 1980’s, with the discovery of the ossification potential of titanium, that implants became a staple of dental specialists. Implant technology is invaluable to the millions of baby boomers with periodontal disease or other dental problems who desire never to fumble with uncomfortable dentures or adjust to an uncomfortable bridge. It is for these reasons that Implant Dentistry has been of ever increasing importance to the dental profession. The usage of
Dental Implant Systems is quite unlike many other areas of dentistry insofar as that there has been a great deal of research into all aspects of its practice. Imaging technology, materials research, and new instrumentation have streamlined the progression from diagnosis to treatment to such a great degree that outcomes are typically predictable and successful. In light of the relatively recent nature of Implant Dentistry’s appearance on the scene, its evaluation with respect to the future of the dental profession is due. Past For as long as mankind has been in existence, so too have teeth.
Throughout a lifetime primary teeth emerge and are lost, by permanent dentition. Implant dentistry, the replacement of permanent dentition, finds its roots in the advances in metallurgy of the late 1800s. Gold and Platinum, as well as porcelain were all used in attempts to anchor implants to the Jawbone. Titanium, the metal around which implant dentistry is built today, was first used in the 1980s. A Swedish surgeon, Per-Ingvar Branemark discovered that titanium could anchor to bone predictably, without causing inflammation or serious rejection risks.
This pioneering discovery paved the way for implant dentistry based around osseointegration. Implant systems today, revolving around the usage of titanium screws as dental implants, are based in the discoveries of Branemark. Within the past twenty years, the science behind osseointegration has been mastered to such a degree that everything from success rates to average recovery times can be known. Other relatively recent improvements, including changes in surgical techniques and advances in bone grafting have even more greatly improved the art of Implantology.
Medical imagining enhancements and the development of new implant products keep the practice growing at a pace for the 21st century. The research and technology that makes implants both safer and longer-lasting exists on the open market today. Present Today, technology and discretionary spending by baby boomers are responsible for the remarkable growth of implant dentistry in the last 10 years. Baby boomers will be the richest senior-citizen generation in our history, and the implant business, like all others, is driven by the power of the dollar. While demand for implants is surging, the demand for the standard procedures or a geriatric population is not sustainable. The market will adjust and dentists today must prepare for future trends. Although possible today, it is unlikely that 10 or 15 years down the line any practice will be easily maintained revolving around implants alone. The high per-capita wealth, and relative abundance of the age group mean that business models based around their existence will be futile ten years down the road. The next generation to be in need of dental care, those born in the late 60’s and early 70’s benefitted from better pediatric dental care.
The overall incidence of periodontal disease and tooth loss should be lower, compared to that of the baby boomer generation. A long term plan for the future must be based in the short term implementation of a multitude of implant-based procedures. Therefore, implant dentistry should become a regular service in a general dentist’s office. This mainstreaming of the implant business will allow general practitioners access to individuals in need of one, two, or even three placed implants – a need which typically arises out of necessity as the result of an accident or injury.
Though the overall market for implants will shrink, the core demand will not. Implants are now widely accepted by dental practitioners and patients as superior to bridgework and other procedures to replace missing teeth. As a result, the investment in new technologies and products will continue by implant companies. Today there is no other discipline that can boast the ability to replace a body part to perfection as implant dentistry. Implants are predictable, life-long replacements which, even if damaged, can be fixed with relative ease. Comparing the lifetime of a dental implant to that of a hip or knee replacement is illuminating.
There is no reason why an implant might fail, but both knee and hip replacements usually last about 15 years. In the future, implant technology and bone growth factors will advance the profession even further. Research There are several realms within dentistry that are in one way or another connected to implants. Even research not directly connected to the procedures related to implantology is revealing. Older patients today experience a great increase in their overall quality of life after being exposed to the benefits of implant surgery. A transition from removable entures to implant dentures allows the elderly to eat more ‘normally’ as well as more nutritiously. New research today revolves around both materials and bone growth factors. Longitudinal research is also especially applicable to implant dentistry, as it based in the reactions of bone to foreign materials. Technology Surface treatments and nanotechnology that improve the rate of osseointergation are shaping the future. These changes are exciting but they also present a problem as new implant designs and surfaces often are clinically untested by manufacturers.
Long-term research and clinical use will help make these products more predictable. It is in this way that manufacturers earn trust amongst dental professionals. General Practice Until relatively recently, primarily oral surgeons were the ones placing dental implants. It wasn’t until the late nineties that periodontists began placing implants as well. Today it is the general dentist who places, by a large margin, the majority of dental implants. Interestingly enough, the training necessary in order to perform a dental implant is rather reasonable.
The American Association of Implant Dentistry believes that after 300 hours of didactic training, as well as additional clinical instruction, both general dentists and specialists should feel comfortable, and well equipped enough to place dental implants. Implantology is thus relatively accessible to all members of the dental profession. Specialists The origins of the placement of dental implants lie with the oral surgeon. A surgeon by profession, the future of advanced procedures in implant dentistry lay with the specialists.
As with all of dentistry, the more challenging cases are often referred to those who specialize in a particular aspect of dental medicine. In particular, the placement of permanent dentures is unlikely to be often performed by general dentists. Requiring the placement of either four or six implants at the same time, precision is required during surgery, as is a great deal of monitoring of recovery. Although it is unlikely that specialists will be able to maintain practices built around implant dentistry, it is probable that the art of implant placement will continue to be an integral part of any advanced and pecialized practice. Future The introduction of titanium implants to those practicing implantology could be considered the development with the most gravity of the past 20 years. Titanium integrates with bone very well. Titanium implants are used in order to assure an excellent fusion of bone to the surface of the implant. Ever improving designs and the emergence of bone grafting materials have enabled dentists to treat an ever increasingly large patient pool. Many patients who are treated today would have never been considered as successful candidates for dental implants.
The success rates and overall predictability of implants have allowed huge advances not only in placement, but in recovery as well. Current research in dental implants has even carried over to the medical practice of orthopedics. Implants As the placement of dental implants becomes more and more mainstream a procedure, it will be integrated into the practices of more and more general dentists. Patients will in the future be able to rely on their family dentists to perform more and more involved services and treatments.
Although implants may eventually become the bread and butter of a general dentistry practice, the relative decrease in population of high-worth geriatric patients could again push patients toward more mainstream procedures. It is more likely that a general dentistry practice will gravitate toward single-tooth replacements. The unique size and financial well-being of the baby boomer generation has helped spur tremendous implant growth. Thanks to evidence-based research done primarily for this patient pool, many benefits may be afforded to another group entirely.
The benefits of implants should appeal to a younger generation of professionals, ever more conscious of appearance – even defining themselves by their aesthetic characteristics. The emergence of cosmetic dentistry as an economically viable field is owed, in a large part, to this fact. Today both men and women look to plastic surgeons for a variety of procedures. The fact that appearances are important to this demographic indicates that aesthetic dentistry will greatly appeal to them, when a procedure is necessitated.
Even today, part of the aesthetic makeover desired by many thirty-somethings includes veneers or implants to achieve a nearly perfect smile. The locus of oral-health and cosmetic surgery lies in the work of the Implant dentist. Functionality alone is seldom the lone motivator in the desire for partial or full-mouth implants. Many patients, adjusting from dentures, are now able to chew certain foods and thus enjoy a better quality of life thanks to dental implants, but this relatively modest improvement is often considered a side benefit to either the convenience or aesthetics of ever-present implants.
Elderly patients are likely elated when they are finally rid of the bridge that never fit right or the discomfort and embarrassment it could have caused. For this reason, both dental professionals and patients must plan to approach implants as the manifestation of a discretionary spending decision. In the future, bonding, bridging, and splinting teeth will continue to exist for they are the most effective means of maintaining a low cost to functionality ratio. Implants will continue occupy a middle-ground between vanity and convenience – two excellent motivators for a patient with disposable income.
It is unfortunate that even though patients today enjoyed relatively effective pediatric dental care, many still consider the entirety of oral health to be a luxury rather than a necessity. This is understandable when the work of a dentist is compared to that of a medical specialist. Cardiologists make life and death decisions, and this fact strikes a chord with patients much more than the dentist who aims to strike fear into the heart of the patient who may eventually suffer from periodontal disease. When a bone is broken, patients have no choice but to confront the issue.
The same cannot be said for a tooth with a dead nerve in a state of decay. Almost everything done by general dentists, and even most specialists, is not a service performed as an essential healthcare expenditure. Dentists will continue to perform primarily noncritical care with the aim of fixing or preventing acute problems as well as providing restorative and cosmetic improvements which support the preferences of patients. The implant market today is growing due to the greatly increased success rates of implants. Patients who are told that they require a root canal have several options.
The cheapest procedure is simply to have the tooth pulled. This is common amongst members of lower socioeconomic status. The standard procedure is the root canal itself. A premium procedure, likely to appeal to patients with a lifetime ahead of them, lies with the dental implant. It is a more permanent solution that is often times more successful as well. A single-tooth implant is recognized today as the best means of replacing a tooth. Gone are the days when a three-tooth bridge is considered king. Candidates for root canals today often prefer to remove the tooth and get a bridge or implant.
Patients are ever-more informed of the variety of pros and cons of dental procedures thanks to information readily available on the internet. Assuming successful osseointegration, the dental implant has no possible eventual downfalls. More and more patients therefore are opting for the implant, a procedure which is more aesthetically pleasing, more effective, and more successful in the long term than any other dental procedure. A bridge, for example, requires the modification of the anterior and posterior teeth to which the bridge itself will be bonded.
In the future, more and more patients will opt for implants over bridges due to a desire not to cut down healthy teeth Sole-Provider Dentistry Competition within the dental profession has driven many to invest a great deal of time and money in recruiting patients and maintaining positive patient-provider rapport. In order to serve more and more patients, dentists today must market themselves as providers. Accepting patients’ dental insurance plans is another means of establishing or maintaining relations. The trend in the past was for general dentists to perform fillings, root canals, and bridges.
Today this is changing, and the future of dentistry will lay with the effective integration of a wide range of services into a general practice, rather than simply writing a referral to a specialist. With dentistry in particular, patients prefer to stay with the dentist with whom they grew up. For this reason, a provider capable of performing a multitude of novel procedures benefits patients with easier access to care, as well as benefits directly, thanks to the ability to perform more complicated and more profitable procedures more often.
In order for this transition to be possible, dental implant companies today often offer courses and training in order to familiarize general dentists with these novel procedures. Simple exposure shows that patients today have more options than ever before. That being said, in order to actually perform implants, a great deal of continuing education is required. As dental education changes, allowing young graduates to focus on what once used to be only specialty training while still in dental school, many graduating dental tudents will be able to offer more than dentists from even ten years ago. This increased earnings potential helps keep dentistry an ever-changing profession. For those who studied implant dentistry early, the immediate future looks quite good. Improving technology may soon outpace what is needed by a dental professional. Digital imaging for example, although useful to dental professionals when compared to radiographs, may not be incredibly valuable to the public. Procedures performed today can be done without the luxury of digital imaging.
In convincing a patient to opt for a dental implant, this is where digital imaging has been instrumental. Computer-manipulated images, highlighting, and likely scaring, patients regarding issues in oral health, is not always beneficial to the patient. Instead of building up the luxury aspect of the experience of getting an implant, a better option lies in aiming to keep the overall cost to perform an implant low – patients could greatly benefit from an implant at the cost of a three-unit bridge.
Technology drives up the price difference between procedures, and in order for implants to remain a common procedure, they must be in demand by patients. The price difference, driven by the integration of technology, pushes patients on the fence about implants toward opting for bridges or root canals. It is for all of these reasons that the future of implant procedures will be performed in the general dentist’s practice.
Following all other dental procedures, the difficult cases will continue to be referred to specialists, but for patients needing single-tooth replacement, the prospect of the procedure being performed by a family dentist grants the possibility of greater outcomes to the ongoing oral care of the patient. Implants are at the core of the future of dentistry. The economics of the procedures will change as it becomes more commonly available, but their usefulness will continue as the most effective long term solution to many problems in oral health.