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Optimizing Predictability in Implant Dentistry

Diagnostic and Treatment Technologies

As the interest and demand for dental implants as the procedure of choice continues to grow ... so too does the number of implant failures grow, more or less keeping pace with the number of patients undergoing implant surgery.

Technology leaders in the industry remain focused on improving resources that can enable dentists, periodontists, oral surgeons, prosthodontists and other implantologists to actually improve the quality and long term value of implant treatment at levels that weren't possible just a few years ago.

Nobel Biocare and Materialise are two such companies that, through bioengineering and applicaton of CAD/CAM technologies, have been able to assist doctors in developing and performing dental implant treatment plans with near phenomenal accuracy.

Technology Coalescence

Many dental practices and specialty practices that focus primarily on implant surgery are combining more and more technologies that will continue to accelerate the public's acceptance and agreement that dental implants are indeed the Gold Standard of Tooth Replacement.

No Bone Loss No Grafting
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No Jaw Bone Loss Extractions
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A tooth extraction device that first emerged in Germany and used by only a knowledgeable few dentsits, is now being distributed in this country. Called the Easy X-TRAC System, it uses a unique approach to extracting teeth that can result in zero bone loss in many cases.

Atraumatic tooth extractions including the Ogram Method of tooth removal are being discovered by more and more dentists and surgeons to offer the sensible method of removing teeth that can eliminate or minimize the need for bone grafts... that the public oftentimes commonly associates with all extractions.

Jawbone expanders or ridge expanders are specialized instruments used by some implantologists and specialists that can prepare an individual implant site more efficiently than routine implant drilling sequences. Specialized bits are gently hammered into an implant site, simultaneously creating a space for the implant device while significantly compressing the cellular structure of the jawbone material itself.

Osteotome Ridge Splitting Expansion
Click Picture to watch Bone Expansion
The use of expander tools, in most cases, eliminates tissue damage that can be caused by overheating of drill bits, improves overall osseointegrative properties between the bone and implant device, possibly eliminate the need for supportive bone grafting.

Unfortunately, relatively few implant surgeons and implantologists have access to and are skilled in bone expansion treatment modalities.

Puros Allograft Ossix Membrane Surgery
Click Picture to watch Puros Allograft Bone Grafting

Bone grafting, therefore, is the most common and popular procedure, one that patients typically associate with dental implant site preparation.

Lastly, bone expanders have a very beneficial impact on the preparation of maxillary bone tissue where bone porosity is typically higher, as compared to the mandible, or lower jaw. This porosity issue can also be a factor for certain types of patients since there are known differences in bone mass between men and women... within cultures and across certain cultures.

Bone Compressing Implant Hybrids

NobelActive Site Prep
Click Picture to watch drilling animation

Nobel Biocare and Ocobiomedical (creators of the o-rings for denture implants) have eac developed a new implant device that auto-compresses the bone tissue in the immediate treatment area as the implant is being inserted.

The grooves of the implants are etched (both are patented methods) to specifically stimulate the osseointegrative process that dramatically increases the stability and durability of the implanted tooth (teeth).

Osteocompressive Immediate Function Implant
Click Picture to watch animation

In contrast to the drilling sequences used for standard implants, the NobelActive and the Ocobiomedical Osteocompressive prepare a smaller diameter opening in the jawbone.

Both implant devices are steeply tapered and have deep self tapping thread design that automatically compresses the bone tissue as the implant is slowly torqued into position.

Diagnostic and Virtualized Treatment Planning Software

Specialized computer software applications that have existed for years and years within the field of Medicine have been adapted for the Dental Industry. Common CatScan technologies that revolutionized medical surgery are now available for dentists and dental specialists.

Virtual Treatment Plans
Click Picture to watch Virtual Treatment Planning Software Demonstration
Materialise, creator of the SimPlant system, takes the best advantages of 3 Dimension Imaging, enabling doctors to diagnose, assess and locate the best implant sites for nearly any given patient, assuming jawbone integrity has not be radically compromised. Specialized implant devices are paired with each unique implant site. Certain surgery technologies offer patients varying degrees of minimally invasive

Similarly, Nobel Biocare, creator of the NobelGuide, utilizes custom imaging software products that enable doctors and their patients to Virtually Plan needed treatments that include precision levels of assessment and site preparation that are practically impossible to achieve without the technology. Nobel Biocare also provides a full line of implant devices and restorative products that are selected based on the location of the implant and its anticipated load factor.

CatScan Technology Leap Frogging

Galileos Imaging
Click Picture to watch Galileos Cone Beam Scanning Video
More recent developments in Digital Imaging equipment are now making medical and dental diagnostic assessments even more precise that are enabling doctors from several fields of Medicine and Dentistry to provide corrective surgeries that couldn't be performed just a few years ago.

Cone Beam scanning equipment, in contrast to the traditional CatScan apparatus we are all familiar with, can now produce digital "slices" that are a fraction of a standard Cat Scan slice. Idiosyncratic changes in tissue structure and integrity can now be "seen"... digitally ... and be prepared for treatment.

ICAT Cone Beam catscan
Click Picture to watch i_Cat Cone Beam Video
Sirona, developers of the Galileos Cone Beam apparatus and another developer, i-CAT from Imaging Sciences International have created technologies that are having a rock solid positive impact on diagnostic capabilities, increased choices in surgical treatments and the overall outcome of practically all interventions that incorporate digital imagery and virtual treatment planning.

Dental Implant Failure

Dental implants can fail for a variety of reasons. Many of the advanced diagnostic technologies outlined above help oral surgeons, implantologists, periodontists, prosthodontists and other implant dentistry practitioners gain an objective advantage to better control the incidence of failures.

Implants can fail, nonetheless, in the healthiest bone tissue imagineable. These failures are usually a function of how well an implant device becomes integrated with jawbone tissue. Bone porosity (density) and healthy blood supply are significant criteria for predicting success. But, other factors can interfere with the customary 3-6 month (or more) period alloted for osseointegration to become complete.

Measuring - Monitoring Osseointegration: Scientific Objectivity

A fairly new technology exists that implant specialists rely upon for assessing and monitoring the osseointegration process of one or several implants. Health issues, eating habits and other seemingly inexplicable factors can interfere, prevent or possibly reverse the osseointegration process.

Ostell Mentor has developed a device that utilizes Resonance Frequency Monitoring to generate accurate technical data based on the pulsing charactersistics of the monitoring device. Noninvasive and requiring only 2-3 seconds to administer, data patterns are generated that measure bone formation, changes in bone height, degree of osseointegration and bone stiffness.

In general terms, the Ostell Mentor essentially provides objective technical data that "indicates" when osseointegration is complete and the implant(s) is ready for final restoration with crowns, prosthetics, etc.

Doctors and practices that have adapted the use of this innovative technology now have opportunities for monitoring and intervening, where indicated, to assure and/or promote the long term endurance that dental implants are known for. Reliance upon older inaccurate assessment methods is not required.

In some instances, patients who have been declared non-candidates for implant surgery may have new opportunities avialable to them with this digitized assessment device.

Implications for Implant Dentistry

The Galileos and i-Cat technologies are gaining rapid acceptance. While many scanning centers routinely make these technologies available to all medical and dental practioners, there are some individual practices that are purchasing their own equipment. Size, versatility and ease of use (as compared to a bulky CatScan chamber) of these technologies are an attractive feature that appeals to everyone, including the doctor AND the patient.

Ostell Mentor Photo
Click Picture to watch demonstration Video
Assessing bone mass in individual jawbone structures is accurate and quick. Compromised bone and loss of integrity is mapped out... assisting dentists and doctors in either selecting the healthiest areas for implant treatment or to select areas that would benefit the most from augmentation treatments for otherwise compromised upper and/or lower jawbones.

Having access to new assessment standards for measuring, controlling and influencing factors involved with healthy implant integration (osseointegration) for single or multiple implant sites can have untold beneficial impact on treatment planning.

New Treatment Opportunities

Patients who have access to these new technologies may discover they have treatment opportunities that might have been denied to them just a few years ago.

The ability of individual dentists and dental practices to offer these near compelling services are a function of training, experience and the number of investments necessary (financial and additional training/certifications).

Patients with unusual treatment needs that might benefit from any combination of the newly developing technologies will probably have an easier time locating good resources in larger metropolitan areas as opposed to smaller communities.

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