Dental Implants in the Dental Practice, Part One

By Mark A. Iacobelli, D.D.S., F.A.G.D., F.I.C.D., M.I.I.F.

Tooth #30 has been endodontically treated, hemisected, and treated with individual crowns on each root. Note the lingual fistula on the mesial root.

The “Sense” of Implants for the General Practitioner

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.

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.

Quadrant after extraction of #30, socket augmentation and implant placement.

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.

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.