Dental Implant Guide: What you need to know about implant advances

May 10, 2013

Whether surgically placing or just restoring, many of you are getting more into implants. Here, we explain why and offer some tips to help ensure you’re successful.

Whether surgically placing or just restoring, many of you are getting more into implants. Here, we explain why and offer some tips to help ensure you’re successful.

More general dentists are integrating implants as a service they can offer patients, and it’s easy to see why they are capitalizing on this burgeoning market. Implants are on a steep upward trend, according to iData Research, an international marketing research and consulting firm that studies the dental industry.

It reports that, in 2011, the total U.S. dental implants market for dental fixtures and final abutments was valued at $754.6 million, while the dental prosthetics market hit $9.64 billion. Every segment of the dental implants market, as well as the final abutment and dental prosthetic market, experienced growth in that year except for inlays/onlays, as a result of the decline of the in-laboratory fabrication of inlay/onlays.

Driving the demand

U.S. demographic trends are bolstering the increasing demand for implants. The American Association of Oral and Maxillofacial Surgeons has found that 69 percent of adults ages 35 to 44 have lost at least one permanent tooth to an accident, gum disease, a failed root canal or tooth decay. Additionally, by the age of 74, it is estimated that 26 percent of all adults will have lost all of their permanent teeth.

Babyboomers, too, are accounting for the increased use of implants. They want to maintain attractive, youthful smiles and the dentures their parents took in and out of their mouths won’t cut it. At the same time, the attributes of cosmetic dentistry, commonly pictured on reality TV shows, have become a more accepted part of American culture, fueling patient interest.

For providers, improved technology makes implants easier to place. More dentists- with the appropriate education-are willing to delve into offering them.

No decline in site

The future for dental implants looks rosy, but the experts agree there are tips and strategies that general dentists should consider to successfully integrate the service into their practices.

We spoke with dentists who have practiced implant dentistry for decades to get their input and strategies on how to make implants a thriving part of a general dentistry practice. You’ll also find manufacturer-submitted tips and advice throughout the article, all designed to help you master implant care in your practice-whether you’re actually placing implants or offering treatment planning and implant restoration.

Training/education

Education, of course, is key to achieving competence in placing implants and making it part of a general dentistry practice. Fortunately, much has changed, including the availability of continuing education, in the 62 years since implants were first introduced. In the early days, implants had a dubious reputation among dental professionals, and dental schools even refused to teach about them, according to the American Academy of Implant Dentistry (AAID).

Dr. Joseph Orrico, of Illinois Implant Dentistry, has been placing implants for 34 years.

“I was ahead of the curve,” said Dr. Orrico, a past president of AAID. “There wasn’t a whole lot mentioned about them in dental school, and they didn’t have the continuing education courses they have today.”

Because of this, Dr. Orrico said he learned by doing. “You watched a few, you assisted on a few and then you went out and did them,” he remembered.

Dr. John Minichetti, of Englewood Dental in Englewood, N.J., said he was lucky to receive good oral surgical and periodontal training in dental school and during his residency before he started placing implants 30 years ago. He also received on-the-job training while working under a prothodontist/implantologist.

While training is more prevalent, technology is always changing, and both recommend keeping up on advances through CE programs.

“Implant dentistry is consistently evolving. The key to staying ahead is continuing education,” Dr. Orrico said.

Any general dentist interested in placing implants will need to evaluate the depth of training they require. Dr. Minichetti recommends a comprehensive course such as the MaxiCourse, offered through the AAID.

It provides 300 or more hours of lecture, laboratory sessions, live surgical demonstrations and home/office assignments, and is presented in 10 parts, once a month, over a 10-month period.

Certification

Implant dentistry is not a recognized specialty, but dentists can receive certification from AAID. (Dentists who graduate from an approved MaxiCourse will meet the minimum educational requirements for an associate fellowship.)

AAID offers an Associate Fellow Membership that has educational and experiential requirements, as well as a two-part examination. Candidates interested in the more rigorous credential of Fellow Membership must have practiced implant dentistry for at least five years, provide both the surgical and restorative phases of treatment, and meet the educational and experiential requirements for the examination.

Another certification is the Diplomate in Implant Dentistry offered by the American Board of Oral Implantology/Implant Dentistry.

Dr. Orrico said pursuing rigorous credentials establishes competence, as well as credibility, with your patients.

“It’s not a recognized specialty. Credentialing is all we have,” he said.

Patient base

The potential patient base for implants is broad, especially given the statistic that 26 percent of adults will lose all their natural teeth by age 74.

 

Dr. Orrico said 80 percent of his patients receive implant surgery or prosthetics at his practice. He acknowledges the name of his practice-Illinois Implant Dentistry-draws patients to his door who already expect they will need to replace a tooth or teeth.

“It’s how you market your practice. People come here knowing what we do,” Dr. Orrico said.

Dr. Minichetti said he reaches out to potential patients through a variety of means including his website, e-blasts to patients and other external marketing.

Specialist support

“Start easy.” That’s how both Drs. Orrico and Minichetti advise general dentists who are new to implants. They suggest handling simple cases such as single teeth extractions and referring more complex cases such, as impactions, to specialists. Dr. Minichetti said he tries to have a rapport with other specialists to whom he may refer. On occasion- for patients who want it-he will tap the expertise of an anesthesiologist who visits his office to put patients under.

Dr. Orrico said he does all his own surgery, and he hasn’t experienced any negative feedback from specialists in regards to his work. The patient base is great enough that he believes there is plenty of work to go around.

“There are a lot of patients out there,” he said.

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Staff enthusiasm, buy-in

Both Drs. Orrico and Minchetti said their team members are eager to learn new procedures.

“They love it. They don’t want to be bored doing the same thing all the time,” Dr. Minichetti said.

However, dentists need to consider what training the team may need and how it will be done. Opportunities are available through professional associations, and dentists may even choose to take it on themselves. In addition to assisting the dentist, there are other areas staff may need to get more training on such as financing and scheduling.

Technology/armamentarium

The cost of purchasing basic equipment and systems to deliver implant care is estimated at $10,000 to $15,000, Drs. Orrico and Minichetti said. Additional expenses can be significantly greater when adding technology like 2D and 3D imaging, but the diagnostics delivered by 3D imaging can be invaluable when treatment planning and surgically guiding implants.

“That’s for a basic set-up,” said Dr. Minichetti, who also advised choosing an implant company that provides ample knowledge and support.

“A Panorex is still considered the gold standard, and it’s been that way for years,” Dr. Orrico added.

Both suggested GPs take advantage of this technology to improve their implants care, but added that some practices may want to consider outsourcing these 3D scans if purchasing a unit isn’t in their budget. Mobile imaging centers have evolved and are a nice option for those not yet ready to invest in cone beam 3D imaging.

The good news is that technologies and materials have advanced significantly, and placement has become easier.

“There are a lot of advances in bone grafting materials,” Dr. Orrico said. “It’s always evolving.”

Implants also have become easier to place. “It doesn’t require the amount of surgery it used to,” Dr. Orrico said. “It’s not as technique sensitive. The surgery is less complicated.”

Equipment is better, too. “You can get drills that approximate the size of the implant socket,” Dr. Orrico said.

Educating the market

Both Drs. Orrico and Minichetti agree: Once you start placing implants, you’ll have to spend time educating patients about the risks and benefits of the procedure.

“You always want to talk about the benefits and risk factors,” Dr. Orrico said. “There are always risks with a surgical procedure.”

Recovery time, potential for infection, the number of visits, the advantages of an implant over a bridge or a crown, the cost and how to finance the procedure are all topics you may delve into when discussing implants with patients. But in recent years the predictability has improved so much that dental implants today often are the best long-term solution for patients. On top of that, dental insurance companies are starting to come around to the fact that a dental implant also can be the best economical choice in many cases, considering how long the restoration lasts and the fact that the tooth or teeth will no longer be susceptible to other costly dental procedures such as a root canal.

“The more you know the easier it is to teach,” Dr. Minichetti said. “You will educate your patients.”

Patients also may come in with preconceived notions that you’ll need to address. For instance, some centers offer same-day implants, and patients may come to their GP expecting the same time frame. Dr. Orrico said part of his education process is to advise patients it will usually take three-to-four visits from placement to restoration.

“I like to ensure the success of the implant before I go in and restore it,” Dr. Orrico said.

He said patients also want to be assured about various practical aspects of receiving an implant, such as knowing how the gap in their mouth will be filled as they wait for the permanent placement.

Treatment planning

The first step in any successful implant is the treatment plan, the dentists agreed.

“It’s the most important part of the process,” Dr. Orrico said. “It’s where you start.”

Both said they invest ample time in devising a plan that has the best chance for creating a long-lasting and attractive smile for their patients. Knowing where you are headed is as important for the dentist as it is for the patient, they agreed.

“I compare it to an artist,” Dr. Orrico said. “Before he puts a brush to the canvas he wants to know what the painting is going to look like.”

The demand for dental implants is out there, and the technology is now to the point where you can be confident in treatment planning and delivering great care to your patients.

Stay on top of the education, the implant systems available and the latest technology, and you’ll find yourself moving ahead in this growing field of dentistry.