10 rules of order in implantology
1. Choose one well-documented, scientifically supported implant system. Any dental implant system demonstrating ongoing research and design will achieve high success rates and be adequately equipped to deal with most clinical challenges. Surprisingly most successful implant systems are similarly designed, making the thought of owning different implant systems in the office redundant. Implant macro- and micro-topography may vary, but similar success rates are seen. Prosthetic connections and abutment designs appear very similar.
2. Not all dental implant companies are created equal; warranties, customer service, availability of representatives and technical support may be highly variable. Companies that tend to merge may have a transition stage where customer support may vary.
3. If you pursue both the surgical and prosthetic phases of treatment, be ready to assume twice the responsibility for diagnoses and clinical execution. As a prosthodontic specialist, keeping up with the prosthodontic and laboratory literature alone is complicated enough. I rely on my surgical team to provide the most up-to-date surgical information to guide my prosthetic objective.
4. If you fiddle with any implant, restored or not, you just bought it. On a larger scale, this involves the topic of informed consent. It’s common to see patients with prosthetic complications relating to implant dentistry. Make sure you have a full disclaimer regarding any proposed intervention; otherwise, you may be held responsible for a pre-existing condition.
5. All screws loosen with time; its not if, but when. Properly supported prosthetic designs and proper torque execution will minimize such complications. Remember one screw loose per week is too many.
6. Most insurance companies don’t recognize implant prosthetics. Properly inform your patients of this reality.
7. Even good implant systems can have complications and failures. Poor surgical execution, patient selection or management and/or poor prosthetic design can all create problems with the best of systems.
8. Some single-implant cases are quite difficult, and some multiple-implant cases are quite simple. Not all single-implant cases are predictable (i.e., matching a central incisor); while multiple, implant-supported, posterior bridges can be quite predictable.
9. Implant prosthodontics is not simple. In general, any prosthodontics case is not simple, regardless of what a salesperson might tell you. Prosthetic components can be technique sensitive, and they can be difficult to select. Step-by-step instructions can oversimplify and misrepresent the clinical challenges.
10. The likelihood that an implant is malpositioned is directly related to the surgeon’s resistance to a surgical guide.
This article was published in Implant Tribune Canada Edition, Vol. 4, No. 1, April 2016 issue.