May 14, 2010
This is a tricky blog for me to write because I vehemently oppose making outlandish, unrealistic and overly optimistic claims. Sometimes the best planned and executed dental care succumbs to the wear and tear environment of the mouth, or uncontrolled dental disease. Any decision to begin complex dental treatment should be well thought out, and performed with the utmost caution. This especially applies to dental implants. However, there is considerable debate regarding the protocol for implant treatment. Forty years ago, it was believed that implants had to be placed in a near sterile environment-in near perfect bone. Also, they believed there could be no force on the implants while healing, or they would not integrate, and that the teeth had to be connected. The problem was that not many patients fit this protocol, in order to satisfy the protocol it took a long time, required removable dentures and was not suitable for single teeth. Eventually, we began to realize that very often implants could be placed at the same time as the tooth extraction- which saves time and preserves bone. Dr. Gradwell of Allentown, who places my implants, was one of the first to embrace that concept years ago. Now it is considered the standard of care in most situations. Later, the idea of no force on a healing implant was challenged. This meant that in many cases temporary teeth could be placed on a newly placed implant. This was huge. In 2000, Dr. Gradwell and I attended immediate load training at Baylor University, in Dallas, Texas. Today, it is our goal to be able to remove teeth, place implants and place teeth the same day. This makes a dramatic difference for people because it requires less time, and eliminates the need for removable dentures or partial dentures. It is incredible how well this works, but it is more incredible how often I have heard from patients that they were told it couldn’t be done and how hopeless they feel. I know you can’t use a single case to represent all cases because individual results do vary based on individual circumstances, but the results in the following case are typical of what we have seen, time and time again, over the last 10 years.
The patient is a 50 year old woman, who presented with 22 remaining hopeless and broken down teeth. She had a history of gum disease, decay and abscesses. The remaining teeth were extracted, and 14 implants were placed. Temporary teeth were fixed to the implants the same day. She strictly followed a soft diet for 4 months after which we x-rayed the implants, and tested them for integration. All 14 implants integrated well. I do not use this case as an example because it is unusual. I use it only because it is the most recent. Implant success rates hover around 90% in the best of circumstances. It is only with respect and humility that I use a case that shows 100% integration. My point, as I said, is not to make overly optimistic claims. It is just to illustrate the change in perspective of what is possible. Those who are most dentally debilitated need to know that it may not need to be that way.
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