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Concluding Postscript Analysis STEPHEN M. TAUBENFELD VICTOR I. SENDAX
Outline
The Role of MDIs in the Contemporary Imaging Evolution: A Current Assessment
Positive Patient Psychology in Relation to Mini Dental Implant (MDI) Therapy
Positive Patient Psychology in Relation to Mini Dental Implant (MDI) Therapy Stephen M. Taubenfeld The psychosocial challenges faced by patients who experience uncompensated tooth loss are very real, and the consequences of missing teeth on self- esteem can be extremely debilitating. Simple activities of daily social life for an edentulous person, such as speaking, smiling, laughing, eating, and kissing, are rarely accomplished with total self-assurance. Replacing lost dentition is therefore not only essential to the maintenance of general medical health and bone preservation but can also have a profound beneficial impact on an individual’s mental health stability. The novel methodology of the mini dental implant (MDI) system is patient-friendly at its core. The nature of the procedure and follow-up care contributes to an overall positive experience for the patient. From a surgical standpoint, MDIs are so slender that they can be inserted directly through the overlying gum tissue and inserted into the underlying bone in a single minimal surgery. Many patients fear the relative invasiveness of conventional implants and associate them with a slow, painful recovery period. MDIs, however, are associated
with significantly less postinsertion inflammation and soreness. Moreover, the relevant advantage of MDIs that evokes the most powerful psychological benefit is the fact that it is often possible to provide the complete implant service in a single office visit. Even in the rare event of a lost implant, the consequences, both physical and emotional, are measurably less severe than those of conventional tooth replacement systems, particularly when extensive grafting procedures are also necessary. Some of the most profound clinical examples of positive mental health outcomes can be found in the adolescent patient population, a cohort not typically associated with edentulism. This elusively dynamic yet psychologically vulnerable stage of development is often characterized by multiple challenges to a young person’s developing selfesteem. Symptoms of depression and anxiety in young adults are gaining increasing awareness in the mental health setting and are often attributed to the harsh, competitive environment in which teenagers play, learn, and mature. Consider the actual case of a teenage boy born with a defect that
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Concluding Postscript Analysis
failed to manifest itself until the appearance of his other permanent teeth: anodontia of his lateral incisors. He was initially fitted with a space-maintainer (retainer) appliance, the type that some of his friends wore in conjunction with orthodontic therapy, which adversely affected his taste and prevented him from participating in sports that required a protective mouthpiece. The daily multiple cleaning rituals for an active teenager requires discipline and can be a tremendous obstacle. He began withdrawing from social situations in which he previously gained pleasure. The prospect of dating girls and experiencing kissing made him anxious. The next solution attempted was a “flipper” type of rudimentary partial denture fitted with prosthetic teeth. However, his active lifestyle resulted in several of them fracturing. When dental implants with transitional fixed resin teeth (allowing for interim jaw growth) were proposed to the young patient’s parents, they immediately assumed that the cost would make them inaccessible, that the surgery
would be lengthy, and that the recovery would be painful. With MDIs, the reality was quite the opposite, and he was fitted with two incisor MDIs in a single office visit. The implants gave him immediate biting function along with the morale-boosting sensation that they were his very own teeth, but most importantly they rehabilitated his confidence and restored his social freedom during a critical period of self-development. The real-life emotional advantages of MDIs at times transcend the obvious clinical benefits to pat ients at every chronologic level, from teen to aged maturity, reinforcing positive self-image and practical functionality on a daily basis. There can be no question that this lifestyle enhancement has a parallel positive impact on ones’ mental health status. Indeed, it is a medical milestone that we can share with our needful patients to help them achieve a healthier and more satisfying existence—less handicapped by debilitating tooth loss—and managed with minimal traumatic invasiveness.
The Role of MDIs in the Contemporary Imaging Evolution: A Current Assessment Victor I. Sendax With the recognition of bicortical stabilization techniques as the key to stable MDI longevity, it is useful to understand the role of imaging advances that have come to the fore and that significantly improve implant diagnostic and placement procedures. Panoramic x-rays, tomographic modifications, and CT scans with volumetric collimated enhancements in tandem with computer-guided 3D surgery techniques have been skillfully designed to ease the pathway for mastering more complex and challenging maxillary and mandibular implant cases. Impressive scan views highlight the extensive scope of these digital imaging developments as they may apply to advanced MDI technology, to conventional implant applications, and to varied hybrid combinations of MDIs, conventional-width implants, and natural tooth abutments. However, in this new era of increasingly sophisticated implant guidance devices and techniques, it is useful to remember that all of these visualization enhancements have a common purpose: namely, to render with more quantitative precision and accuracy the placement and ultimately the restoration
of implant-supported prosthodontics, both fixed and removable. It is equally important to recognize that the need remains to provide implant services to a large undercared-for patient population that could benefit enormously from a simplification of implant procedures leading to greater affordability and access. With this goal in mind, we see that the MDI can fulfill its role as a valuable niche procedure when patients need cost-effective dental implant therapy, particularly when medically compromised candidates are informed by their attending physicians that they are contraindicated for any invasive surgical procedures, including conventional dental implant insertions and extensive grafts. As minimally invasive and virtually nonsurgical entities, MDIs can usually gain physician acceptance when carefully planned and programmed by the implantplacing surgeon, allowing such patients to receive cost-effective, essential oral implant therapy with minimal significant health risk exposure, and with unequivocal medical clearance.
Positive Patient Psychology in Relation to Mini Dental Implant (MDI) Therapy
The sections of this textbook compiled by specialized hospital-based doctors such as Bohle, Lish, Peckitt, and Sussman attest to the consistent ability of MDIs to survive with minimal morbidity even under the most rigorous and threatening of local and systemic medical conditions. The conclusion that may reasonably be drawn from these graphic case examples is that if MDIs have long-term as well as routine shorter-term predictability, consistently demonstrated while under the cloud of such highly negative oral and systemic morbidities, it should confirm that MDIs can be considered on a par with conventional implants and, in select cases, may even surpass the usefulness of standard-width implants. The enhanced ability to insert ultrasmall- diameter MDIs directly into narrow areas of bone without encroaching on vulnerable adjacent structures (e.g., sinus, nasal cavity, buccal or labial and lingual bony plates, neurovascular elements, & adjacent roots) has allowed the oral implantologist greater latitude in avoiding invasive hard and soft tissue grafting surgeries and associated flaps/ sutures. Immediate functionality also implies less trauma to hard and soft tissues and vulnerable patient psyches, as well as reduced bone plate dieback and crestal bone loss. Although MDIs do not require routine use of CT technology (with its attendant costliness and radiation exposure risk) and have been typically placed with only basic periapical
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and/or panoramic radiographs, it is understandable that the more complex the case under consideration the more rational is the use of CT scanning as an ancillary aid to avoid vulnerable adjacent structures and to make maximum use of the available bone. This is especially the case when hybridized combined applications are being considered that may involve MDIs, conventional implants, and natural tooth abutments, and where the need is greatest to objectively evaluate the uneven morphology of the insertion sites in three dimensions and to critically assess the potential added value of partial and full flap surgery visualization and thereby enhance the precision of insertion. The associated MDI benefits do not imply that MDIs are offered as a routine panacea or a cureall substitute for conventional implants. Rather, the advocacy should be to fully consider hybridizing MDIs with conventional-width implants for more challenging treatment plans. In fact, the most sophisticated use of advanced digital imaging techniques is to help determine what implant system or hybrid combination is best adapted to the site-specific morphology of the area(s) under consideration and to correlate these findings with an affordable treatment plan, clearly embodying all the advances that have come to make oral implants an accessible mainstay of the modern dental profession and truly compassionate clinical practice.