IMPLANT DENTISTRY ”

By Jerry Bird, DMD, FDA President

Did you know that the history of dental implants can be traced back to ancient Egypt where they carved seashells and stones to replace missing teeth? As early as 2000 B.C. early versions of dental implants were used in ancient China and the first recorded case of a replacement tooth made of metal came from the body of an Egyptian King around 1000 B.C. That was a long time ago. One of the most important developments that lead to our current dental implants occurred in 1957 when a Swedish orthopedic surgeon named Dr. Per-Ingvar Brånemark began studying bone healing and regeneration and discovered that bone could actually grow in proximity with titanium and could effectively adhere to the titanium and not be rejected. Brånemark called this “osteointegration.”

Now implants are commonplace and they come in many shapes, sizes and different coatings to enable the best integration into bone. In the general population, the use of dental implants has become a great treatment option for replacing missing teeth. It doesn’t matter the age, people want to replace missing teeth and they want to look younger, better and enjoy eating all foods again. Of course, dental implants are not inexpensive and patients can be concerned about finances and length of treatment time. Older adults have complex medical, social and economic issues that must be taken into consideration, and dentists need to give careful attention to help each patient consider the best tooth replacement therapy.

For many, dental implants have become the increasingly common treatment option for missing dentition. With the population becoming increasingly older worldwide, the dentist is confronted with patients who have more complex medical and social histories and dental implants. When patients need and desire tooth replacement therapy, there are many options such as conventional removable or fixed prostheses to a combination of fixed and removable implant-supported forms of tooth replacement.

For the majority of the population, the clinical success of dental implant therapy has improved so much that many clinicians consider it to be a standard of care. Tooth replacement therapy can vary from single-tooth replacement with conventional or implant-supported restorations to full-arch replacement. Each option, including no tooth replacement, has advantages and costs that must be weighed in consideration of patients’ desires, understanding, resources and perspectives.

Some dentists place single implants only, and some can do full arch replacements while others work as a team with their surgical specialist. No matter the option you choose, you need to evaluate the patient for any systemic conditions that maycompromise healing — immunocompromised states, uncontrolled diabetes and the antagonistic effects of medications. In general, the survival rates of dental implants in older patients can be affected by systemic conditions associated with aging, including long-term smoking, diabetes and postmenopausal estrogen therapy. Patients who undergo implant surgery face the same medical and surgical risks that are similar to those of outpatient procedures. And, of course, our patients need to be encouraged to take excellent care of their investment to assure long term success.

New advances in digital dentistry have enabled more advanced diagnostic information. The dentist can now use a surgical guide or denture to indicate the desired implant position, angulation and need for hard and/or soft tissue augmentation before or during implant placement. Guided implant surgery with the use of cone-beam computed tomography scans and intraoral scanners have made it possible to get the best position and restoration for the patient.

It has been proven that dental implant therapy can significantly improve the lives of our patients. Through discussions with the patient, his or her caregiver and, possibly, other family members, the clinician can assess the patient’s expectations and desires carefully and balance them with the time and resources needed to accomplish the best outcomes. In the end, I know you’ll agree that dental implants have come a long way in a very short amount of time. In 1984, when I first started out in practice, we graduated from one-piece blades, to now primarily endosseous root forms. All things change over time. The innovation in dental implants will continue and will most likely become easier in the future for us as practitioners and more beneficial for our patients.

Opioids

HEALTH CARE PROVIDER CHECKLIST:

Inform

Non-opioid alternatives for pain treatment, which may include non-opioid medicinal drugs or drug products are available

Non-opioid interventional procedures or treatments, which may include: acupuncture, chiropractic treatments, massage, physical or occupational therapy, or other appropriate therapy are available.

Discuss

DOCUMENT IN PATIENT’S RECORD

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“Alternatives to Opioids,” an educational information pamphlet created by the Florida Department of Health printed or in electronic format (required, available at bit.ly/2KXvZ2h). Also, a checklist and poster.

SUMMARY:

All health care providers must include non-opioid alternatives for pain and pain management electronically or in printed form in their discussions with patients before providing anesthesia, or prescribing, ordering, dispensing or administering a schedule II controlled substance for the treatment of pain. Effective July 1, 2021.

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