Dental Tribune United Kingdom Edition

sional journals supplement the current training needs of the younger generation of dentists especially. The end of dogmas While implantology was marked by many dogmas from its beginning and the mid- 1990s, this had changed at the time when our 15-year obser- vation period begins. However, implantology was later called into question in its entirety. Whether it was healing times, waiting times after augmen- tation or prosthetic concepts - everything underwent scru- tiny. On the one hand, some of these dogmas did in fact prove to be no longer sustainable because of remarkable devel- opments, especially improve- ments in implant surfaces. On the other hand, the mark was at times overshot in the elimi- nation of other dogmas, cre- ating the need to back-track. This was a painful experience for both patients and implan- tologists. One dogma that we encoun- tered in the observation period was that of a strict refusal of immediate implant placement. There is general consensus today, however, that under suitable conditions an imme- diate implant placement can be a high quality and sustain- able alternative to established procedures. One clinical case shows an immediate implant placement in the maxillary an- terior teeth: the extraction and the immediate implant place- ment of a maxillary anterior tooth that was not worth pre- serving under the guidance of a drilling template and implant position (Fig 1), transfer into the oral cavity (Fig 2), and the condition immediately after insertion of the implant crown (Fig 3). The prospering of the im- plant market A welcome variety of new implants, implant forms and prosthetic options has become a reality in the past 15 years. Special implants were devel- oped for special indications so that now even a mandibu- lar molar can be replaced by a corresponding sized im- plant, followed by insertion of a corresponding sized implant crown. Figures 4 to 7 show the clinical and dental appearance of these in a patient. Implan- tologists who placed several hundred implants annually were considered the big play- ers on the implant market in the 1990s. Achieving the mark of 100,000 implants placed per year in Germany signified that the peak had been reached. This was not the case, since the one-million mark was also reached within the scope of a rapid, almost unimpeded de- velopment. While the increase has been slower in recent years and global economic developments even caused a brief decline, today we can assume that the implant mar- ket will continue to grow. The maximum growth phase falls into our observed period. Development in the eyes of implant manufacturers From manufacturer to global player - this would be an ac- curate description of the de- velopment of some implant manufacturers. The develop- ment of some of these com- panies over the past 15 years, the size of their companies and the number of their employees today are indeed impressive. And these prosperous compa- nies share other characteris- tics as well: the acquisition of products and entire firms in order to expand or supplement their product portfolio and their pressing on to the field of digital dentistry (CAD/CAM, planning, etc) into which these global players invest large sums of money. Revenues must be generated so that these in- vestments can be made - and they are still made, albeit de- clining owing to the economic crisis. Still, the implant market is booming. Although the consist- ently two-digit annual growth rates some implant manufac- turers had started to become used to have become more moderate today, a great deal of money can be made with implants. As a result, an ever- increasing number of implant suppliers and systems make it impossible for the individual user to keep track. Aside from new systems, an increasing number of generics are being launched on the market. Focus on red-white aesthetics The President of the German Society for Dental Implantol- ogy (Deutsche Gesellschaft für Zahnärztliche Implan- tologie), Prof Frank Palm, aptly remarked: “What was celebrated as a triumph for some colleagues 20 years ago is today taken to court.” Den- tists who practised implantol- ogy were not prepared to find themselves confronted with a debate that had spread from North America to Europe: that of red–white aesthetics. This new focus on achieving the highest possible aesthetics for implant-prosthetic treatments was linked to implantology and distanced itself from surgery, which had been dominant up until that time. In the early phase of im- plantology, the main focus was on safe placement and the best possible placement in the bone, sometimes even at the expense of subsequent prosthesis treatment owing to unfavourable placement of the artificial abutment teeth. Now, however, prosthetic standards and issues have become the centre of the discussion. Place- ment techniques were modi- fied and new techniques were established in order to satisfy these requirements. Patients no longer, or only occasionally, accept demanding and com- plex cases like the following case. Both implants in the an- terior maxillary region were placed too far buccally, and there was a gap of 5.5m be- tween the implant shoulder and the cementoenamel junc- tion of the adjacent teeth (Figs 8–10). Treatment with a long- term temporary restoration would only have yielded an unsatisfactory aesthetic result. However, under certain surgi- cal and dental conditions - as shown in our second example - superior results and stability for a period of ten years can be achieved even with challeng- ing initial situations. In 1999, an immediate implant was placed in region 12. The fol- lowing images show the steps of treatment (Figs 11–13). The last image shows the condition after ten years (Fig 14). This development was made possible mainly by mas- sive improvements in the area of augmentations, which can now be performed with sig- nificantly higher predictability. This development was further enhanced by a considerable improvement in the training of implantologists. These im- provements are significant for both undergraduate study and post-graduate training. Thus, the universities and profes- sional associations who have contributed immensely in this area deserve much credit in this respect. The battle of healing times It was but an episode, yet one that caused an incredible fu- rore at the time: the debate about shortened healing times. Stimulated by a media hype in which the specialised press only played second fiddle and the lay press appeared to be in the lead, the healing times of some implant manufacturers were inflated. Values were cor- rected downwards almost on a daily basis. Some manufactur- ers went along with it, while others remained firm. Some participants felt they needed to be at the forefront, others stayed out of it. A short but re- markable ascent was followed by a rapid crash. A personal highlight for me was an article in a tabloid newspaper that said, “Extrac- tion in the morning; directly followed by augmentation and implantation; a firmly seated supra-construction im- plemented at lunch time, and then endless servings of spare ribs!” As can be seen from this euphoric statement, some got carried away, while others had to painfully back-track. What remains is the realisation that, owing to improved surfaces and other conditions, the long healing times recommended in the early phase of implantol- ogy can in fact be reduced con- siderably, but not at any cost. New options for improving the implant site The afore-mentioned domi- nance of prosthetic implantol- Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 Fig 6 Fig 7 Fig 8 Fig 9 Fig 10 Fig 11 Fig 12 Fig 13 Fig 14 Fig 15 Fig 16 Fig 17 page 15DTß November 19-25, 201216 Implant Tribune United Kingdom Edition