Dental Tribune United Kingdom Edition

positive statements and evalu- ations by implant manufactur- ers and distributors. However, all this changed considerably during the past five years. Suddenly, new topics were given priority, which shaped specialists’ conventions - top- ics that had previously been partially suppressed if not ne- gated. I remember only too well the implant congress held by a very important Ameri- can implant manufacturer in Frankfurt/Main in 1998, where I reported on a concept for the treatment of peri-implantitis developed at the University of Freiburg and was then re- buked by the main speaker, who was from the USA, dur- ing the ensuing panel discus- sion. He asserted that he had “not seen one case of peri- implantitis in 20 years of im- plantology - this phenomenon does not exist and, if it occurs, it can only be attributed to a lack in skill on the part of the implantologists.” How times have changed. However, trou- bleshooting and complications in implantology and even the word ‘failure’ have been men- tioned in the themes of many congresses held by leading professional associations of implantology in the past years. Patients’ expectations While a consistently positive and at times even euphoric tone prevailed regarding the topic of implants for many years, a few critical voices and later increasing criticism emerged at the beginning of the observation period. This was - concurrent with a notice- able increase in the number of implants - based on the consid- erable increase in implantolo- gy failures and complications. The following images depict total implantological failure - the loss of a purely implant- supported complete maxil- lary restoration caused by an infaust peri-implantitis (Figs 15–17), leaving profound osse- ous defects. However, in line with the consistently positive evalua- tion of implants and the per- sisting promise that the use of implants would yield opti- mum results always - and of- ten publicised by the lay press - our patients’ expectations have increased considerably in the past 15 years. Patients as- sumed that, regardless of the individual situation, he or she would always receive the opti- mum results. In this regard, it seems reasonable to maintain a self-critical attitude and to concede that we did not always contradict this general as- sumption vehemently enough. And then what was bound to happen, happened: at times, the result was not what the patient had expected. An awk- ward situation arises when the dentist, based on the initial di- agnosis, considers the result to be successful and the patient considers it a failure. A long- time legal expert sums up this situation accurately by stating that, “Two-thirds of all pend- ing court proceedings were filed by patients whose expec- tations were disappointed.” Rather unfortunately, the in- creasing number of court pro- ceedings are mostly related to implantology. It cannot be by chance that the premiums for mandatory professional liabil- ity insurance have increased considerably. Emerging criticism German periodontists Dr Thomas Kocher referred to implantology as “the red light district of dentistry”. Whether this evaluation is justified is a matter to be decided individu- ally. Personally, I do not agree with this evaluation, but a grain of truth might be found in its reference to overtreat- ment. In this regard, the ex- traction of teeth in favour of implants, even when not indi- cated, is a concern voiced in- creasingly by periodontists and those in favour of conservative treatment. We have to address this issue by individual evalua- tion of each patient, as well as through academic discussion. Implant versus tooth preser- vation has been a frequent debate at conventions and im- plant symposia in recent years. In my opinion, this would not have been possible ten years ago. Trouble-shooting concepts Unexpected complications, such as implant fracture and failure of implant supra-struc- ture connections (Figs 18–21), necessitated the development of surgical and prosthetic trouble-shooting concepts and modification of constructions in implant and abutment de- sign. However, these were not readily available and have not yet been finally agreed upon. In other words, they cannot be said to be common knowledge in implantology, at least not in the treatment of peri-implanti- tis. Similar statements can be made with regard to pre-im- plantology arguments, where a pleasing variety of surgical techniques and materials is listed, but no generally valid scheme has been agreed upon. The fact that the need to develop and convey these trouble-shooting concepts is generally recognised today and that these concepts are yet widely supported by the partic- ipants on the implant market is gratifying. The specialist press has made a valuable contribu- tion here and continues to do so - numerous articles that re- ceived a great deal of attention during the past 15 years are those that dealt with implan- tology and implant-prosthetic troubleshooting. Digital implantology I consider the establishment of 3-D diagnostic imaging, with all associated possibilities, to be the significant development during the 15-year observation period. It is true that only im- plantologists used the new 3-D technology during the initial phase of dental volume tomog- raphy (because they made up the group of dentists who could actually afford this expensive equipment); nevertheless, 3-D technology constituted a quan- tum leap for dental diagnostic imaging as a whole. Today, we have almost un- believable possibilities at our disposal that even the greatest optimists would not have con- sidered possible 15 years ago: highly complex patient cases can now receive minimally in- vasive treatment and have im- plants placed even without the need for augmentation. Our first case shows a highly atrophied mandible, in which four implants could be placed without any prior aug- mentation owing to 3-D data and planning (Figs 22–24). Three-dimensional diagnos- tics are sometimes also em- ployed to clarify facts when complications have arisen, for example neural lesions after implantation (Figs 25 & 26) and bone necrosis after admin- istration of bisphosphonates, and erroneously diagnosed as peri-implantitis (Fig 27). My personal conclusions It is difficult to draw a conclu- sion regarding the develop- ment of implantology over the past 15 years because it has been so multifaceted and rap- id. To conclude, I would there- fore like to quote my academic teacher and former supervisor, Prof. Wilfried Schilli, who, as a founding member of the Inter- national Team for Implantol- ogy, was undoubtedly among the pioneers of implantology and has contributed to improv- ing implantology through his university work: “Who would have thought that implantol- ogy could develop like it did in less than twenty years.” This very true statement encompasses many aspects: the admiration and apprecia- tion of what has been achieved, the satisfaction with having in- itiated a procedure that is con- sidered to be the safest in the entire field of medicine, and some criticism regarding any development in oral implantol- ogy that did not turn so well or went off course. DT page 17DTß Fig 19 Fig 20 Fig 21 Fig 22 Fig 23 Fig 24 Fig 25 Fig 26 Fig 27 November 19-25, 201218 Implant Tribune United Kingdom Edition About the author Dr Georg Bach Rathausgasse 36 79098 Freiburg/Breisgau Germany Tel.: +49 761 22592 doc.bach@t-online.de