Implant Tribune United Kingdom Edition

Implant Tribune United Kingdom Edition | 3/201522 TRENDS&APPLICATIONS Implant dentistry is an elec- tiverestorativetreatmentso- lutionwithasurgicalcompo- nent for dentally fit patients. If properly executed,it is one of the most successful and clinically researched treat- ment modalitiesindentistry. Unfortunately, patients who arenotdisease-freearebeing treatedwithdentalimplants and,asaresult,thelitigation ratehasrisensharply. A success rate of 98 per cent is almost universally claimed when promoting implant dentistry to pa- tients. So, if implant dentis- try is 98 per cent successful, then why are more cases failing and why is litigation increasing? Lack of proper training, poor treatment planning and poor execu- tion(surgicalandrestorative) are undoubtedly the main culprits.Ifaclinicianhasthe appropriate surgical and restorativetrainingindentalimplan- tology,doesthebrandofdentalimplant used make a clinically significant dif- ferencetothesuccessrate?Doespay- ingmorefortheimplantandrestora- tivecomponentsreallyproducebetter results?Whyispriceanissue? Price should generally not pre- vent access to high-quality, well- researched and effective dental treat- ment. However, the current pricing structureinimplantologymeansthat a huge proportion of patients do not have the disposable income to cover thecostsofsuchtreatment.TheMcGill study demonstrated the numerous benefits (functional, clinical, psycho- logical and general health) for eden- tulous patients in whom dental im- plantswereusedtostabilisecomplete dentures.Theimprovementsinchew- ingefficiency,generalhealthresulting from an improved diet and general well-being (more social interaction owing to a lack of fear of teeth falling out)showsthesignificantimpactden- talimplantsmakeinsocietyasawhole. How can this situation be changed to allow more potential patients to accessdentalimplanttreatment?First, clinicians could significantly reduce feeschargedtopatients.Thiscanonly happenifthecomponentandlabora- torycostsarereduced,withthedentist passing the savings on to the patient. Anotheroptionisthatdentalimplant companies reduce the prices of both implants and restorative compo- nents.Accordingtotheindustry,how- ever, prices across the industry are already competitive and companies needtocovertheirbusinesscosts. Isthereanalternativetotheabove? Clinicians cannot reduce charges without assistance from the dental implant companies and all dental implant companies are private busi- nesses with shareholders who want to produce products (implants) that benefit society and see some return ontheirinvestmentintermsofprofit generation. Economic drivers Market forces must come to bear in dentistry. In the current global economicclimate,ignoringthefinan- cial implications of the decisions we make is no longer an option. Patients expect high-quality, safe and afford- able treatment. For this to happen, clinicians need to source products at a reasonable price point, passing on these savings directly to the patient, reducing overheads and treatment charges and, therefore, increasing ac- cess to treatment. Some of the pres- tige implant companies have already felt the impact of the loss of market share and have either bought out competitors,createdjointventuresor incorporated competing products intotheirproductlines. Dosmallerimplantprovidersoffer potential benefits? One is certainly their ability to re- spond more quickly to increased patient expectationsoftreat- ment. The rapid ex- pansion of digital dentistry, CAD/CAM technology and intra-oral scanning is resulting in smaller companies being able to provide clinicians with a total, open-source guided surgery and restorative solution. With larger companies, the ability to change di- rection is much more difficult and time-consuming;turninganoiltanker takesmoretimethanadinghy. Key points of consideration when reviewing a new implant system Globally, all medical and dental products undergo strict vetting pro- cedures to ensure patient safety, including product durability testing, animal studies, human trials and testing at universities. They are then required to obtain a CE mark, FDA approval or some other approval to allowtheproductstobeusedinclini- cal dentistry. In short, once a product has a CE/FDA mark, it meets all the necessary testing and patient safety requirements to be used on humans. All CE/FDA-marked sys- temsmeetthesamestan- dard whether affordable orprestigebrands. The next step is to as- sessallclinicallyrelevant criteria. Since there are more than 1,300 dental implant systems avail- able, clinicians needs to assess all available clini- cal and scientific data and test the validity of various claims made by dental implant compa- nies.Ifcheckingforcerti- fication/approval is the first step for a clinician, then the second should be establishing how fu- ture proof the new im- plant is. In the early days of implan- tology, dozens of companies started trading and most of them closed in a relatively short period. For early adopters of those systems, the risk was not being able to restore or maintain such systems, as parts were no longer available. Therefore, asageneraldentist,oneshouldverify the length of time for which the system has been on the market, who the parent company is and what the connection interface is (is it a clone systemofawell-knownimplantthat is no longer in patent?). In simple terms,ifthecompanyceasestotrade, can I still source components and maintainmypatients? Implant-speciﬁc considerations Asignificantproportionofconnec- tion options (internal hex, external hex, Morse taper and conical con- nections)arenolongerinpatent.The clinical research on these has already beendoneandtheirsuccessrateshave beenwelldocumentedinamultitude ofstudies.Asaresult,mostaffordable implant systems are adopting these non-patented connections rather than developing their own, meaning that prosthetic components are cross-compatible with other similar systems. A clone connection implant can thus be restored with a high-end restorative component provided by another implant company or using patent-free connections by open- source milling centres that can pro- vide these components for signifi- cantly lower costs. One caveat with open-source milling is to check the quality of the milling provided in order to avoid the complications that arise from poorly fitting restora- tions. Systems like the ICX now provide non-precious metal blanks with pre- milledimplantconnectioninterfaces and ceramic blanks bonded to adhe- sivebasecomponents.Itisapremade titanium implant connection that is bonded to the all-ceramic block. It is themillingoftheimplantconnection interface that is the most vital part of the process, so if an open-source cen- trecanobtainapre-milledconnection blank, then its work is much reduced and the dentist can be rest assured of a high-quality component with an accurate fit. The benefit of adhesive bases in all-ceramic work is the im- proved strength of the connection and reduced fracture rates compared withall-ceramicabutments. Is using one of the clone connec- tions listed above an issue? All these connections function with excellent long-term, clinically documented results. The key factor for success is the closeness of fit between the in- ternal/external implant connection and the mating surface of the abut- ment, also called the micro-gap. This produces a stable, rigid connection with no abutment movement under loading. A stable implant–abutment interface combined with platform switching is the key to bone preser- vationaroundtheneckoftheimplant andavoidingscrewloosening. How can one most easily compare multiple connection platforms in a simple and easy to understand way withoutneedingadegreeinmechan- ical engineering? Engineer Holger Zipprich from Goethe University Frankfurt’sdentalschoolinGermany has produced real-time videos of Making implantology affordable Controlling costs and increasing access to dental implant treatment By DrTussTambra,UK 1a 1b 2a 2b

Implant Tribune United Kingdom Edition

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