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ePaper created 2018-02-16, 11:17:41 | version 1.38.0
implant procedures opinion | general nature, where the sole purpose is to train dentists to place implants and do this well and not how to do it with a specific implant system. ended up with problems. One does not have to be a rocket scientist to understand that, with a mouth full of pathogens, the success rates will go down. One thing that worries me a great deal is all the copy-cat versions of implants that are being mar- keted to less experienced dentists who cannot determine what a good product is. I always tell my audience to never treat patients differently to how they would treat their own family. The unfortunate thing is that I often see members of the audience looking down because they feel admonished. They do not understand that they get what they pay for and that failures are very costly and can hurt both their reputation and patients. I have been heavily involved in developing con- cepts like “Tooth Now”, according to which a tooth is extracted and immediately replaced with an im- plant and loaded with the final abutment and a temporary crown, with extremely high success rates when it comes to both implant survival and even more so the aesthetic outcome. Therefore, I am not against immediate loading at all, but case selection is very important. That is why good train- ing courses conducted over longer periods are so important. Another topic that gets me going is the market- ing of new teeth in an hour. Patients that for dec- ades have not taken care of their natural dentition are now being treated in accordance with concepts like immediate loading. Within an hour, any re- maining decayed teeth are removed and replaced with implant-supported crowns and bridges in the belief that the patients will start taking care of their new teeth. Unfortunately, this is not realistic. In my opinion, this is a ticking time bomb. It is just a matter of time before patients will come back with problems like peri-implantitis and failing implants. Who is going to sort that out? In the good old days, patients had to cooperate first and then we placed the implants. Maybe this was a bit harsh, but suc- cess rates were higher then and fewer patients Guided surgery is both, good and bad. The saying of “garbage in, garbage out” is apt in this regard: if one has the wrong information or interprets the digital information incorrectly, one might get into trouble if a fully guided surgical template is based on that. I do not agree with fully guided surgery as it is today, as I believe our brain needs to be con- nected instead of just computers. Do not get me wrong, I love to work with digital planning tools like NobelClinician (Nobel Biocare) to optimise my treatments, but instead of fully guided I prefer to use simpler surgical and/or pilot bur guides that do not force me to drill in a certain way._ Editorial note: At EAO 2017, Dr Göran Urde presented a paper titled “Evolution of surgical protocols in implant dentistry” as part of the scientific programme. contact Dr Göran Urde is the director of the Futurum Clinic at the Malmö Univer- sity’s Faculty of Odontology in Sweden. CAD/CAM 4 2017 59