Photos provided by Gary Jackson.

New Designs, Technologies Promise to Modify Implant Options

BALTIMORE, MD - There are more than 177 implant companies in the United States today, and although many good implants are on the market and working successfully, new designs and technologies will continue to modify implant options, according to a speaker at the Updates in Contemporary Dentistry Meeting held here last week. Scott Parker, DDS, who maintains a private practice in Redmond, WA, was invited to speak on implants by the meeting sponsor, Dental Learning, because of his extensive background with and publications on restorative dentistry. Parker reviewed the history of the implant process, reviewed types of available implants, and discussed final restorative placement. The key to practicing good dentistry, Parker said, is finding what motivates you and offering that to your patients. Dental Implant History In 1952, Professor Per-Ingvar Brnemark discovered that it was impossible to recover any of the boneanchored titanium he was using in his research with rabbits, because the titanium had apparently bonded irreversibly to the living bone tissue. Brnemark subsequently demonstrated that, under controlled conditions, titanium could be structurally integrated into living bone with a high degree of predictability and dubbed the process osseointegration. The first practical application of osseointegration was the implantation of new titanium roots in an edentulous patient in 1965. More than 30 years later, these implants were still functioning perfectly. Present Day Fast forward to present day, and implants are quickly becoming the standard of care for missing teeth. Implants have progressed through blade forms, subperiosteal, transosteal, ramus frame, endosteal, and root form endosteal implant styles with various degrees of success. Parker said that nearly all implants today are root form implants made from various high grades of titanium, and studies are under way to produce commercially available zirconium implants in the United States. Zirconium implants are already in use in some countries today. There are several types of root form implants, varying from straight to tapered, nonthreaded or threaded, coated surface or etched surface, and 1 piece and 2 piece implants. Implant surface technology has also changed over the years, encompassing grit blasting and thermal acid etchings. With grit blasting and thermal etching, we create a macro- and microstructure that allows the osteoblasts to fully envelope and integrate with the surface, creating a stronger implant interface, Parker said. Even the connections for the implants have changed. The purpose of the connector is 2-fold. The connector securely stabilizes the prosthetic component and facilitates easy placement. Unfortunately, these types of connectors can have small movements due to ill-fitting connector-implant junctions, which results in cratering in the bone around the implant. This phenomenon is expected and accepted as normal, but has been associated in studies with increased inflammation with associated increase in inflammatory cells. In a European study of more than 11,000 implants, the overall failure rate was about 2.3%; these failures were largely connected to a lack of osseointegration and perioimplantitis. Because of the potential for implant failures and cratering, Parker pointed out that a connector without microgaps and therefore no micromovement would be ideal. He mentioned the Ankylos implant (DENTSPLY Tulsa Dental), which features a Morse taper, one of the strongest mechanical connections in engineering. He said because the implant/abutment surface area is high, there is less micromovement, hence no rocking or rotation, basically eliminating the potential for bacteria. The process of platform switching, which uses an abutment that is smaller than the diameter of the implant, reduces the proximal edge microgap and micromovement, thus reducing inflammation or bacterial-induced bone loss. Many DENTSPLY companies, including DENTSPLY, Astra, Bicon, Biohorizons, Keystone, Nobel Biocare, Straumann, Zimmer and others are using the principle of platform switching. Parker encouraged attendees to look at these technologies because positioning of the implant at or below the crest of the bone increases bone and tissue volume, reducing the need for grafting. The stronger connections associated with platform switching mean smaller implants can support larger teeth, according to Parker. Collaborative Approach Parker encouraged a team approach to the implant restoration process, incorporating dentists, surgeons, technicians, and patients. Parker also stressed the importance of communicating shades with patients He mentioned Vita's Easyshade device, which measures tooth shades. He said this technology enables clinicians to measure natural teeth, check restoration shades and track bleaching progress. He encouraged attendees to discuss options with patients for addressing missing teeth, and to come to a conclusion on what the dentist and patient want to accomplish with the procedure. Finally, he urged dentists to consider looking for implants that: are easy to use feature strong connectors are stable periodontally are stable at bone level provide good aesthetic outcomes have proven track records

Scott Parker, DDS

Scott Parker, DDS, graduated from Loma Linda University School of Dentistry in 1996. Since then, he has been committed to providing exceptional restorative care in a progressive, yet conservative manner. He has been a Clinical Instructor for the Northwest Aesthetic Continuum through the University of Washington, and has lectured throughout the United States and Canada on esthetic procedures and dental technology. Recognized by his peers for his conservative excellence, as well as his down-to-earth manner, Dr. Parkers realistic approach to everyday dentistry has made him a highly sought after lecturing clinician. He is a consultant for many dental companies on product development and clinical testing. He is a member of the Academy of RV Tucker Study Clubs, the American Dental Association, the American Academy of Cosmetic Dentistry, and the Academy of Laser Dentistry. Dr. Parker has published several articles on restorative dentistry and adhesion. He maintains an exclusive private practice in Redmond, WA. Dr. Parker Disclosure: Affiliation/finanical interest/grants/research support from DENTSPLY Caulk, DENTSPLY Tulsa, Kerr, SDI, GC America, Heraeus Kulzer, Tokuyama; Advisory Board, Nucalm; Editorial Advisory Board, Dental Product Shopper; Advisory Board Chair, Dentallearning.net (honorarium).

Dental Learning

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