Dentaltown October 2017 - 82

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A Better View
of Implants
Dr. Howard Farran and Dr. Ernest Orphanos
discuss periodontics, implants and the
importance of magniﬁcation at work

D

r. Ernest Orphanos began
practicing as a periodontist in
1994 in Florida, where today he
focuses his services on dental implants
and procedures related to dental
implants, including All-on-4.
Orphanos, who is the visiting
lecturer for the postgraduate
department of periodontics at Tufts
University, lectures nationally and
internationally on this procedure,
which allows four implants, as well as
teeth, to be placed on the same day.
He teaches other surgeons All-on-4 at
his educational center in Boca Raton,
which made him a perfect candidate
to discuss the technique on a recent
episode of the Dentistry Uncensored
with Howard Farran podcast.
The conversation, recorded in June,
also touched on the changing field of
periodontics, the importance of proper
magnification and other topics. An
abridged version follows.
Howard Farran: Some people say
"All-on-4" means "None-on-3." What do
you think of that pushback?

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OCTOBER 2017 // dentaltown.com

Ernest Orphanos: It's inaccurate.
There is a plethora of reasons why
but, by virtue of understanding
the literature, we know that the
longitudinal studies of All-on-4-
compared to All-on-6, immediate-load
and delayed-loading-have the same
10-year success rate.
That's No. 1. No. 2 is, if you do have
a failed implant, you can replace the
implant and weld to the titanium bar
within the prosthesis. No. 3 is because
you're reducing the bone, and you're
reducing this alveolar ridge, you're
getting down into the better basal
bone, so you have less remodeling. You
have thicker soft tissue.
HF: I think that your specialty,
periodontics, has changed more in
the past 30 years than the other
specialties combined. Do you agree?
EO: Not only has it changed, it
has become more all-encompassing.
When to extract the tooth is a very
challenging question to address. The
advent of LANAP surgery, which we
use in my practice, brings in a whole

other dynamic with respect to what
we can do to save teeth. But we also
have to be aware of the longitudinal
studies. We can't base the treatment
we provide on our feelings or our
opinions. It really should be based on
the peer-reviewed literature.
HF: How can new dentists
determine whether they should use
old-school periodontal surgery or
titanium?
EO: One has to defer to experts to
really make the best clinical judgment
for the patient, but a variety of factors
come into play. Age of the patient is
one. If I have a 25-, 30-year-old patient,
I'm going to do what it takes to keep
that tooth for as long as possible. I also
consider root morphology, furcation
involvement, the root trunk size,
mobility and the opposing occlusion.
HF: Is All-on-4 moving toward
All-on-3?
EO: It's already coming out and
has been through a rigorous five-year
protocol. With All-on-3, a definitive
prosthesis for the lower arch is
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