Dentaltown August 2020 - 38

A major problem
in dentistry
today is the
"dumbing down"
of implantology
education
to bring it
to the masses.

there is with a partially edentulous case. Also, without teeth, the surgical guide has no
inherent indexing or stability. The surgical stent needs to be oriented via an index to the
opposing arch and held in place with fixation screws or pins.
This was not a good choice for someone's first case! Patient selection is of paramount
importance. As I discussed earlier, your first cases should be simple, straightforward and
predictable.
In my beginner guided implant surgery course, I tell doctors that their first two dozen
cases should be single-tooth, from first molar to first premolar, and flapless (i.e., adequate
bone and keratinized tissue volume).
Only after they have mastered these cases should they should come back and learn
about flap design, suturing, simple bone grafting, multiple (no more than four) implants
and anterior aesthetic zone implant surgery.
Many of my students have taken other implant courses and told me that my approach
has brought them success. This is the same way that surgical specialists learn to master
their surgical skills: slow and steady. The last thing you want to do is to spend thousands of
dollars on an implant system and give up after your second case because of a poor result or
complication. Implantology is a great addition to your clinical skills. If you stay within your
training and comfort zone, you will enjoy doing implants and have many happy patients.
So in this case, was it the use of an outside technician to do the planning, poor surgical
guide design, poor case selection or inadequate doctor training that caused a disaster? It
was all of the above.

CASE 2
A dentist in my neighborhood asked me to help him with an implant he had placed,
which he was afraid was failing. This dentist tried to follow what I teach. He had taken
the implant planning course that came with his CBCT and one weekend implant course.
He started with a simple case in a young, healthy patient: a mandibular first molar, with
plenty of bone and plenty of keratinized tissue.
He planned the case following what he was taught in the planning course, made sure
that the surgical guide was accurately placed and stabilized, and placed the implant through
a tissue punch with no problems. His postoperative radiograph (Fig. 2) shows acceptable
implant placement. It was closer to, and parallel to, the tilted second molar. Ideally, though,
it should have been closer to the second premolar and more parallel to it. The patient had
an unremarkable recovery.
The patient began complaining of tenderness around the area of the implant about
two months after placement. His dentist told him that this was normal and would get
better. But it did not.
When the patient presented for the four-month postoperative visit, he was still having
aching in the area, and his dentist noted that the implant was mobile. A periapical radiograph
(Fig. 3) showed bone loss around the implant fixture. At that point, he called me for advice.
He then referred the patient to my office.

Fig. 2

Fig. 3

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Dentaltown August 2020

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