by Kenneth W.M. Judy, DDS, FAGD, FACD, FICD
While the analogy might seem far-fetched, oral implant therapy is, in a sense, dentistry's answer to Einstein's quest for a "unified theory," i.e., a set of mathematical equations that would tie together relativity and quantum mechanics. The macro-universe that we see when we gaze at the stars and beyond as well as the micro-universe of subatomic building blocks could then be understood. Einstein and his colleagues, working for the past six decades, have failed to explain how the universe works. On the other hand, over the same time period, my colleagues who have dedicated themselves to research and clinical practice in the multiple areas of implant therapy have succeeded in demonstrating to us how the oral cavity and related structures which are affected by implant therapy really work. Of course, they are to be congratulated. But a very legitimate question is, "How do these wide-ranging achievements affect my practice?"
Quite often, I find myself saying to patients at their initial consultation, "What I am proposing is not rocket science. It is easy to understand." Then we jointly look at various diagnostic materials and talk about options ... even physics and biology. Some patients say, "Doc, I trust you. Go ahead and do what you think is best for me." Others want a high level of understanding. Then I have to have a "menu," based on my education and the extent of my clinical practice. In one form or another, the same is true for all of us. To adequately demonstrate this principle and weave it into the fabric of the accomplishments we have witnessed in the field of oral implant therapy, a good place to start would be what we can offer in a structured manner to patients who are edentulous or soon to be edentulous in the mandibular arch. Most patients abhor the fact or the thought of lower dentures. Let's face it — poor function, denture pastes, facial distortion, and becoming social recluses are hardly appealing prospects for the future.
Treatment options or the "menu"
The majority, probably 90% or more, of mandibular implant cases done in the United States do not involve major bone grafts and can be treated by well educated generalists or generalist/specialist teams when required. But the keys still are education and clinical experience. If we propose a therapy menu to patients, they should be made to understand what they are "ordering," — the risks and benefits, the immediate and future costs, the number of visits, and success rates, as well as the experience of those who will be treating them. On my personal menu of treatment options are subperiosteal implants, small-diameter implants, and standard root-form implants. While there is most likely some "wiggle room" in the chart below, depending on the nature and locale of one's practice, it should serve as a beginning point for both your patients and your office auxiliaries.
Obviously, I have made a number of assumptions, but in general, the above parameters have been extremely successful in my communications with patients. What you should expect — and what does in fact exist — is a very high percentage of case acceptance. Treatment can be tailored both to patients' needs and financial capabilities. A number of cases will be utilized to demonstrate the applicability of my personal menu.
