A boom for general dentists: The paradigm has shifted

May 1, 2009
The use of dental implants as a routine modality for replacing missing teeth is a departure and paradigm shift from conventional dentistry.

by Dr. Chris Hughes

For more on this topic, go to www.dentaleconomics.com and search using the following key words: implant dentistry, Dr. Chris Hughes, Focus On. "Dental Implant Prosthetics", Dr. Carl Misch, general dentist, implant-supported prosthesis.

The use of dental implants as a routine modality for replacing missing teeth is a departure and paradigm shift from conventional dentistry. It's a sea of change in the way dentists think about replacing missing teeth, and it can open up a world of possibilities for general dentists.

One of the most common services in dentistry is replacing missing teeth. Historically, dentists have relied on existing teeth or the edentulous alveolar ridge to support a dental prosthetic. This began in dental school when dental students made their first bridge, partial denture, and full denture.

After dental school, this perspective was reinforced by our experience, comfort zone, and the economic realities of patients and practices. For patients who didn't fit the mold, such as those with a denture or removable partial who “couldn't get a good fit,” we said, “That's all that can be done.”

In essence, this was true, but it didn't alleviate the patient's problem. This is how things were, but it isn't how things are now. The dramatic advances in implant dentistry have caused a paradigm shift in the way dentists view replacing missing teeth or fixating a prosthesis. It presents rewarding opportunities for the general dentist and new hope for patients.

The future is already here

Often when a new technique is introduced, there's skepticism as to its practicality, affordability, and patient acceptability. This is especially true in private practice. Whatever services a dentist provides must make economic sense for his or her business. During the last 20 years, implant dentistry solved the problems inherent with tooth- or ridge-born prosthetics.

Once patients become aware of the tremendous value of an implant-supported prosthesis versus what they had before, they are more willing to invest in treatment. This creates new financial opportunities for general dentists, which makes economic sense for their practices. Twenty years ago, this was not the case. Fortunately, things have changed, and the future is now.

New markets for the general dentist

Implant dentistry has created two new kinds of patients: those whose resorbed ridges no longer support a removable prosthesis, and those who refuse to have teeth cut down to serve as abutments for a fixed bridge. In the U.S. alone, there are about 18 million edentulous patients. The majority of these people suffer due to a loose denture.

Not only can these people not chew well, which causes digestive problems, they can't enjoy the daily act of eating. Although eating is necessary to nourish the body, it is also a social function. Typically, these dental cripples go from dentist to dentist hoping to find a new set of dentures that “fit.”

Unfortunately, no ridge-born denture can really “fit” or be retentive when there isn't enough ridge to support it. Ironically, patients often blame their dentist for a poor fitting denture, when in fact it's the patient's deficient alveolar ridge — not the denture — that is the problem. When a loose denture is secured with dental implants, not only is it a source of new income for the dentist, it's a life-changing experience for the patient.

The other type of implant patient is one who refuses to have teeth reduced to support a fixed prosthesis. With the advent of the Internet, patients are increasingly aware of medical and dental advancements. They're no longer willing to accept, without reservation, the doctor's treatment recommendations.

In many cases, these patients research their options. If the doctor cannot confidently and predictably provide an implant-supported prosthetic for these patients, they will find a doctor who can — regardless of any wonderful past relationship. So the question becomes, “Which side is the doctor on — the losing side or the receiving side?”

General dentists start with implant dentistry

Strangely enough, there's a lot of buzz about dental implants, but not about implant dentistry. Implant dentistry is about creating a prosthesis that is secured by fixture(s) in bone (i.e., the implant) that will adequately restore function and natural esthetics to the area of missing teeth.There are two important components: the implant-supported prosthetic and the implant. General dentists are perfectly adapted to enter this discipline from the prosthetic end first. A resource to begin to understand implant prosthetics is Dr. Carl Misch's book “Dental Implant Prosthetics.” There are also numerous implant prosthetic continuing education courses.

After getting comfortable with knowledge about implant prosthetics and occlusion, the doctor should treatment plan and envision the prosthesis. A diagnostic wax up on mounted models is a good start. Next, the restoring doctor needs to find a dental implant surgeon. This specialist can be a general dentist, oral surgeon, periodontist, prosthodontist, or endodontist with training, skill, and experience in implant surgery and implant dentistry.

The other critical factor is that this doctor is compatible with the restoring doctor and is readily available to him or her throughout the treatment period. Ideally, the surgical and restorative doctor should meet to jointly treatment plan the first several cases. However, the restoring doctor should always remember when treatment planning that the prosthesis is the ultimate goal, not the implants themselves. So if the implants cannot be placed in a suitable way to support a prosthesis, they are of no value.

Consequently, it's the responsibility of the restoring doctor to guide the surgical doctor as to where the implant should be placed and why. A highly skilled implant surgeon will respect this, and will know how to create suitable boney sites for ideal implant placement. Remember, implant dentistry is a prosthetic discipline with a surgical component.

Future of implant dentistry with restorative dentists

Although the “team approach” to implant dentistry is common today, it makes the most sense from the patient perspective to see one doctor and have one fee for the entire procedure. It makes even more sense from the clinician perspective. It is obvious that treatment planning, surgery, prosthesis, lab coordination, hygiene, and long-term occlusal management can be more efficiently handled by one clinician with good training and practical experience in all aspects of implant dentistry. A properly trained restorative dentist fits this profile perfectly. Thus, the future of implant dentistry lies in the hands of those GPs who embrace this idea. They will reap the financial, professional, and personal rewards that implant dentistry has to offer.

Dr. Chris Hughes practices in Herrin, Ill. His practice is focused on implant dentistry, esthetic dentistry, and IV sedation. He is a Fellow of the Academy of General Dentistry, Associate Fellow of the American Academy of Implant Dentistry, and sustaining member of the American Academy of Cosmetic Dentistry. His practice is featured in the November 2008 issue of Dental Economics®. Reach Dr. Hughes by e-mail at [email protected].

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