By Dr. John Jameson
This month, Dr. John Jameson interviews Dr. Victor Sendax, a past national president and fellow of the American Academy of Implant Dentistry and past president and diplomate of the American Board of Oral Implantology/Implant Dentistry. He also is a patent-holder in mini-dental implants, magnetics, and abutment couplings, and is considered by many to be a pioneer in the field. Dr. Sendax is a director of IMTEC Corporation, which manufactures and markets the Sendax MDI mini dental implant system.
Dr. Jameson: What kind of practice growth and change have we seen with the integration of implantology into the treatment mix and plans?
Dr. Sendax: It's given an enormous impetus to the totality of the dental practice. The history of dentistry is a mix of different things. We've come a long way in improving operative dentistry, which includes crowns, fillings, inlays, etc., with esthetics, bonding, and other issues. The advent of dental implants has given practitioners a "leg up" when restoring patients' mouths with complex problems. It has en hanced the dentist's ability to present himself as a true doctor of the mouth, rather than a technician or dentist related to the idea of "fill 'em or pull 'em." Implants have given the average practitioner a new lease on dentistry.
Dr. Jameson: What changes have you seen in implant design?
Dr. Sendax: We've tried to simplify what has become a complex field. Implants were originally simple, straight forward devices that have become increasingly complicated as we have developed many variations of the basic idea of a jaw anchor. Screws, parts, devices, and attachments all have multiplied and complicated the practitioner's ability to offer implants to the public. With that complication, costs have increased; but the technology has improved enormously. Our ability to place the implant and modify the environment around the implant with grafts and membranes has led to large-scale enhancements to the fundamental type of implant procedure. It's become complicated and more expensive, but we're moving into an exciting time because simplification of implants is now being examined.
Dr. Jameson: What about the general practitioner who is looking to include implants? What is a good source of education?
Dr. Sendax: One of the problems we have in dental-implant education is the lack of adequate undergraduate training in implants in dental schools. However, that's beginning to change. I chaired a program at the American Association of Dental Schools meeting last year in which a forum was conducted to discuss the advances in undergraduate programs dealing with implants. I think this is an area for the general practitioner to get an extra educational boost, but it is still sporadic. The missing educational process is made up for by continuing-education programs. A lot of these programs are sponsored by implant manufacturers. It's a questionable issue: Should training in this complex area be conducted by manufacturers? I'm not saying they aren't doing a good job of educating, but inevitably there will be a certain amount of bias in their teaching sessions. It would be nice for tomorrow's practitioners to come out of dental school with an underlying understanding not only of the theory of implants, but also the practice, placement, and restoration of implants.
Dr. Jameson: How did you get the education you needed to obtain a "comfort zone" when discussing implants with patients?
Dr. Sendax: The main source was working with other practitioners in a mentoring relationship. If you receive your hands-on training under the watchful eye of a dentist who is well-versed in implantology, you will gain very good training experience. I worked with some heavy-hitting practitioners many years ago, and those mentors were able to give me the background I needed. I think it's harder to find that kind of relationship today. Dentists now need to go to training centers sponsored by schools or practitioners. I still think the ideal setting is in an undergraduate setting. We're moving in that direction, but it has been - and continues to be - a slow process.
Dr. Jameson: What are your impressions of the new implant products available today?
Dr. Sendax: The mini-dental implants - used initially as temporary or transition implants - gradually are becoming respected for their longer-term applications. I think that's a big breakthrough for our profession. I've worked in the implant field for more than 30 years, and these cost-effective devices have allowed me to treat patients whom I couldn't have treated otherwise.
In 1976, we placed mini-implants (1.8 mm in width) directly through the soft tissue and the crestal bone and into the surface beneath the cortex by the maxillary bone. We would use a small drill at moderate speed. The implant also has become self-tapping, which means we're not drilling a hole in the bone or damaging it. We're looking for something that can become functional immediately, without waiting for the site to heal. The bone doesn't have to grow into contact with the mini-implant, as it does with a conventional implant - a concept considered radical years ago. At first, we encountered resistance because these implants only could be counted on to integrate sporadically. It gave these implants a guarded reputation; they were considered "hit or miss" and unpredictable. This stemmed from the fact that, when dentists substantially drilled into the bone, we didn't realize that it takes a certain amount of time for that bone to grow into contact with the implant and support it. We were left with a troublesome scenario - sometimes the implants would work beautifully; sometimes they would be a problem.
What I've attempted to do is take the basic Bränemark principle - which is to have bone in direct contact with most of the surface of the implant - but not destroy any bone at the beginning of the procedure. We developed a proprietary thread design (a modified reverse buttress thread) and were able to get the implant to work its way into the bone with auto-advancement. It's as if the implant is drawn into the bone as you turn it, rather than having to work hard to get it to happen. The amount of compression on the bone is modest and not destructive. When the implant reaches its position in the bone with this slow turning process, the implant is considered integrated in the Bränemark fit. At the light microscopic level, we can see a direct bone interface and contact with the implant surface, and it's immediately supported by the bone. It also gives us a high level of predictability and stability. Even though it's very simple and straightforward, it represents a radical departure from what has taken place in the past.
The device is not the primary issue here; it's the insertion protocol that is paramount. We didn't want to do surgery. We wanted to take a small starter implant directly through the soft tissue and just enough into the bone to form a "starter." We arrived at a width ideally suited to withstand structural damage. Through trial and error, we settled at 1.8 mm, which was structurally sound and permitted itself to slide and slip right into the underlying bone with little or no trauma or force if we did our preliminaries correctly. The first one we did in 1976 still is functioning for that patient. The woman is in her 90s and going strong. She never wanted to part with the system after we tried it on her. It's only been adjusted, but not altered. Not every case has been like that, but it has been very instructive to me to see it withstand all of the functions over the years. It has stood the test of time. It may be new to the profession, but not to me and some of my colleagues. The FDA never gives a system its seal of approval, but allows the person(s) the right to market the device to the profession with approved labeling. The FDA has said that it's OK to market this device for transitional and ongoing applications, meaning it's not only allowable to be sold in the profession for temporary use, but also for ongoing use.
Dr. John Jameson is chairman of the board of Jameson Management, Inc., an international consulting firm. Dr. Jameson lectures internationally on high-tech dentistry and its integration into the dental practice. He provides research for manufacturers and marketing companies. Dr. Jameson may be reached at (580) 369-5555 or by e-mail at email@example.com.