Implant dentistry will become part of core practice

by Craig Cooper, DDS

It’s no surprise that the market for implant dentistry continues to grow impressively as the result of advances in science and technology and from the purchasing power of the most affluent older generation in U.S. history - the baby boomers.

First, let’s acknowledge the tremendous impact of evidence-based research in making dental implants the most predictable procedure - from an outcomes perspective - in dentistry today. We’ve evolved from the development of the first commercial titanium screw implants in the 1980s to a plethora of new implant products and systems which have been fueled by rising consumer demand. Companies are investing millions in implant technology because aging baby boomers with periodontal disease and other dental problems don’t want to bother with clumsy and uncomfortable bridgework. Folks who prefer driving BMWs to Fords want the best when it comes to dental care ... and many are willing to dig deep in their pockets to pay for it.

Implants aren’t new, they’re just better

People have been losing teeth since Adam met Eve, and through the ages procedures have been used to replace missing teeth with permanent, anchored implants. Some archeological findings have shown that the ancient Egyptians and Mayan Indians in South America tried to re-implant lost teeth with substitutes made of wood or ivory. Believe it or not, the first effort for human transplantation occurred in the 18th century when lost teeth sometimes were replaced by teeth from donors. Given the lack of knowledge about immune system responses and tissue rejection, it’s unlikely many of those crude procedures were successful.

Advances in metallurgy led to pioneering work in the late 1800s to implant anchors made from gold, platinum, and even porcelain in the jawbone. However, the seminal breakthrough occurred serendipitously, as often happens in science. In 1952, a Swedish orthopedic surgeon named Per-Ingvar Branemark accidentally discovered that his bone-anchored titanium microscope had bonded permanently to bone tissue. Annoyed, but curious, he pursued further investigation of this phenomenon and proved that titanium could be fused with living bone with great predictability and without inflammation or significant rejection risk. He first implanted titanium cylinders and fused them to the hipbones of rabbits. Additional studies included use of titanium screws as dental implants, and the science of osseointegration was born. The first practical application occurred in 1965 when titanium implants were given to an edentulous patient. However, it wasn’t until 1985 that the technique became accepted in dentistry. The implant systems we use today are based on Dr. Branemark’s original research.

With the knowledge and confidence that titanium fosters osseointegration, many improvements occurred in our field in surgical techniques, medical imaging enhancements, bone grafting advances, and the continual development of new implant products. With solid research and technology making implants safer and more long-lasting and predictable than ever, the market is booming today. But let’s also give due credit to the huge patient base comprised of adults who were born following World War II.

It’s a boomer market … for now

At the risk of overstating the point, technology and discretionary spending by the baby boomers are responsible for the remarkable growth of implant dentistry in the last 10 years. Baby boomers will be the richest senior-citizen generation in our history, and those of us in the implant business know our field is being driven by their dollars. While demand for implants is surging, let’s not delude ourselves into thinking this trend will continue forever. The market will adjust and we must be ready to adapt our practices to future trends. I strongly believe that very few, if any, of us in 10 years will be able to maintain a practice just doing implants.

By 2017, many of the baby boomers will have died. It will be impossible to replace their business due to the size of this population group and its high per-capita wealth. It is my opinion that the next generation, born in the late ’60s through ’70s, has benefited from better pediatric dental care, so the overall incidence of periodontal disease and tooth loss should be lower. Also, this group and subsequent generations might not be able to spend as lavishly as the baby boomers did. Clearly, the long-term future of implant dentistry depends on its becoming a regular service in the general dentist’s office. The mainstream implant market will be dominated by one- or two-at-a-time replacements precipitated mainly by accidents and injuries.

Though the overall market for implants will shrink, the core demand will not. Implants are now widely accepted by dental practitioners and patients as superior to bridgework and other procedures to replace missing teeth. As a result, the investment in new technologies and products will continue by implant companies.

Implants going mainstream

As dental implants become mainstream, more general dentists will include implants as a core service. This will make their patients happy because they want to be able to rely on their family dentists to provide a wide range of services, including implants. There won’t be huge numbers of implants performed in the average practice, but implants will be a viable part of a family dentist’s practice, especially for single-tooth replacements.

While I contend the unique size and financial well-being of the baby boomer generation have helped spur tremendous implant growth, let’s not forget that the permanent esthetic benefits of implants are very attractive to younger generations who are and will remain very conscious of how they look. They are driving the current boom in plastic surgery and cosmetic dentistry. More and more women and men in their 30s and 40s are undergoing facelifts and other cosmetic procedures. For many, part of the makeover involves getting veneers or implants to achieve that near perfect smile.

Implant dentists today are part oral-health professional and part cosmetic-solutions provider. It’s wrong to think our patients are coming in for partial or full-mouth implants strictly to achieve better functionality. Yes, many patients are better able to chew certain foods and enjoy a better quality of life thanks to dental implants. So, it’s good riddance to that bridge that never fit right and the discomfort and embarrassment it may have caused. For these patients and others, implants represent a discretionary spending decision. We are not competing for the health-care dollar. Vanity and convenience are the prime motivators.

We are not the local cardiologist whose decisions could have life or death implications. For example, I had heart bypass surgery four years ago and there was no choice. I had to undergo this procedure or risk having a heart attack. Let’s not assume that our patients see our services as essential health-care expenditures. What we do most of the time is offer noncritical care that helps patients keep their natural teeth, fix acute problems, and provide restorative or cosmetic improvements that support lifestyle preferences.

Today, the dental implant market benefits from the increased success rates of implants, particularly when compared to root canals. The single-tooth implant, rather than a three-tooth bridge, is recognized as the best treatment for replacing a tooth. Many candidates for root canals today would rather take the tooth out and get an implant. The Internet educates patients about the pros and cons of various dental procedures. The more they learn about the advantages of implants, the more they want them. After learning that implants don’t require cutting down healthy teeth, patients opt for them more frequently than for three-unit bridges.

Demand for one-stop dentistry

Many of us spend considerable time and money recruiting patients and making sure we keep them. Sometimes marketing is a very effective way to attract new patients, as is accepting patients’ dental insurance plans. I’m also finding that the best way for many dentists to keep patients in their practices is to offer a wide range of services instead of routinely referring to specialists. Patients want to stay in the offices they grew up in whenever possible, so why not make it easy for them by performing implants and other procedures?

Dental implant companies are responding to this trend by offering courses and other training tools to help general dentists become familiar with implant products and procedures. However, general dentists interested in adding implants to their practices are advised to get expert, comprehensive, professional training offered by the American Academy of Implant Dentistry (www.aaid.com).

While the future still looks rosy for dental implants, I’m concerned that the technology, especially in the area of increasingly sophisticated digital imaging, might be outpacing its overall value to the public. While digital imaging has been instrumental in helping fuel acceptance of and demand for implants, how far should it go?

I believe we should focus on keeping implant fees about the same as what commonly is charged for a three-unit bridge. We don’t want too much of a technology-driven price gap and negatively influence patient demand for implants, despite their advantages compared to bridges and root canals.

Implants belong in the general dentist’s practice. The tough cases always will be referred to the dentist with the correct experience to address the problem. But patients needing single-tooth implants will want them performed by family dentists as part of their ongoing oral health care.

Craig Cooper, DDS, practices implant dentistry in Indianapolis. He is past president of the American Academy of Implant Dentistry, and teaches courses on implant dentistry. Contact him by e-mail at [email protected].