Question ...
In the November 2004 issue of Dental Economics, there was a letter to the editor expressing concern about your suggestion in a previous column that general dentists should become involved with implant surgery. He felt this procedure was not appropriate for general dentists. Would you elaborate on your opinions about the prerequisites for a general dentist who wants to learn to place implants?
In the November 2004 issue of Dental Economics, there was a letter to the editor expressing concern about your suggestion in a previous column that general dentists should become involved with implant surgery. He felt this procedure was not appropriate for general dentists. Would you elaborate on your opinions about the prerequisites for a general dentist who wants to learn to place implants?
Answer from Dr. Christensen ...
As I begin to answer your question, I will state clearly that I have great respect for those specialist practitioners (oral surgeons, periodontists, prosthodontists, and recently, endodontists) who are placing implants. I must also state that I am a board-certified prosthodontist who, because of my research orientation over many years, has been involved clinically with every aspect of dentistry. Most of my many years of practice have been related to oral rehabilitation, from minor to complex, including hundreds of implants - both surgical placement and prosthodontics.
There are indications for general dentist placement of implants, and there are many contra-indications. The general dentist must know the differences, some of which I discussed in a previous column. My personal prerequisites for a general dentist who wants to place implants are as follows:
1) An interest in the surgical aspects of dentistry.
2) Successful experience in the surgical aspects of dentistry.
3) Hands-on continuing education in implant placement and restoration. This includes detailed education on patient selection, implant indications, and contraindications.
4) A commitment to observe and learn from a practitioner who places implants.
5) An association with a local mentor who is willing to answer questions and assist in teaching the general dentist to place implants.
6) A commitment to become up-to-date on the use of antibiotics and analgesics.
7) A commitment to constantly update the dental team on the emergencies which occur in the dental office. You also should purchase and use a pulse oximeter and other diagnostic and emergency devices deemed necessary.
8) Agreement to provide adequate postoperative care. In my opinion, unlisted phone numbers - now common among dentists - are not acceptable for someone placing implants.
9) Commitment to continue learning as the field changes. Although I completed an approved graduate program which qualified me in my specialty, I use only a few of the concepts or techniques taught to me many years ago. Continuing education is mandatory in implant dentistry.
Before graduate programs were available on implants, I learned to place implants using the concepts I have just described. You must remember that only a few years ago, every person who started placing implants - including periodontists and oral surgeons - had to learn through self-education and clinical experience. Often forgotten is the fact that most of the implant placement, design, and research pioneers from North America in the 1950s were general dentists and prosthodontists, not surgeons.
My own area - fixed, removable implants and maxillofacial prosthodontics - has many complex procedures, comparable to or more difficult than implant placement. But I am willing to teach any general practitioner who has the motivation to learn any of the aspects of prostho-dontics, using the same prerequisites I listed in this column.
It is well known that a general dentist who becomes involved with any identified specialty procedure soon refers more patients to specialists than he or she did before becoming involved with that area. As a result, everybody wins - the patient, the general dentist, and the specialist.
I have no reservation in stating that implant placement in bone of adequate quality and quantity in healthy patients is well within the realm of general practice, and this procedure should be encouraged for general practitioners to learn and it should be taught in predoctoral dental school.
For practitioners of all types, PCC has several implant videos which will update and instruct in all phases of simple and some complex implant dentistry. For more information about V2300, “Making Decisions About the Successful Use of Implants”; C900A, “The ‘Mini’ Implant for General Practitioners”; V2301, “Simplified Implant Surgery”; and V2392, “Prosthodontics for Implants Simplified,” contact Practical Clinical Courses at (800) 223-6569, or visit our Web site at www.pccdental.com.
Question ...
From time to time, I feel it is necessary to repair a previously placed resin-based composite with a new addition of resin, without taking out all of the old resin. Is there a predictable and successful way to do this? I have had several failures when I have attempted to repair old resins.
Answer from Dr. Christensen ...
As you know, the best way to repair a restoration is to remove all of the old resin and replace it with new resin. However, sometimes, for various reasons, each of us would rather repair a previously placed resin. In the event of a previous pulp exposure or near pulp exposure during the original restoration, I would rather repair the restoration than take it out entirely. If the old restoration is large, the patient is better served if the old restoration is not totally taken out , thus reducing the potential for removal of more tooth structure.
How do you best repair an old restoration? I suggest conservative removal of the defective portion, followed by careful inspection of the remaining portion of the restoration to ensure that it is still retentive and that the remaining margins are acceptable. Make sure that all caries has been removed in the new tooth preparation, and that the remaining old restoration appears to be serviceable. When repairing a restoration, place undercuts in the old resin, as well as in the remaining tooth structure. A one-fourth or one-half round bur can easily be used to place small retentive features. Make the repair restoration retentive by itself, because it will not bond well to the original restoration.
Sandblast the remaining old restoration with aluminum oxide, using a Danville Materials’ Microetcher IIA or a similar device. This procedure removes the resin debris from the glass filler particles and allows better bonding of the new resin to the old. Wash the old resin and the newly repaired preparation well. According to the manufacturer’s instructions, place Parkell Add & Bond, which is an adhesive designed to attach new resin to prepared old resin. This technique should provide adequate retention and reasonable longevity for the combined old and new restoration.
Again, I would like to emphasize that the best way to repair an old restoration is to replace the entire restoration.
Our popular video, C501B, “Predictable Long-Lasting Class 2 Resin Restorations,” discusses how to place nonsensitive, predictable, relatively easily placed restorations. For more information, contact Practical Clinical Courses at (800) 223-6569, or visit our Web site at www.pccdental.com.
