Dean Morton, BDS, MS, FACP
Confidence in these procedures is associated with implants that are predictable in terms of their biologic response and therefore capable of handling a range of placement and loading protocols. Improved outcomes can be associated with both tissue and bone-level implants with the SLActive surface, irrespective of inclination. Ultimately, a definitive prosthesis can be planned and used to appropriately coordinate all aspects of treatment—both surgical and restorative. The patient receives treatment that incorporates the latest implant, restorative, and radiographic options. Ultimately the clinician delivers an efficient and predictable outcome, whether immediate or accelerated, that brings satisfaction to all.
The patient type is also evolving. Today many patients present with a failing dentition rather than an edentulous arch. Treatment considerations include removal of teeth and management of the edentulous ridge. Advances in implant design and surfaces, treatment methodology, and assessment protocols help to greatly reduce total treatment time. The evolving portfolio of components increases predictability for all loading protocols, and increased satisfaction for patients.
An increasing number of options that reduce the invasive nature of surgery and improve efficiency are available. Altering implant and connection angle can help make surgery less invasive with immediate placement of implants and reduced need for augmentation. These protocols can distalize the connection and manage the biomechanical influence of any cantilever. The bone level and bone level tapered implant designs can be ideal.
There are reasons, however, for caution. Extraction of teeth partnered with large mucoperiosteal flaps and extensive ridge modification is a complex surgical procedure. It requires a great deal of clinical experience. As complexity increases, the quality of the clinician becomes more critical. The patient presented here benefits from the collaboration between the periodontist and the prosthodontist. The experience, skill, and education of the team is broad spectrum, and difficult to obtain from any single specialty. For example, the space required for uneventful restoration is less understood by the surgical team while the complexity of evolving surgical procedures can be difficult for the restorative team to appreciate.
In summary, the treatment presented here illustrates a contemporary, patient-focused team approach to a complex clinical presentation. Success relies on an evolving and well-executed protocol incorporating the very best implant and restorative options.
Dean Morton, BDS, MS, FACP
Professor and Chair, Department of Prosthodontics
Indiana University School of Dentistry
Indianapolis, Indiana
