A conversation with Dr. William Martin

Please introduce yourself to our readers. What is your background?
I’m the Director for the Center for Implant Dentistry at the University of Florida, College of Dentistry. I received my DMD training at the University of Florida and furthered my education attending Baylor College of Dentistry for Prosthodontics. I am a Diplomate of the American Board of Prosthodontics and a Fellow of the International Team for Implantology (ITI).

Do you see any trends in implant dentistry?
Over the past 6-7 years, our patient consultations have shifted from initiation of treatment to management of implant complications. Most patients we see today have implants in place and are having problems with them, such as peri-implantitis or prosthetic problems. I think that’s the evolution that we’re faced with in implant dentistry. As a broader range of people start incorporating implants in their practice, and as more people get implants, you are going to have a higher number of complications.

How do you use Osstell in your clinic, and what are the main clinical benefits you have experienced?
We were one of the early adopters of Osstell. It used to be case-specific, but now it is used on a daily basis to gather additional information for the overall treatment of the patient.

For example, we have patients that come in with complications, where we have no previous background on them; we have no history on the implant, whether it was placed in a compromised situation, lacked stability, grafted, etc. So we use tools to try to diagnose what the problem is with that particular implant. Utilizing the Osstell with its Implant Stability Quotient (ISQ) readings gives us additional information in determining the health of the implant. I feel when access to the implant connection is possible, the Osstell gives us a minimally invasive approach to evaluating the health of the implant.

The other area where Osstell plays a big role is in the education of young clinicians. We use the ISQ values after placement to give them a parameter to relate to the feel of the osteotomy preparation and how this may correlate to implant stability.

We also see a benefit with the Osstell device based upon our patient population. Most of our patients fall under a category of advanced or complex, most often referred to us for treatment due to difficulty. It is not uncommon to see patients that either have a history of implant failure or are in the need of large amounts of augmentation. So we often find ourselves using all the tools available to diagnose and treat in an effort to ensure a successful outcome.

How do you determine the degree of osseointegration before the final restoration?
We are trying to integrate Osstell in the new surgeons’ environment so that they use that in combination with their experience to determine osseointegration. Osstell can play a role in confirming the osseointegration before sending the patients back to whoever referred them. Osstell is extremely beneficial when you get measurements over time, at time of placement, and before loading. I always want to see the progression — that the numbers are getting bigger.

How do you decide which protocol to use?
It is really based upon what clinical characteristics our patients present with. I am a firm believer in Dr. Dennis Tarnow’s “one miracle at a time.” We often find our patients exploring broad options to finance their treatment, so it’s not in our best interest to do anything that could put the implant(s) and rehabilitation in jeopardy.

How much does a failure cost?
We use a dental implant system that will replace the implant at no cost after failure. So when patients are compliant with our recall and maintenance program, they will not incur a cost for the implant, but will be responsible for any grafting, radiographs, and adjuncts needed to replace the implant. Where it really hurts you is in the restorative side of things. Many of those costs are passed on to the patient, depending on what you offer as far as a warranty. We educate patients that nothing is permanent, that there are associated risks, and that maintenance and follow-up is required.

I can tell you an example I heard in a lecture regarding the cost of failure: In his practice, a clinician had a 96% implant success rate, and he was placing 1,200 implants a year. That means he had about 4% failures, which is about 48 failures a year. Each one of these failures would be negotiated with the patient, and the price would be determined. If another company then comes along and says it can increase your success rate from 96% to 98%, that’s a significant difference. You have then reduced the number of failures to 24 a year. Even small changes in percentages make a huge difference in chair time and overhead.

Don’t miss Dr. Martin’s lecture at the Osstell Corporate Forum at the Annual Meeting of the Academy of Osseointegration in San Diego, California, on February 18, 2016, from 10:15 a.m. to noon.

For more information, please visit the website: osstell.com/ao2016.

This article was provided by Osstell.