Improving outcomes through preplanning and preparation

Implant dentistry is unique in that it continues to evolve at a much faster rate than other forms of dentistry. The techniques, modalities, and designs regularly shift to address clinical needs such as primary and secondary stability concerns, peri-implantitis, accuracy, speed, and ultimately, patient demands.

It is in the area of patient expectations that many practitioners are seeing the most need for change. While optimal esthetic desires continue to perpetuate, the need for a more expeditious procedure is growing. This need is predicated by patients’ busy lifestyles, the constant onslaught of communication created by social media and other modalities, and the general busyness of the population overall. Recent reports indicate that Americans are finding themselves busier than ever, with data from the U.S. Bureau of Labor Statistics indicating that the average productivity of the American worker has increased 400% since 1950!

Less time can translate into a need for faster, more effective procedures. And for the partially or fully edentulous patients, or those who are terminally dentate, there is a need for a faster and more effective way to get a full arch replaced with implant-supported hybrid prosthetics.

Conventional methods require a laboratory technician to convert a denture chairside while a patient undergoes extractions, grafting, and other processes necessary to prepare the site for implants and the accompanying full-arch prosthetic. This time requirement can extend a procedure to more than 5 hours, while the patient remains in the chair. Oftentimes, the patient is sedated during the surgical portion of the procedure and then awakens to find that his/her teeth have been extracted and he/she is now edentulous. This can cause anxiety in a patient that may be exacerbated by prolonged time awaiting a provisional prosthetic to be fabricated by a technician.

Advancements in guided technology are now allowing for more complex procedures involving numerous implants and an entire arch to be conducted in a precise manner due to collaborative, comprehensive, yet convenient preplanning sessions. Patients typically prefer this type of dentistry because it can reduce time in the dental office from 4-6 hours per arch to 3-4 hours when performed properly.

Guided surgery workflows, pioneered by laboratories like nSequence® in Reno, Nevada, transform full-arch surgery into a precise, preplanned effort by having the surgeon, restorative dentist, and lab personnel participate in a comprehensive consult prior to the surgery, which allows for all parties to agree on the exact course of treatment to be taken. This collaborative approval also allows for fabrication of the provisional restoration — in this case, a PMMA prosthetic reinforced by an integrated metal bar, based on a set of clearly mapped diagnostics, readily available day of surgery. This adjustment allows for placement of the provisional within an hour of suturing after implant placement occurs. The patient is then given a set of teeth in a more expeditious manner and is able to be immediately loaded with immediate function for a more pleasing experience.

The need to freehand implant placement is sometimes unavoidable, as CBCT technology — while precise — is not entirely without error. There are instances where dehiscences or other bony defects may not be visible, and therefore, flap reflection during these types of cases may reveal an unexpected challenge. However, when possible, the conveniences allotted by preplanning a case and the ability to fabricate a provisional for the day of surgery are numerous. These benefits address the growing need to make implant dentistry — even more comprehensive cases — convenient for the busy patients or for the patients who do not want to endure long hours of post-surgical time in a dental office awaiting their new teeth.

Dr. Michael A. Pikos