Richard Hughes, DDS

What can you tell us about your background?
I earned a B.S. in microbiology from the University of Maryland, College Park, and a Doctor of Dental Surgery from Meharry Medical College in Nashville, Tennessee. I was exposed to subperiosteal dental implants while a student at Meharry. The surgical and prosthetic faculty at Meharry had a collaborative effort with the VA Medical Center located on the Vanderbilt campus. At the time, I thought the surgery for a subperiosteal implant was way too much for a person to go through for the sake of eating and having teeth. I thought dental implants were quackery. To say the least, I was an extremely narrow-minded dental student.

Fast-forward to 1990. Dr. Sammeh Hannah, an oral surgeon with an infectious enthusiasm for dental implants, sent some other GPs and me to a Core Vent prosthetic course in Timonium Maryland. I did not understand a thing from the course!  I felt like an absolute moron. I reluctantly got into dental implants in 1991. A patient came in and specifically requested dental implants. He explained that he was done with partial dentures. Dental implants were not as popular then as they are today, but the way he described his plight struck a chord with me! I changed his life, and this experience changed my life. I soon thereafter took a Core Vent surgical and prosthetic weekend course. I buckled down, applied myself, and mastered the material from this course. A month later, I placed the implants in the gentleman, and subsequently restored him with cement-retained fixed prosthetics in two quadrants. The implants from this first case are still functional, but prosthetics have subsequently been re-restored twice.

Soon after this, I enrolled in the 13-month-long dental implantology program at Howard University College of Dentistry in Washington, DC, which was in conjunction with the American Academy of Implant Dentistry. I was bitten by the bug, especially after listening to Drs. Leonard Linkow, Morton Parel and Bob James. These three men changed my life. I subsequently earned Fellow status with the American Academy of Implant Prosthodontics, and a couple of years later Associate Fellow of the American Academy of Implant Dentistry. After that, I went through a divorce and focused on my children and not so much on implant dentistry. About 10 years after the divorce, I met my better half, Dr. Cindy Vu, and with her support, soon became a Diplomate, American Board of Oral Implantology/Implant Dentistry (ABOI), and Fellow of the American Academy of Implant Dentistry. Several years after becoming an ABOI Diplomate, I was chosen to sit on the ABOI Part One Test Construction Committee and to be an oral examiner for the ABOI and a reviewer for the Journal of Oral Implantology. I subsequently became a consulting oral examiner for the AAID. I take these responsibilities very seriously. I am also on the faculty of the Vancouver AAID Maxi course, Vancouver, BC, Canada.

Is your practice limited to dental implants?
Pretty much, yes. I have about a 90% surgical and prosthetic implant practice. I even perform implant revisions for other doctors’ patients.

Why did you decide to focus on implantology?
I realized that I could not effectively treat prosthetic patients without dental implants. Plus, more patients were asking for dental implant treatment as time progressed. So I merged dental implants into my prosthetic services. It’s emotionally and professionally satisfying to rehabilitate patients with deep dental needs.

How long have you been practicing, and what systems do you use?
I’ve been a doctor since 1982 and started placing and restoring dental implants in 1991. I use A.B.™ Dental, Bicon® Dental Implants, and Quantum™ Implants. I still place and restore blades (Pacific Implants Inc., Ultimatics Inc., and Parc Dental), ramus frame, and subperiosteal implants.

What training have you undertaken?

I took a fantastic year-long dental Implantology program at Howard University College of Dentistry. Even though I was already keenly interested in dental implants, I became absorbed by this field after I was exposed to Drs. Morton Parel, Bob James, and Leonard Linkow in the Howard University program. After hearing them, I never looked back. There I was exposed to a wide array of surgical and prosthetic methods. I was taught by Drs. Leonard Linkow, Terry  Reynolds, C. Benson Clark, and Hilt Tatum, to name a few. I took classes from Drs. Joel Rosenlicht, Richard Borgner at Tatum Surgical, Anthony Sclar, Joseph Chakroun, and James Rutkowski. I’ve also had personal instruction from Drs. Leonard Linkow and Ralph Roberts in subperiosteal, ramus frame, ramus blade, and blade implants in general. There are many more that I cannot recall. My training was multimodal, so I feel fortunate that I have many reliable ways to treat my patients. My staff and I recently trained at the Sclar Center in Miami, Florida, in the All on 4® concept. The Sclar Center did an excellent job teaching this concept.

Who has inspired you?

My parents and family were always behind me and encouraged me to study dentistry or medicine. My childhood family dentist, Dr. Jack Reynolds of Edgewood, Maryland, inspired and encouraged me to become a dentist. Dr. Cindy Vu, my better half, has always been an immeasurable source of support; without her by my side, I would not have made the professional strides I’ve made. I was very fortunate to have been mentored by Drs. Leonard Linkow and Ralph Roberts. They opened my mind and taught me many ways to treat and help patients. I give thanks to Maurice Valen of Impladent Ltd. for imparting his vast knowledge of bone physiology to me.

What is the most satisfying aspect of your practice?
Improving people’s quality of life, self-esteem, appearance, and function. I like getting people out of their physical and mental pain. I am blessed to practice a profession that I love. Getting up and going to the office is not a chore but an enjoyable experience. Many patients, both men and women, tear up when I tell them I can treat them, after they have been told by other doctors that they are not candidates for dental implants. Many hug my staff and me when we complete their treatment, which for us is always a big deal. I thank God for giving me the intellect and skills to help people, and my parents for teaching me a strong work ethic and to always do my best.

Professionally, what are you most proud of?

I am proud of several things. I was made an AAID Honored Fellow last year. I am still humbled by this distinction. Dr. Ralph Roberts, who is one of the early pioneers in implant dentistry, asked me to place one of his implants in him. He flew from California to Virginia for treatment. I extracted his fractured maxillary right lateral incisor and placed one of his STR (Single Tooth Replacement) implants. I made an impression immediately after implantation for the final crown and provided provisionalization on the same visit.

There are several other things I’m proud of as an implant dentist. I’m proud of the credentials I have earned and activities, which were discussed earlier. I also testified with Dr. Ralph Roberts before the U.S. Food and Drug Administration on July 13, 2013, for the reclassification of blade-form dental implants from a Class III to a Class II medical device. Thus, blade-form dental implants have the same classification as root-form dental implants. I’m an officer for the Southern District of the AAID. I also sit on the Board of Directors of the American Academy of Implant Prosthodontics and the International Academy of Implants and Transplants. The fact that other dentists in my community and implant dentists seek me out for dental implant treatment on themselves is also a distinction.

As I mentioned earlier, I am humbled and do not take any of this for granted.

What do you think is unique about your practice?
My staff and I treat people as if they are houseguests. It is also unique that I place and restore a relatively high volume of implants.  I treat several implant patients every day, performing the different stages of implant treatment, employing several dental implant modalities from root forms, blades, and subperiosteal implants. I even employ the All-on-4® concept to treat patients. I also give one-on-one instruction to dentists who want to learn about implant dentistry.

What has been your biggest challenge?
I transitioned from a general practice to a surgical and prosthetic implant practice when the economy was tanking. It was hard enough practicing dentistry during 2008-2013, let alone shifting from a general to a specialty practice. This transition was tricky — balancing marketing efforts for general and implant patients while developing brand recognition as an implant dentist. This also impacted negatively on cash flow for a while, but everything clicked, and I’m in full gear. This was particularly difficult, but I had faith and believed in myself!  One needs a vision and a plan. Cindy and my staff were extremely supportive during this time. They also believed in me and my leadership. I am also challenged and intrigued by the exciting changes in prosthetic dental materials and digital imaging.

What would you have become if you had not become a dentist?
That’s an interesting question!  It’s hard for me to imagine not being a dentist/implantologist! Perhaps a virologist, medical pathologist, general or orthopedic surgeon. I could even see myself as a civil engineer building roads, bridges, dams, or buildings.

What is the future of implants and dentistry?
I can see more dental implants placed and restored by general dentists as patients’ demands increase and as dental schools introduce dental implants into the basic curriculum. Obviously, there will be changes in implant surface technology and the constituents of the implants themselves. I am keeping an eye on the zirconia and short-body implants. There will be a resurgence in blade, disc, and subperiosteal dental implants once doctors realize the limits of bone grafting. I can see a move away from using xenografts and allografts, toward strictly autografts and alloplasts combined with platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). There is and will continue to be a revolution in regenerative dentistry. Just look at how PRP and PRF have changed our regenerative capabilities. We should keep a sharp eye on stem cell research. God only knows how it will change dentistry and medicine. I would also keep an eye on using stem cells to grow teeth. This could be a big game changer.

CAD/CAM restorations will become more feasible to employ in the dental office by way of cost, prosthetic fit, and esthetic results. The changes in pharmacology will have a demonstrable impact, both good and bad, on dentistry and oral implantology. The changes in dental materials and imaging are stimulating to say the least and will continue to evolve.

There will be discoveries in craniobiology, growth, and development that will positively affect orthodontics and dentistry in general.

What are your top tips for maintaining a successful implant practice?
Always keep the patient in mind, and pay attention to your bottom line. I do not believe in employing more people than it is necessary to efficiently run my practice. Always treat your staff with respect; you cannot build a respectable practice without good staff.  Hire slowly, and fire fast; there is no need to keep deadwood on the payroll.

Keep your treatment plans as uncomplicated as possible but well engineered. Be firm on collections but flexible on payment plans. Don’t rush patients into treatment. Again, there is no substitute for hard work. Sometimes patients who request dental implants are best managed with conventional prosthetic dentistry.

Top 10 favorites
1. My family and country
2. Being a grandfather
3. My fantastic staff
4. My Titleist® 910D3 driver and fairway woods
5. Learning in general
6. A good beef pot roast
7. Old movies (starring Humphrey Bogart and Gary Cooper)
8. Fly-fishing, golf, and hunting
9. AB dental Implants and drill stopper burs
10. OsteoGen® products by Impladent Ltd.

What advice would you give to a budding implantologist?
We all start as beginners, so get well trained in basic surgical principles and prosthetics, inclusive of occlusion. Take an AAID Maxi course; it’s a great start. Find a willing, knowledgeable, and experienced mentor. Always keep an open mind. There is more than one modality and way to treat a patient. I like the phrase, “I would rather have a mind opened by wonder, than closed by belief.”  Listen to your patients, and help them discover the best way for their treatment. Get involved with the American Academy of Implant Dentistry and the American Academy of Implant Prosthodontics. These organizations and others I’ve mentioned are fantastic, and each one brings different elements to the table. The International Academy of Implants and Transplants meeting offers a lot of unscripted live surgery for the attendees to view and study. There is no substitute for hard work and burning the midnight oil!  Measure 3 times, and cut once. Always maintain a balance with your family and practice. Family and health are the most important, hands down.

What are your hobbies, and what do you do in your spare time?
I enjoy downtime with my family. I also enjoy golf, hunting, fly-fishing, and learning in general.  I also like following Maryland Terps’ sports.