What is new in contemporary practice?

There have been tremendous advancements in existing technology and materials science. Diagnosis, treatment planning, and clinical therapeutics have become more accurate and efficient with the use of these tools. However, these advancements have not necessarily made the overall practice easier.

Immediate loading is not new. Throughout the 1960s and 1970s, blade implants were commonly placed, and they were routinely immediately loaded as they healed by fibrous integration. Personally, as soon as the ITI team launched the single-stage hollow basket implant, I embraced the concept of immediacy. I began utilizing single-stage protocols for immediate bridges, single implants, and full-arch cases as a routine part of my practice.

Scanning technology also has been in use. In the late 1980s and 1990s, we were already using hospital-based CT scans for implant cases during residency and private practice. Some of the significant changes include the addition of biologic modifiers. I have been using the BTI protocol for 15 years, developed by Dr. Eduardo Anitua, MD, DMD, which involves growth factors, drilling speed, autogenous recovery, and ridge expansion protocols. Additionally, the introduction of different laser wavelengths, such as LANAP, has revolutionized periodontal therapy by accelerating and modifying treatment. It allows for the treatment of advanced occlusal periodontitis that was previously difficult to address surgically. Full-mouth therapy can now be delivered without sutures or flapping, providing a conservative and repeatable treatment modality. Moreover, the use of surgical guides has evolved placement strategies, and pinhole placement options have become more common in various cases. The advent of CAD design has improved the tolerances between different parts and prostheses, although misfits still occur.

Many of the implant designs that are now considered standard of care were already available and being designed in the 1980s. Our colleagues in Europe were pioneering implants with specific biologic parameters, including reducing crestal bone loss through platform switching, achieving zero micro-gap for bacterial penetration and micro-movement, optimizing cell surface, and designing threads for optimal primary stability. As implant designs matured, macro-mechanical retention (primary stability) increased, micro-mechanical biologic healing (secondary stability or osseointegration) reduced to 12 weeks and then 8 weeks, and bone-to-implant contact approached 70%.

Globally, the dental profession has made tremendous strides in improving overall health outcomes. The periodontal research community has significantly advanced our understanding of the intricate relationship between oral inflammation and systemic inflammation. The connection is now clear, leaving no room for doubt. However, the U.S. has been slower in addressing critical health concerns such as the toxicity issues associated with the materials we use. Specific areas of concern include fluoridated water and metal alloys, which have been shown to disrupt cellular, electrical, and immune functions. As a result, I have observed an increase in sensitivities, neuralgias, unexplained pain, peri-implantitis, and implant failures.