Dental implants, news from the AAID Congress in Boston

aaid.jpgHe mentioned the successful completion of the legal, medical, and social battle for the recognition of implantology as an independent branch of dental medicine, which took several decades.
Perhaps it was good luck for the meeting itself that no breakthrough news emerged this year. At the end of the 6th decade of its existence, the company had a chance to evaluate the importance of its discoveries from the recent past.

There is a general consensus that modern implantology can hardly be performed without a cone beam or other tomography. Without 3D imaging, a dentist is prone to a myriad of potential mistakes. Patients are promised a 90 to 100% success rate of treatment, and some dentists even talk about 98% or 99%. This is, of course, utter nonsense, as long as the dentist doesn't know the key aspect, which is the real width and quality of the bone, before starting the operation. The conference concluded that the time is coming soon when any implant without tomography examination will be considered non lege artis, with all the consequences resulting therefrom. Approaches to the acceptance of CT-guided surgery are much more careful. This technique facilitates implantology for less skilled surgeons, provides many benefits, and often enables the entire treatment to be completed in a single day, including prosthetic solution, using a flapless procedure, which means without flap elevation. However, the costs of such surgery are still very high. The real large-scale use of these technologies is unlikely, especially given the conditions of Czech dentistry, unless the competition brings the prices nearer to the possibilities of the market. Meanwhile, such surgery does not employ bone augmentation and thereby moves implantology back to the stage when prosthetic treatment had to be adjusted to the lack of bone. The treatment is often fast and expensive, but not satisfactory in aesthetic terms.

Another distinctive trend is a departure from heroic surgical procedures with major reconstructions of the height and width of the alveolar processes. American dentistry, perhaps under the influence of the crisis, woke up. It realised that its main mission is to treat 40 million toothless Americans, whose quality of life could be dramatically improved using several implants and stable tooth restorations. There are huge opportunities in this field, which will certainly be more important in social terms than aesthetic struggles for 1-2 mm of the interdental papilla. Undoubtedly, the not very convincing outcomes of many challenging operations which were described in superlatives in recent years also played an important role in this situation. In the past, Congress communications often demonstrated that the use of a replacement bone product of one or the other manufacturer almost automatically results in the growth and regeneration of the bone structures. It was revealed that such growth has not been that convincing or predictable. Many authors now prefer the prosthetic replacement of the height of the alveolar process by fixed restorations with "pink" ceramics over several years of complicated operations aimed at fully reconstructing the height and width of the alveolar process. To achieve this in the order of several millimetres is much more complicated than is sometimes reported. Not a single word was mentioned about the great hit of the past years, bone growth factors. It was revealed that the high price of these products in practical life does not correspond to their benefits. We will see what happens in further development. There is also a consensus regarding a reduction in the number of implants that is necessary. Many authors espouse a strategy with 4 implants in both jaws (if the conditions are optimal and the patient is not prone to bruxism).
In complicated situations, the use of 6 implants should be safe, primarily in the maxilla. It seems that the extensive approach, such as "every tooth needs its own implant", or 8 to 10 implants per jaw, has come to an end.

The highlight of the Congress was the excellent lecture by Dr. Amos from the Cleveland Clinic, who talked about the anatomical and technical complications he faced during his first transplant of a human face. This surgery raised many new questions but also provided answers in the form of several technical solutions that move face reconstruction surgery into new dimensions. I remembered many patients from our country who need such an operation, and I believe that a team of surgeons will be formed in the near future who will be able to take on such a challenge. It should be noted that the aforementioned first patient had originally suffered less damage, which was exacerbated by the unsuccessful attempts of less skilled surgeons.

At its 59th Congress, the American Academy of Implant Dentistry showed itself to be a very mature society, which has successfully built a new medical discipline that helps patients in an unusual way and with great reliability. The Academy can be progressive but it must cope with some crazes and excesses which sometimes satisfy the dentist at the expense of patients. Its priority is a sick human rather than research alone. We look forward to next year’s Congress, the jubilee 60th gathering, this time in Las Vegas.

Assoc. Prof. Roman Šmucler, MD.
Department of Stomatology, First Faculty of Medicine, Charles University Prague

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