For many years, most dentists were reluctant to replace missing teeth with implants - even when the existing bone was suitable and the patient actually preferred a nonremovable solution as compared to dentures or partial dentures with bridgework. The caution was understandable. Placement involved more extensive surgery than most dental procedures. Even implant “specialists” had a hard time knowing exactly where to place the titanium screws. Therefore, the surgery was somewhat exploratory, and could easily miss the mark. This resulted in unattractive, poorly angled, dysfunctional restorations that often needed to be redone or fixed with expensive replacement parts. For these reasons, implants were not an attractive option for patients, especially since they also would have to endure the five- to six-month healing period usually required before an implant could be loaded. Implants were a risky business for some. Many practitioners were unwilling to tie their reputations to a costly, possibly unpredictable procedure that caused inconvenience, and often, disappointment. Fortunately, dentists now can take advantage of two recent technological innovations to incorporate implants as a successful and lucrative part of their practices.
First, new implant surface technologies, such as Astra’s OsseoSpeed, dramatically accelerate osseointegration, and often cut healing time in half. Patients now can have new teeth in three months rather than six, perhaps even sooner depending on the quality of the bone and gums. The faster healing process and shorter waiting time result in happier patients.
Second, and even more exciting, CAT scan technology - such as the i-CAT Cone Beam 3-D Dental Imaging System - is revolutionizing diagnostic and placement procedures for implants. Although CAT scans have been around for a long time, i-CAT systems are designed specifically for dentistry and eliminate most of the risks that steered dentists away from implants in the past.
The i-CAT system allows dentists to completely diagnose, drill, and place implants on a computer screen before actual surgery begins. A scan takes only about 20 seconds, reducing a patient’s chair time and exposure to radiation. The system provides high-resolution three-dimensional views of critical anatomy, e.g., roots, nerves, bone structure, and tooth orientation. i-CAT imaging software allows dentists to render the jaw at various degrees of translucency, exclude selected anatomical components, and experiment virtually rather than surgically to determine the most suitable implant type, size, location, and angulation. The 3-D visualizations also make it easier for patients to understand the process, allowing doctors to fully explain and illustrate their diagnosis, planning, and anticipated results.
i-CAT software will produce a 3-D model of the jaw with virtual drill holes. A laboratory then can use that model to create a nearly fail-safe, clear-plastic surgical template. The doctor simply places the stent over the edentulous areas, and drills through the prefabricated holes. Templates remove the exploration from the actual surgery, making it faster and less stressful for the surgeon and far less invasive for the patient. The results are predictable and consistently successful, and the less-invasive surgery reduces healing time. If the implant is prepared with a new, fast-integrating surface technology, it can be loaded with a temporary quite quickly, sometimes on the same day (although this is not typical). Moreover, labs can use an i-CAT 3-D model to produce the temporary, which expedites treatment even more.
The treatment once considered risky to one’s reputation is now a potential source of patient referrals and enhanced profits. Some dentists might feel that any increased revenues will take a long time to offset the roughly $150,000 cost of an i-CAT system. This is true, although the price is gradually decreasing. When i-CATs cost about $100,000, I expect them to follow the lead of CEREC systems, which were once expensive and rare but are now affordable and ubiquitous. Fortunately, dentists need not wait to take advantage of the new technology, so long as they are in proximity to a cutting-edge laboratory. For example, they can send patients to MicroDental Laboratories, which has invested in i-CAT technology and now offers scanning services. The lab will scan the patient, mill the template, and create the temporaries. The service is quick, affordable, and requires no substantial capital investment. The new technology enables better communication, faster healing, fewer follow-up visits, and higher success rates for implant procedures - and produces satisfied customers.
Dr. Christopher Pescatore lectures worldwide on topics such as state-of-the-art esthetic procedures, techniques, and materials. He holds a U.S. patent for a nonmetallic post system to restore endodontically treated teeth. He is the former clinical co-director and current featured speaker at the Las Vegas Institute for Advanced Dental Studies. He has a full-time practice in Danville, Calif., dedicated exclusively to esthetic dentistry, and also serves as Clinical Director of MicroDental Laboratories. Contact him at (925) 362-9330, or at [email protected].
