How to choose the right implant system for your practice

by Emile Martin, DDS

Editor’s Note: This is the second of three articles devoted to the role of implants in dentistry. In the June issue, Dr. Jeffrey Meister related why and how he decided to add implants to his practice. In this column, Dr. Emile Martin shares advice on what to consider when selecting dental implant systems.

Maybe it’s time for you to start doing implants. Your patients are asking about them, and there’s the thorny problem of neighboring dentists promoting implants and acquiring new patients.

For either the general dentist or specialist, adding implants can be good for the practice, both in attracting new patients and expanding existing services to current patients. For example, if some of your older patients are complaining about embarrassing, loose dentures, wouldn’t it be exciting to recommend implants, perform the procedure, and smile broadly as their quality of life improves significantly?

Unprecedented patient demand for implants is being fueled by growing public awareness that this procedure has one of the highest success rates in dentistry; 97 percent. So now what? The next steps are getting the proper training and selecting an implant system.

In my opinion, you cannot self-educate in implants, regardless of how long you have been in practice or how much surgery you perform. Implants are a specialized procedure learned best in a formal educational setting. Yes, you must go back to school, so to speak, to become proficient at implant dentistry. But it’s worth it. Don’t believe claims that weekend seminars and other quickie courses will prepare you to become a proficient and successful implantologist.

Educated consumers want practitioners who have excellent qualifications in implant dentistry, and strenuous credentialing will help improve one’s chances for successful outcomes. For general dentists and specialists alike, I highly recommend the American Academy of Implant Dentistry’s credentialing program. The requirements are rigorous and, as a result, AAID’s credentials are the only ones recognized by the courts as bone fide in implant dentistry.

It is also critical for new implant dentists to find mentors for ongoing advice and consultation or possible referrals of difficult cases. No practitioner can handle every case. One in 10 implant cases may have challenges related to bone augmentation needs or other restorative concerns. Perform the routine procedures and learn how to handle the tough ones from a skilled and trusted mentor. To find a mentor, look no further than the roster of AAID credentialed members.

The next step is deciding how much to invest in implant systems and which one to choose. Go to any dental products exhibition and you’ll see a bewildering array of implant products in various shapes, sizes and materials with assorted implantation equipment and support products. Companies employ skilled marketers to extol the virtues of their products and favorably differentiate them from other systems. For nine in 10 patients, it really doesn’t matter which implant system is used. Variations in the size and shape of implants become relevant for the exceptions, such as patients with low bone volume.

In my 20 years practicing implant dentistry, I have used many implant systems and most of the varied geometric shapes. For this article, I reviewed the Web sites of various manufacturers to see what they are saying about their products and support services.

I won’t compare and contrast specific dental implant systems because there are too many to cover and this piece would be a laborious reading experience. Instead, I will review what I believe are emerging trends in the industry and what practitioners should look for when selecting an implant company. I recommend visiting many online, such as Nobel Biocare, Zimmer, Biomet 3i, Innova, Dentsply, Bicon and Tatum. While wading through the marketing patter can be tedious, it’s helpful to learn some common features of various implant systems.

Many companies today are trying to be one-stop resources for implant systems and other professional dental care products. Industry consolidation is fueling this trend as companies obtain new product lines through mergers and acquisitions. Lately it’s difficult to keep up with who’s who and who’s selling what. However, I advise against relying on one company for all of your implant dentistry needs.

As mentioned earlier, most implant products on the market will achieve desired results in 90 percent of patients, so it’s best to deal with more than one manufacturer to guard against backorders, recalls and other production and supply problems. However, with that said, I believe that getting to know the intricacies of an individual system when first starting out makes sense. Then as you incorporate more procedures and patients with greater difficulties, you have the background to select a second, third, and possibly fourth system.

Most implant companies today are marketing titanium products and claiming to promote osseointegration. We know titanium is a wondrous substance that integrates very well with good bone. For patients with sufficient bone mass, based on the literature, there’s really no statistically significant difference in the performance of implants made with titanium.

Companies also are touting the special thread patterns and surface enhancements in their titanium implants to achieve faster and more stable bone integration. In the absence of extensive controlled comparative trials, it’s difficult to assess all the data presented by manufacturers about their products. All of them work well in promoting bone integration because of titanium. Whether or not specific thread or groove patterns in an implant make a significant difference in achieving faster bone integration isn’t as relevant as knowing that all titanium implants do a superior job of fusing with the jawbone.

Implant shapes and contours are major features promoted by manufacturers. Their Web sites display close-ups of various implants and descriptions of their benefits. Most claim their tapered implants are ideal for single-stage procedures. In my experiences with different implant products, I have found that most threaded implants work very well. However, determining what size and shape to use is a diagnostic call by the implant practitioner. It’s quite difficult to put a 5 mm diameter implant in a 3 mm wide ridge. Thus, in most cases, the characteristics of the extraction site dictate the size and shape of the implant. In situations when it isn’t clear which type of implant will work best, a less experienced implant dentist should consult with a mentor for insight and case experiences. Clinical assessment through ridge mapping and advanced digital imaging may improve the treatment outcome.

Even though companies keep adding products - making it almost impossible to keep up with all the innovations in sizes, shapes and coating surfaces - one trend I am pleased about is the reduced number of drills required for implant insertion. For years, six drills were required for implant procedures, but the technology has advanced to the degree that only three drills are needed today. This not only saves time, it lessens trauma to the bone.

After you have visited the Web sites, how do you select the right implant system for your practice? There is little risk involved because all of the implant systems work well for more than 90 percent of your patients. With that understanding, the focus shifts to finding the company that provides highly attentive service and customer support and convenient product ordering.

I strongly suggest taking time to meet with sales representatives for the companies you’re considering. Almost all the reps I deal with are professional, knowledgeable and helpful. It’s their job to provide updated product support and most do it very well. The difference lies in the customer support provided by their companies. Do they have on-line product ordering? Is someone available on a toll-free line to answer questions, troubleshoot problems and handle equipment malfunctions? Is the product ordering fast and simple to reduce staff time spent on this task? Finally, how often do the representatives visit your office? I have learned that the smart ones call a week or two ahead to set up appointments and guarantee I will be available for about 15 minutes to hear what they have to say about new products and services. Those who drop in almost never get to see me, and the trip is basically a waste of time for them.

How much must you invest to get started? Once you have been appropriately trained and have chosen the companies you want to work with, I believe most practitioners will spend less than $10,000 for equipment and supplies. That figure does not include digital imaging systems, should you decide to acquire this capability. I don’t think it’s necessary to have a lot of inventory on hand, especially for new implant practitioners. Here’s where product ordering procedures and customer service come into play. You don’t need inventory if your implant company can send products in two days or less.

One last word about implant education - it doesn’t stop. This is a very exciting field in dentistry, and technology continues to make it better in terms of safety and predictable outcomes. Go to seminars or meetings like the AAID Annual Scientific Conference to keep up with new trends and developments and, above all, to expand your network of mentors. Consider enrolling in an AAID MaxiCourse^®. There are three offered in the United States: in New York, Georgia, and California. Additional information about AAID and its MaxiCourses is available at www.aaid.com or call the academy office at (877) 335-AAID (2242).

Emile Martin, DDS, is an implant dentist in Syracuse, N.Y. He is a fellow of the American Academy of Implant Dentistry and can be reached at (315) 446-7442 or [email protected]. For more information about the AAID, visit www.aaid.com or call (877) 335-AAID (2243).