Practice Building Technology
Implant Terminology and Descriptions
The world of implants has a language all its own. The following definitions, descriptions, and clinical photographs will help you distinguish between the 3 types of implants.
Mini implants have a diameter of 1.8 mm to 2.5 mm and come in lengths of 10 mm to18 mm. They are intended only for overdentures or denture stabilization. These restorations are tissue borne but implant retained, meaning that the load is still on the tissue and bone; the small-diameter implant is just there to keep them in place. (See Figure 1)
Hybrid implants have a 2.9 mm to 3.25 mm diameter and come in various lengths, depending on the manufacturer. (See Figure 2)
Traditional implants have a diameter of 3.5 mm or more. With a traditional implant, the load is not only on the tissue but mainly on the implants—the big difference between the mini and traditional implants. Traditional implants can be fully loaded once they have had time to osseointegrate, which usually takes 3 to 5 months, depending on the type of bone they are placed into and whether it is a recent extraction site or a grafted area. These implants are restored with removable or fixed prostheses. (See Figure 3)
Figure 1—Mini implants are mainly used for denture retention. These implants are great for patients who may be medically, anatomically, or financially compromised. In this case, the patient was dissatisfied with the look, fit, and retentiveness of his existing prosthesis. Not only did we make new dentures, but we also placed 4 mini dental implants (Imtec) for extra retention in the lower arch.
Figure 2—Due to their increased width and strength, hybrid (moderate-sized) dental implants can be loaded to a greater degree than a mini dental implant. The removable prosthesis used in association with these is considered tissue borne in the posterior and implant borne and retained in the anterior. Hybrids are great for the edentulous population, which may not have enough bone for traditional implants but has more of a ridge than that for minis. They also work well with younger denture wearers or in areas of softer bone like the maxilla. In this case, a recently edentulated man in his early 50s was dissatisfied with the retentiveness of his upper complete denture that opposed natural teeth. He wanted an affordable palateless denture that was implant supported and implant retained. We placed seven 3 mm x 12 mm hybrid (OCO Biomedical) dental implants. The patient was very pleased with the outcome.
Figure 3—In this case the patient was dissatisfied with a lower partial that was opposing a complete upper denture. The remaining teeth on the lower arch were extracted, the bone was leveled, and 10 traditional implants were placed. These implants were restored with 10 CAD/CAM (Atlantis Abutments) abutments and then a fixed bridge, segmented into 3 pieces. The patient was so pleased with having a fixed restoration that she ended up doing the same thing in the upper arch a couple of years later.
Dental Implants: Meeting a Need and Building Your Practice
Dentists wanting to build their practices, especially in this challenging economy, should consider incorporating dental implants. Not only will they boost productivity, but, most important, they will fulfill patient needs to correct the increasingly common problem of edentulism or partial edentulism.
Patients place great value on dental implants once they have been educated about their benefits. Even in difficult economic times, many patients perceive implants to be worth the cost. Providing implants and other needed dental services under one roof will help you build your practice and better serve your patients.
Fulfilling a Need
As people mature and live longer, they are more likely to experience tooth loss, and most of them are going to need some kind of replacement. Statistics show that 69% of adults ages 35 to 44 have lost at least 1 permanent tooth to an accident, gum disease, a failed root canal, or tooth decay.1 By age 74, 26% of adults have lost all of their permanent teeth.1
Unlike a few years ago when many people were focusing on cosmetic dentistry, elective treatments have slowed down because of the economic challenges that many people face. In Michigan, where I practice, the economy has been quite poor for some time. In the last 8 or 9 years, however, requests for functional/ re constructive procedures have increased. This is an especially strong trend among patients with dentures who often face daily difficulty with basic functions such as eating and chewing.
Many Baby Boomers are facing the loss of multiple teeth and need full reconstruction of some sort. People who have been wearing dentures for many years find their dentures no longer fit because of bone loss that has occurred over time. With repeated denture re-lines, there will be a point when re-lines don’t help anymore and some type of implant support is needed.
Under One Roof
Why is it important to offer many dental services under one roof? I like to use Target as an example. People enjoy shopping at Target because they’ll find just about everything in one place. Not everyone wants to go to a specialty store for every little product they need for their home. The same could be said for your patients. They know, trust, and like you, and they would rather have you perform and follow-up most dental procedures. Doesn’t it make sense to get the training and experience in implants so that your patients can come to you?
My Experience
When I first started out, my goal was to stick with cosmetic dentistry. However, I quickly learned that with the Michigan economy, this was not enough and I really needed to expand my practice. I first decided to focus on removable dentistry. Many dentists dislike doing dentures because it’s hard to satisfy most people when the dentures inevitably become loose. You can make the best-fitting denture and it’s still going to be loose to a certain extent if there isn’t enough ridge or bone support. I soon invested in training for the placement of mini-implants. I found that denture retention was great with these implants, and that it was also an economical way for patients to retain their dentures.
Once I completed my mini implant training and gained sufficient confidence with them, I learned how to place largerdiameter— hybrid—implants. Eventually, I found myself getting more complicated cases where patients had a combination of teeth and edentulous areas and needed more reconstruction, or they didn’t have enough bone and needed bone grafting.
I received more complex training at the Misch International Implant Institute to gain advanced knowledge of implant dentistry. You never want to go beyond what you’re trained for. Fortunately, there are great training programs available (see Educational Resources).
Getting Started—Education and More
Before incorporating implants into your practice, spend the time and money to receive the proper training. Whether it’s mini implants or hybrids, treatment success vs. treatment failure will hinge on proper and thorough training.
Many dentists begin their foray into implant dentistry with mini implants (Visit www.dentalproductshopper.com/practice -building-implants for an explanation of implant terminology and view implant photos). Mini implants are nearly always used for overdenture procedures. The next step is single tooth replacement. Many manufacturers offer great training courses for single tooth replacement.
I have been mentoring dentists in implant dentistry through my 2-day inoffice courses. Day 1 is a lecture. On the second day, I guide the dentist through straightforward single implant cases for which they do the placement and remaining steps. In-office training means the dentist doesn’t have to pay for the travel of the entire staff and can work in his or her own office to do a live patient surgery.
For more involved cases, advanced training is available at the Misch Institute or through a Maxi Course, offered by the Oregon Academy of General Dentistry. Dentists who are interested in advanced cases are required to get continuing education at a center offering such training. Advanced training typically involves about five to six 3-day courses, costing approximately $15,000 to $25,000 in postgraduate training.
Can Patients Afford Implants?
It is my experience that there’s an increased value associated with all types of implant dentistry because the patient needs help to improve function or eliminate denture slipping. To some extent, these patients are “pre-sold.” Most of the people coming in are over 45 or 50, and they are often at a stage in their lives where they are more financially set than the younger cosmetic patients.
Financing is typically easier for more mature patients. In addition, implant dentistry can be done in phases, so patients can pay as they go. In my experience, a mini implant usually requires 2 visits; hybrids, 3 to 4 visits; and more complicated cases require about 6 visits.
What Don’t Your Patients Know?
As Carl Misch, the head of the Misch Institute, says, “You don’t know what you don’t know.” Patients need to know that they are not stuck with dentures. Even in difficult times, and living in an area especially hard-hit by the poor economy, I have built my practice because of the value placed on the implant services I offer my patients. If I can do it, you can too.
Reference
1. American Association of Oral and Maxillofacial Surgeons. www.aaoms. org/dental_implants.php.
Ara Nazarian, DDS, has a private practice in Troy, Michigan, specializing in implants and restorative dentistry. He is the only dentist in Michigan to have received the Excellence in Dentistry Award. An active member of the Academy of General Dentistry and a Fellow in the International Congress of Oral Implantologists, Dr. Nazarian lectures around the world and has published many articles on cosmetic dentistry, implant dentistry, and full mouth rehabilitation.
