Whether you're a specialist or restorative dentist, we are all faced with challenges; however, sometimes these challenges are avoidable with proper planning. If you're a restorative dentist, have you ever found yourself faced with the request to restore an implant that was not where you wanted or needed it placed? If you're a surgeon, have you ever been told by the restoring doctor that they would have liked or needed the implant you placed for them in another position?
Clearly placing and restoring implants requires a degree of planning to ensure the most predictable results. While the complexity of the planning required is case dependent, there are two basic fundamentals that apply to every case: First implants must be surrounded by a sufficient amount of tissue and second they must be positioned properly to facilitate the final restoration. It's not enough for an implant that has been placed to be simply restorable.
In a properly planned case the implant should be placed so that it allows for the desired restoration. In other words, just because you can put a restoration on an implant does not mean it should be restored or that it will meet the patients desired outcome. In order to know where an implant is to be placed there must be a clear plan ahead of time in regards to the final restoration. While it's imperative that any implants be placed to facilitate the planned restoration they must also be placed in sufficient bone.
So what does this all boil down to for us? We have to know where we need an implant or implants for the proposed restoration, and if there is not enough tissue we need to graft it properly. If that's not possible, we must adjust the treatment plan as needed prior to starting any treatment. Unless you are both placing and restoring your patient's implants, it's not enough for you to have just planned the treatment. You must communicate the plan with the entire team involved and make sure everyone is on the same page.
John R. Carson, DDS, PC, Spear Visiting Faculty. [www.johnrcarsondds.com]