Twenty-five years ago, dental implants were considered a fringe element of modern dentistry. Since then, implants have come into vogue, with more and more dental practices advertising “quick and easy” implants through systems such as All on Four and Teeth in a Day. Compared to when implants first came onto the scene, patients now seem to have endless options among dental professionals who claim to have the skill and experience needed to achieve a satisfying, long-term result.
James A. Vito , D.M.D ., offers th is ad v ice: Buyer beware, becau se there’s a mountain of d ifference between a general dentist who learned how to do dental implants by taking a weekend course and a boar d-certified specialist who has devoted his or her career to mastering the art and science of implantology.
“If dental implants are done properly and placed in the right bony housing, there’s no reason why they shouldn’t last 25 to 30 years, or even longer,” he says. “But we’re seeing a lot more situations where implants aren’t lasting n early as long—in some cases only a few months before they fail—and that ’s because those patients probably weren’t good candidates for the implants they received.”
We spoke with Dr. Vito—board certified in implant dentistry by both the International Congress of Oral Implantologists (ICOI) and the American Board of Oral Implantology/Implant Dentistry (ABOI/ID), as well as certified as a master in implant prosthodontics through the ICOI— about what factors make a patient a good candidate for dental implants. He also shared his thoughts regarding the knowledge patients should possess prior to choosing a professional to perform the implant procedure, as well as how that decision will likely affect their outcome.
How do people know if they are good candidates for dental implants?
In some ways, it depends on their expectations. As long as you have the right volume of bone in the implant area, you can have a predictable implant situation. When you try to force the issue, where you just don’t have enough bone to get the implant in comfortably to have a good cosmetic result, you start rolling the dice. It becomes more of a question of not if it will fail but when.
There have been minimally invasive advancements in terms of growing bone less invasively. As a clinician, you need to offer these patients the option to talk about bone grafting, but you have to be knowledgeable and you have to have the armamentarium (resources) to properly do the procedure so you can expand the width of the bone in the area where the implants will be.
We’re seeing more and more patients asking, “Why can’t I have Teeth in a Day?” Patients are often looking for the fastest, cheapest and simplest way to have implants, but Teeth in a Day are not for everyone. Some may have health issues that affect the bone and make them not good candidates—osteoporosis, diabetes or damage from radiation therapy, for example. That having been said, they may be good candidates for a more conventional dental implant approach; they just have to understand and be willing and patient that to have it done correctly it may take a longer time. Patients need to understand that not all patients are created equal and treatment must be customized for each situation.
What role do patients play in the process?
To some degree, the onus should be on the patient since they are the ones having the procedure and paying the fee. They should be more inquisitive as to what type of candidate they are. Anyone with missing teeth has to go through a checklist. “Do I have enough bone?” “Do I have enough soft tissue?” (Both are essential to support the implant, maximize the cosmetics and minimize the complications.) “Is the area amenable to the proper-diameter implant the tooth requires?” “If not, what needs to be done to create the ideal situation so it lasts 25 to 30 years?” Knowledge is power, so know what questions to ask.
You mentioned there’s a big difference in experience between dentists who are credentialed in implantology versus those who are not. Can you explain why?
Someone who is credentialed by a board like the ICOI or ABOI/ID has had to go through intensive written and clinical exams before their peers. They are closely examined to see exactly what kind of knowledge they possess and are asked to present the cases they’ve done, and then defend their work in the event that something went wrong. In order to get to that point in your career, you need to take a more extensive route to receive specialized implant training, so one will have had to address just about any situation possible, not just the best-case scenarios. General dentists can’t necessarily say that because many have acquired their knowledge from a three-day weekend course. If you show a room full of dentists about a situation involving a natural tooth, they would have all the answers about what is needed to ideally restore the tooth. This is because they have had extensive training in this area and take continuing education to maintain this level. If the tooth was in the wrong position or has recession and bone loss, then the general dentist has many more answers to address questionable situations. Show them a blank space where a tooth or teeth were, then they are less comfortable in knowing whether all the parameters for successful implant placement are going to be met and what options are available to improve the situation for ideal placement and longevity. This is the difference between whether an implant will have a nice cosmetic outcome that will last for 25 years or more and a disaster that will fail in less than a few months. Patients who
y are ideal candidates for dental implants already have an idea of what they want and what the restoration should look like. Because many patients are paying for dental implant procedures out of pocket, they will hold the dentist’s feet to the fire for an ideal end result. We see these situations more, where things are not done correctly the first time and then patients seek out clinicians who are more knowledgeable to correct their poor result. In some cases, it means I have to take out the implant and start over. When that happens, the first question is: “Do you know how much time and money I spent on this?”
How does a patient go about choosing the right person to perform the procedure?
Again, it boils down to patients being more knowledgeable. They should look for someone who has the credentialing—meaning someone who has been board certified by the ICOI and ABOI/ID or credentialed (board certified) by other specialist boards like the American Academy of Periodontology and the American Association of Oral and Maxillofacial Surgeons. Certain parameters need to be addressed and adhered to in order to have a successful implant with a good cosmetic result. You need someone who has the experience to know those parameters, and who can have a good, frank discussion about a patient’s individual situation. Patients deserve to have the best dental implant outcome. As long as the clinician provides the optimum situation and patients are willing to have some additional procedures, when indicated, there is no excuse as to why they should not achieve this optimum result. This is done through frank, honest discussions with the patient. Some offices advertise All on Four or Teeth in a Day, and they will give you that treatment no matter who you are or what your situation is. Can it be done? Sure, but it should be done only if patients meet certain parameters that have been discussed already. The vast majority of patients who require this procedure have advanced dental disease situations and are lacking in some of these parameters. It is important that they are evaluated individually, not generically.
Some of these cases will run $15,000 to $20,000 or more per jaw, essentially putting a new midsize car in your mouth. When you’re making that kind of investment, you should choose someone who has mastered the art and science of the procedure, and that kind of mastery comes only from acquiring knowledge and then constantly upgrading that knowledge.
JAMES A. VITO, D.M.D.
523 E. Lancaster Ave.
(610) 971-2590 | JamesVito.com
Photography by Jeff Anderson
Published (and copyrighted) in Suburban Life Magazine, February 2018.