Throwing Darts

Incompetence. The word looms large. In an editorial, unrelated to implant dentistry, Dr. David W. Chambers ¹ began “I am annoyed by incompetence.” Yet, sad to say, the same does apply to implant dentistry. Ask any laboratory technician who is involved with fabricating master models for clinicians who restore root-form implants. You will be flabbergasted, and quite possibly ashamed, to learn of the number of malplaced, either wrong position or poor angulation, implants. No doubt, some situations can be made useable (not necessarily rectified) by means of angulated abutments or custom abutments. Oftentimes this leads to an inferior anchorage that, at the outset, is susceptible to the vagaries of adverse forces; or forces that, with better implant placement, would have fulfilled the need for vertical rather than horizontal loading.

Toward proper implant placement, there are many aids ranging from computed tomography scans to surgical guides/templates to the use of stereolithographic models. For, as Dr. K. G. La Faut ² stated in the title of his presentation, Computer-Guided Implantology: Safety Means Accuracy. Also, what has happened to “prosthetically driven” implant insertions? This is not meant to imply that most clinicians are placing implants improperly, but there are enough who unfortunately fulfill what Dr. Charles E. English had claimed the need for, quite some time ago…bail-out dental implant centers.

Article after article, in journal after journal, begins with the recognition of the fact that osseointegration is here to stay. Today’s major implant companies offer various implants that, for the most part, will integrate with all types of bone. However, we cannot infer that the success of osseointegration will translate into the long-term success of the implant-borne prosthetic complex. Too many implants appear to be placed as if they were dart-boarded. Yes, osseointegration could have taken place, but at what cost to the integrity of the prosthesis?

Over 10 years ago, the results of a multiple question survey were published in the well-regarded CRA Newsletter (Dr. Gordon Christensen). ³ One of the questions was “What are the main problems you have relative to the surgical placement of implants by those working with you?” Two of the answers were brutally revealing in that 48% of the respondents claimed poor angulation of implant, whereas 29% of the respondents claimed wrong location of implant. Granted, this had taken place in 1992. Regardless, do you wonder how much those numbers have been diminished at this time of the maturation of implant dentistry? We fear, not enough. It is that incompetent, or uncaring, minority who drag down the otherwise wholesome services provided by implant dentistry. The dart-throwing surgeon can claim to have high rates of integrative success. This claim is a perversion of the total implant package.

What has happened to good old-fashioned treatment planning with good new-fashioned implant placement aids, where even the best of panoramic radiographs might not suffice to serve as a sole guide for implant placement. Add to this the following thought: Inherent in the need to improve osseointegrative outcomes is communication between those clinicians who place, those who restore, and the laboratory technician who must fabricate the prostheses. For, as Chambers has stated, “What we want, in the long run, is the best pattern of outcomes we can achieve by working together.”¹ Isolationism is anathema to implant dentistry. So is improperly placed root-form implants.

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