I am totally in agreement with Dr. Perel’s assessment in his Editorial (Vol. 13, No. 1 2004) of exercising caution in exceeding the speed limit in terms of implant loading. Let us remember the breakthrough that Dr. BrDnemark brought to dentistry in terms of a workable dental implant model. He held that there were three cardinal rules necessary for the success of a dental implant:
- A gentle, atraumatic preparation of the implant site
- Immediate stabilization of the dental implant in bone
- A period of unloaded healing
Dr. BrDnemark’s approach separated his work from all other previous work that sought to immediately load a dental implant. All previous dental implant work suffered from high failure rates. Dr. BrDnemark’s work approached a 98% success rate; and we all adopted his tenets when we saw the results that had been achieved over years of painful research and development. And then, we all set about to look for a better way! Dental implant manufacturers saw speedier implant loading as a means of selling more dental implants. Clinicians saw speedier loading as a way of attracting more patients and more referrers. Patients just became more confused.
Dr. Thomas Balshi, a Prosthodontist, developed some key immediate load implant procedures in conjunction with the Nobel Biocare Company and Dr. BrDnemark. The purpose of Dr. Balshi’s work was to help treat a specific debilitated patient who would actually benefit from a speedier dental implant application. As a Prosthodontist who places his own dental implants, Dr. Balshi is ideally suited for this type of dentistry and his results to date have been admirable. Dr. Balshi combines Dr. BrDnemark’s surgical protocol with advanced scientific, clinical, and laboratory prosthodontic procedures to arrive at a more timely solution for this group of patients.
But, immediate loading and speeding up the process is not for everyone. Surgeons who push this concept in order to encourage their referring restorative dentists may find that the results, when all is said and done, are less than expected (or maybe they are exactly what some of us would expect). Without proper patient selection, excellent prosthodontic and laboratory back-up, failure rates will increase. An attempt to mass market these procedures and make them ubiquitous might have the effect of turning back the clock to pre-BrDnemark times bringing to mind the old expression, “SPEED KILLS”.
S. Robert Davidoff, DMD, FACP