Dental Implant Prosthetics Carl E. Misch. 626 pp., illustrated. St. Louis: Elsevier Mosby; 2004.
Textbooks such as this one require a staggering amount of time and effort and are not written without frustration and family sacrifice. This text offers an enormous amount of science and information that should be read by the restorative dentist and the surgical participant. This bedrock of implant prosthetic infrastructure is needed by clinicians worldwide. Sadly, many who need this education simply will not take the time or do not recognize the limited depth and breadth of their knowledge. This text provides long needed implant prosthetic guidance.
Presents the rationale for implant treatment with interesting statistics and demographic trends.
An interesting functional comparison and contrast of a tooth with an implant.
A brief history of implants and a generic discussion of component terminology.
Excellent discussion and appropriate graphics to discern various categories of fixed and removable prostheses.
A comprehensive overview of diagnostic radiographic techniques and digital image-driven designs for surgical templates.
Discusses our major nemesis: stress factors, which are often overlooked or misunderstood but are critical. The reaction of bone (strain) to varying levels of overload (stress) is presented well.
Discusses the six patient factors and their role in determining the implant foundation.
Deals with the classic Misch/Judy bone classification so vital for communication and treatment planning.
Bone density (Misch classifications D1–D4) is detailed as well as the six ways it affects case design.
Dr. David Sarment makes a great contribution on proper presurgical diagnostics and designs for surgical templates.
This chapter is unique and vital for successful treatment. Dr. Carl Misch and Dr. Francine Misch-Dietsh discuss preimplant prosthodontics and the critical factors in presurgical evaluation.
The ever vexing questions of when to extract and place an implant or when to connect to a natural tooth. A protocol for evaluation of natural abutments is presented.
Removable partial and edentulous arch classifications are outlined. Important information for communication and treatment planning is presented.
This chapter outlines restorative options for mandibular implant overdentures with attention to biomechanical concerns.
Introduces clinical procedures and nuances of O-ring and Hader clip designs for mandibular overdentures.
Full arch mandibular fixed issues are discussed with the five treatment options available depending on the implant positions.
The treacherous maxillary arch is covered with a focus on bone density, anatomy, and other critical factors. Subantral surgical options are well illustrated with nice graphics.
Fixed and overdentures are illustrated with good biomechanical/fulcrum graphics for understanding implant loading in the maxillary arch. This is a great chapter.
Dr. Martha Bidez and Dr. Misch discuss the ever present, ever challenging biomechanical principles and the resulting osseous tissue responses.
Drs. Misch and Bidez outline issues for a scientific basis for implant design. Geometry, width, length, and thread design are rationalized.
The popular posterior single tooth restoration for the mandible is well covered. Important contraindications, advantages, and disadvantages are outlined.
Maxillary anterior single tooth is covered. This is an important, but in clinical reality, overly abused arena. A must-read chapter.
Cement-retained fixed restorations are covered in this chapter. As the majority of fixed partial dentures at the present time are cement retained, Dr. Misch deals with many issues relevant to our practices.
Discussion of engineering principles of screw-retained fixed restorations along with the advantages and disadvantages of this method.
Drs. Misch and Bidez outline the biomechanical and osseous issues of occlusion. Implant-protected occlusion is the basis for this chapter along with the issue of natural tooth versus implant mobility.
Dr. Misch presents a sound rationale for progressive bone loading in this chapter. This continues to be a controversial subject for implant podiums.
Dr. Misch and Dr. Gerard Scortecci discuss and show clinical examples of immediate load cases. The clinical parameters for successful cases are outlined.
This chapter discusses the maxillary denture versus the implant-supported mandibular prosthesis. There is not a clinician who has treated implant restorations who has not been challenged by these patients. Alternative occlusal schemes are shown.
Dr. Roland Meffert (The Zen master of the peri-implant milieu) discusses the critical issue of maintenance. Read this chapter first and then reread it, as this is the basis of implant health and maintaining a good prognosis for every case.
Drs. Misch and Meffert outline implant health quality factors, established originally by the late Dr. Robert James (so noted by Dr. Misch) of Loma Linda University and modified by Dr. Misch, which are shown for evaluating implant health and prognosis.
The late President Lyndon B. Johnson was one of the most effective Presidents in executing legislation. His aides would be chided for their wanting to “fine tune” and “fine tune” each law proposal. President Johnson replied, “just get it on the books, we’ll fine tune it later.” This text will continue to evolve and fine tune with new knowledge and science.
The reviewer suggests several areas to be considered for future editions: 1) telescopic implant restorations and concepts; 2) hybrid retention concepts such as “screwmentation” as discussed by Preiskel in the literature; 3) greater depth of coverage in attachment choices and applications to implant bars; 4) overdenture versus bar overdenture treatment in the maxillary and mandibular arches; 5) implant metallurgy and alloy choices for implant bars (e.g., corrosion and toxicity issues); 6) CAD/CAM versus classic cast alloy bars; 7) dental resins and polyglass composites in implant prosthetics; 8) mechanical occlusion concepts: Hardy “cutters”, linear blades (metal and ceramic, such as autobalancing composite or centric line; e.g., Sosin/Levin lingual bladed teeth); 9) the biomechanical issue of rigidity versus resilience in fixed and removable restorations; 10) resilient polymers and their implant prosthetic application; 11) dental technology (i.e., what the lab has to have with the various types of restorations to create optimum results; and 12) narrow diameter implants and their role in implant treatment.
This book is a must-read for those who treat implant patients, but it is not a “weekender.” You need time to savor the information and allow it to be properly assimilated.
Congratulations to Dr. Carl E. Misch for a job well done.
Charles E. English, DDS, MDS, PhD
Diplomate, American Board of Prosthodontics
Little Rock, Arkansas