Professional Courtesy: How Long Will It Last? by Dr. Thomas Giacobbi

Professional Courtesy: How Long Will It Last?

by Thomas Giacobbi, DDS, FAGD, editorial director


“How long will it last?” is probably our patients’ most frequently asked question about the work we do. It’s difficult to answer with a single number, especially in the age of implants.

Patients ask this question because their decision could involve a large investment of time and money. Most of us can relate this to the discomfort we have when getting a major project done at home or when our car will be in the shop for a prolonged period. When we know something will last a long time, it validates our decision and the investment.

The question is challenging for dentists, though, because all procedures require precision, the materials have a variety of properties and the dental restoration’s home is never the same. So the answer to their reasonable question becomes, “It depends.”

I think implants belong in a special category when it comes to longevity. Dental implants are placed in adults of all ages and lifetime longevity is certainly possible, but the life span of the restoration attached to that implant is often a different story.

For the patient, it’s a tooth fused to their jawbone that won’t need a root canal in the future, can’t get a cavity and was very expensive from start to finish. Sounds like it could last a lifetime! The reality is much different: Abutment screws can break or wear out, proximal contact spaces open up, restorations fracture, bone loss can still happen, and tooth shades change—to name just a few potential problems.

The implant companies have done a great job with innovation, but this progress requires them to retire old designs as demand changes. Future restorative challenges will require implant companies to provide better resources for implant identification, allow access to legacy parts and remove system roadblocks. The obsession with making every element proprietary has made something as simple as finding a replacement screw an international mystery.

A recent case is a great example of how frustrating it can be for restorative dentists who work with different implant brands. My patient had an existing implant on #30, and teeth #28 and #29 had to be extracted. We had surgeon place an implant in the #28 position for a future implant bridge.

When I called the lab about the case, I was told that scanning the case would create an additional expense and delay the case. The proprietary healing cap scan body on implant #30 meant the lab would have to send it to a special place to have a model made. My best option? Take an old-fashioned analog impression so the lab could make the model. So much for using advanced intraoral scanning technology! Because of that implant company’s effort to make a few bucks by having a proprietary method to create models from digital scans, I’ve asked my surgeons to place a different brand of implants in all my patients.

Practicing dentistry in Arizona means I see patients from all over the country, so implant identification can be a nightmare. I had a patient a few years ago with attachments on lower implants to help retain a lower full denture. She vaguely remembered that the surgeon who placed the implants was in Las Vegas, but not his name. She had a restorative dentist in Washington, but when we contacted that office, we learned it had changed hands. They looked in the old files in the basement, but couldn’t provide information about her implants.

Afterwards, there were numerous calls made to the lab and lots of time spent sending photos of the implant interface and looking at online resources to match up X-rays. Once we had a brand and size identified, we had to place multiple calls to find parts that would fit.

This is just one example of a scenario that will become familiar in the coming years. What’s the solution? Perhaps the implant companies will make their legacy designs public, so replacement parts can be manufactured by a third party. Or if the major implant manufacturers sit down to sign a treaty where they agree on a single screw for all systems, I hope they invite me to attend!

Do you have an implant restorative mystery to solve? Please share your comments below. You can also reach me at via email at tom@dentaltown.com.




 

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