“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
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