Completely Digital Two-Visit Immediately Loaded Implants: Proof of Concept.

Implant dentistry has become a common treatment alternative, yet only a small percentage of patients missing teeth are receiving its benefits. Significant limitations are the small percent of practitioners placing implants due to the long learning curve, as well as the time commitment on the part of the patient. This proof of concept demonstrates clinical implant treatment requiring years of manual skill development on the part of the surgeon, restorative dentist, and technician can be accomplished in 2 visits, completely digitally, without the need for conventional impressions, laboratory procedures, and advanced manual skills. This technique results in reduced learning curve and treatment time. The first visit consists of consultation, diagnosis, CT and optical surface scans of the implant site to include: soft tissue, adjacent teeth, and opposing arch. This digital information is imported and interactively reconstructed in a 3-D open format implant planning software. The implant and restoration are now precisely planned into the optimal bone position with the ideal emergence profile for biologically and esthetically designed restoration. This information is then electronically forwarded to a production facility, where all necessary models are digitally printed and the immediate crown is digitally milled. On the second visit, the patient returns for guided implant insertion and immediate restoration. As digital procedures are refined, many more dental professionals will become involved in providing implant therapy earlier in their careers. This promises to result in reduced costs, making implants available to millions more patients who could benefit from them.

Why guided when freehand is easier, quicker, and less costly?

Computer-assisted implant planning and subsequent production of a surgical template based on this plan has gained attention because it provides restoratively driven esthetics, patient comfort, satisfaction, and the option of flapless surgery and immediate restoration. However, it adds expense and requires more time. Another significant but not so apparent advantage may be improved survival and success over freehand techniques in types III and IV bone. This retrospective analysis was undertaken to examine that possibility. It reports 1-year outcome for 80 implants in 27 consecutively presenting patients treated over a 7-year period using computer-assisted techniques across all bone qualities in commonly encountered treatment indications in private practice. Implants were placed to support single teeth, small bridges, and complete arch restorations in exposed or immediately restored applications, based on primary stability as determined by insertion torque, resonance frequency analysis, and Periotest. For the 80 implants supporting 35 restorations, the median observation period is 2.66 years; 73 implants supporting prostheses in 22 patients had readable radiographs at 1 year. There was a 1-year overall implant survival and a success rate of 100%. Radiographic analysis demonstrated the change in bone level from the platform at 1-year is less than 2 mm. Intra-operative median measurements of primary stability were insertion torque, 40 Ncm; resonance frequency, 76 ISQ; and Periotest, -3. All intra-operative measurements were consistent for acceptable primary stability regardless of bone density. Restoratively driven diagnosis and precision planning and initial fit were possible with computer-assisted techniques resulting in the achievement of high primary stability, even in areas of less dense bone. The ability to plan implant position, drill sequence, and implant design on the basis of predetermined bone density gives the practitioner enhanced pretreatment information which can lead to improved outcome.

Dental students' perceptions of dental specialties and factors influencing specialty and career choices.

The goals of this study were to 1) evaluate dental students' perceptions of dental specialties, 2) identify factors that play an important role in students' decision to pursue specialty training or career choices, and 3) establish a baseline of students' perceptions of the dental fields with the best future in terms of salary, personal and patient quality of life, and overall impact on the dental profession. Surveys were distributed to 494 students at the University of Pennsylvania School of Dental Medicine. Data were collected from 380 traditional four-year students and thirty advanced standing students. Chi-square tests, multivariate analysis, and logistic regressions were used to determine associations and independent contributions of student demographics to their perceptions of dental specialties and factors influencing specialty training or career choices. Debt was a statistically significant factor (p<0.001) in choosing specialty training or career independent of gender, age, or class year. Enjoyment of providing care in a specialty or field was identified as the single most important factor in choosing a specialty career. Half of the respondents had decided not to specialize. Pursuing postdoctoral general dentistry training and private practice in general dentistry were the most commonly reported plans after completion of dental school. Suggestions are made for ways to inform students about specialty training.