The Speed Limit

The Speed Limit
March 2004
Perel, Morton L. DDS, MScD, Co-Editor, IMPLANT DENTISTRY
Volume 13(1) March 2004 p 1
Lippincott Williams & Wilkins
It came over the Internet. The date was November 12, 2003. The subject was Montgomery Hospital Shares 'Teeth In An Hour'TM Success. The 2-page message that followed stated that the hospital in Morristown, Pennsylvania, USA, was instrumental in aiding Dr. Thomas Balshi by using its GE Medical Systems' Light Speed QX/I CT Scan. The radiology department at Montgomery Hospital provided the patient films necessary to sculpt prosthetic teeth for 'Teeth In An Hour' implantation.
Before that, there had been 'Teeth In A Day'TM advocated by Balshi and associates. And, there had been a news release on June 13, 2001, dateline Boca Raton, Florida, USA, that a landmark study conducted by Drs. Jeffrey Ganeles, Marvin Rosenberg and Robert Holt establishing a revolutionary 24-hour procedure for dental implants is being publishedǃ?. Their Teeth TodayTM immediate load procedure allows patients to receive permanent replacement teeth with dental implants by reducing the time from 6 months to 24 hours.
Exciting, isn't it? Why, it was only a decade ago that Roberts 1 advised that Clinicians must be particularly vigilant in avoiding mechanical overloading during the first year of function. The osseous support is fragile because of the high rate of turnover and lack of mineral maturation. Then, Davies, 2 in an erudite article just 10 years later, discussed what is considered to be important in today's concepts of peri-implant bone healing. Implants that would previously only be placed into occlusal function after an extended initial healing period of several months are now loaded increasingly earlier in a matter of weeks, days, or even hours! Davies takes the reader on a thought-provoking discourse from what he terms The Paradox of 'Poor Quality' Bone through microarchitecture of lamellar and woven bone, through distance osteogenesis, through de novo bone formation, onto 3 essential facts that govern our current concepts of endosseous healing, and to osteoconduction as being the key to contact osteogenesis.
Well, you could say that the juxtaposition of scientifically based, updated concepts of peri-implant bone healing with speeded-up dental implant placements and loadings are complimentary. Yes, to an extent they are. What are the parameters for immediacy in implant placement/loading? Certainly, long-term success rates have yet to evolve. And, of course, we must question how effectively and how faithfully are basic prosthodontic principles being executed to fulfill our quest for long-term success. Hopefully these procedures that are immediacy-based are not just for instant gratification of either the clinician or the patient.
Vertical dimension of occlusion, centric relation, vertical loading, crossbite relationships, interocclusal freeway spaceǃ?can these all be given due attention and execution, along with exquisite surgical techniques, in an abbreviated clinical time period? In certain instances, under a strict protocol, with superb preparations, with advanced technology, and by well-trained and well-informed clinicians, the answer is yes.
Exceeding the speed limit on the highway could result in a ticket. Exceeding the speed limit in implant dentistry could result in failure. Proceed with caution! Construction site ahead.
References
1. Roberts WE. Fundamental principles of bone physiology, metabolism and loading. In: NAERT, Van Steenberghe, Worthington, eds. Osseointegration in Oral Rehabilitation. Quintessence Publishing Co; 1993; 164.
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2. Davies JE. Understanding peri-implant endosseous healing. J Dent Educ. 2003; 67: 932-949.
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