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Assessment of endoimplant algorithm
From: Terry Pannkuk
Sent: Tuesday, May 18, 2010 10:05 AM
Subject: [roots] The Endo Implant Algorithm Assessed
In the case attached I extracted a split maxillary second bicuspid
with buccal perio bone loss and placed the implant in two stages.
There are fierce opinions saying endo retreatment doesnít work,
bone needs to be protected at the expense of teeth, socket grafting
should be done, immediate placement is better than two stage to protect
tissue contours, platform switching is necessary to hold bone up
and prevent cupping, and yada yada yada.
In reality and regardless of what corporate shills say:
1.Native bone is king
2.Atraumatic extraction performed carefully with minimal forces on
the interseptal and buccal bone prevents socket collapse even
without foo foo.
3 Short implants in native bone are just as reliable if not more so
than a long implant placed in half foo foo/half real bone.
4 A little stable cupping of bone down to the first thread of an
implant is favored by many restorative dentists versus a narrow
necked abutment placed in a platform switched implant holding up
bone but trapping food.
5 Saving the natural tooth if it is restorable protects the bone and
is worth a meticulous, skilled restorative effort. Saving teeth
should usually be the first option if feasible.
6 Margaís Dutch saying, All advantages have disadvantages holds true
regardless of the big gorilla selling only the advantages.
No rotary file, no implant, no technique, no gadget, is perfect for
I got creamed on the Ankylos site for showing an implant I placed last
week (placement preop plan and postop placement shown below).
Comments were: it should have been Ankylos, itís subcrestal and
should have been supracrestal, you placed it too far buccal, Ďif you
were worried about the socket foo foo why didnít you call the clinican in
Israel who placed instead of trying to nudge it toward the native bone on
the buccal?, more yada yada yada. It was interesting to take a preimplant
CBCT and todayís postimplant CBCT, comparing the significance of the
compromises. I now have a baseline CBCT and can compare bone levels on
all future recalls starting with next year like the recall I attached.
When someone says one product is better than all others, itís like a
politician asking you to trust them.
There is massive confusion and misinformation regarding implantology,
endodontics, and what we should really be doing clinically. I view much
of this confusion and bad science as being created by commercialism;
i.e those selling rotary files, those selling lasers, those selling
graft products and those selling implant designs.
There are none among us that have all the answers but we should be
asking the sources that deserve our trust. Real scientists should be
lecturing, teaching, and researching in the field of endodontics and
implantology, not gurus paid to be shills. We should simply be shown
the interesting and valuable new ideas produced by companies and
inventors, but the validation should be performed by those not having an
interest or stake in the profits, lecture income, or success.
Regarding the attached recall patient; it is not easy to answer the
question: Would it have been better to fill the socket with fake bone,
have questionable integration of the implant surface/threads yet have
a more plumped out buccal bone contour, or do it the way I did it with
no plumping and all native bone fill? For this guy my opinion is clear;
on a supermodel with a big white smile, Iím not so sure.
Routine endodontic treatment is highly predictable and a great service
to patients if done meticulously and with specialty level skills.
Implantology is still just a new discipline looking for some discipline.
It is clearly the Wild West out there the problems with the science of
implantology are even worse than the science of endodontics (in my opinion).