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Assessment of endoimplant algorithm
From: Terry Pannkuk To: ROOTS 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 doesn’t 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 Marga’s 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 all cases. 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, it’s subcrestal and should have been supracrestal, you placed it too far buccal, ‘if you were worried about the socket foo foo why didn’t 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 today’s 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, it’s 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, I’m 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). - Terry
