PREAMBLE
Why do I want to write this book? Since Professor Branemark gave his landmark lecture in Toronto in 1982, there has been a flood of 400 plus implant manufacturers who mainly copied his two-piece dental implant idea. The promise that dental implants held for the suffering masses of people without teeth has not materialized 30 years later. This is mainly because dental implants are perceived and taught to be difficult and kept expensive because less than 10% or less of dentists have learned to place dental implants. Today, mainly the rich and the brave are benefiting as a result.
There is a most unfortunate man-made bottleneck of huge demand upon a small supply mainly because of lack of dentists able to deliver implants and the price being too expensive for the common person. The greater usage of minimized cheaper dental implants and this book hopefully will bridge the gap and unblock the bottleneck by making it easy for the dentist to deliver and cheaper for the patient to pay for.
The fact is that it is actually easier for the dentist and safer for the patient to replace a tooth with an implant than to cut a three unit bridge!!!! Cutting abutment teeth is a gross travesty of G.V. Black's principle of conservation of sound tooth structure, especially if the dentist can replace a tooth with an implant. This book, I hope and pray will bridge the gap between great demand and small supply by increasing the supply of empowered dentists and the usage of minimized dental implants.
AN AUDACIOUS ATTEMPT
A private dental practitioner trying to write a dental textbook is certainly an attempt to accomplish a feat that may compromise academic standards. However, I will still do so because I see a vacuum in the area of small dental implants where textbooks are concerned. However, I am calling it a handbook because it will be both informative and practical, based mainly on clinical experience rather than overt prospective studies. As such, there will be minimal listing of bibliogaphy of journals, books and papers that is ubiquitous in many academic texts. Still, it is considered quite an audacious attempt by a non-academician. Implant Dentistry has a long and checkered history. Professor Branemark is among many pioneers of implant dentistry. He stood out however as the first one who did a longterm documented study on dogs and humans and thus laid down solid scientific foundations for implant dentistry to take off. He logically decided to emulate the size of the original tooth root as closely as possible. The first successful osseointegrated titanium fixtures were designed to emulate generally the shape and size of the tooth root that they were replacing, However, due to the increasing understanding that there are differences between a root held by a periodontal ligament and a fixture held by osseointegration otherwise known as the biological cum mechanical bond between the bone and titanium otherwise known as ankylosis, it made sense that titanium fixtures could be made smaller than that of the roots that they are replacing. This is because square area for square area, ankylosis is a much stronger bond than the periodontal ligament. When I first started learning and using dental implants, we were taught to place as big an implant as the existing bone would allow. Currently, the accepted wisdom is that it is not necessary and most implants that are placed today fall within the range of being 4mm or less in diameter and the part that is within bond ranges from 8 to 12mm in length.
In the last 10 years or so since the late 90s of the last century some practitioners have been using small dental implants to stabilize dentures mainly and later increasingly to mount crowns and bridges for long term use. These small dental implants, called transitionals were initially used to mount temporary crowns and bridges while the conventional sized dental implants were osseointegrating. It was discovered that not only did they do a good job holding up the temporaries, sometimes they were osseointegrated firmly, forcing the dentist to cut it of at the bone level and leave them in situ.
Dr Todd Shatkins came up with a retrospective study in 2007 documenting up to 5000 cases of crowns and bridges secured for long term function using exclusively small mini dental implants. But so far, no one has come up with a textbook to teach the use of mini dental implants systematically. Also, there is still a lot of room for the development of reliable and operator friendly prosthodontic solutions for small dental implants.
As a dentist who uses both conventional sized and small dental implants extensively to replace missing teeth and to rehabilitate dental cripples, I believe that small dental implants have an important place in modern dentistry. Because of its small sizing, economy and ease of placement, I foresee that not only will it be an increasingly used modality in dentistry, it is well on its way to becoming the main workhorse of implant dentistry, once the issues of reliability and long term durability and a good prosthodontic solution has been worked out satisfactorily.
In this handbook entitled, “MOSTDIS: An Important Adjunct In Implant Dentistry”, I will attempt to lay out briefly the versatility and usage of small dental implants together with the introduction of a user-friendly prosthodontic solution for small dental implants.
This book is not written as an academic text but as a basic dental implantology handbook suited for the general practitioner with the relevant write-ups of the history and principles of implant dentistry. Many practical cases will also be described with photographs and diagrams. I hope that this book will lay down enough basic theory and practical guidelines for a general practitioner to begin to get started in dental implantology. This book will not attempt to present all that is necessary but hopefully will serve as a beginning text for the many GPs who have realized that dental implantology is here to stay and that the best replacement for a lost tooth is no longer a bridge but a dental implant.
Dental implantology has remained for many dentists a fearful and risky area to delve into even though there is an increasing realization that dental implants are here to stay, and that in order to offer patients the best possible dental treatment, dental implantology must be closely integrated into all the different fields of dentistry, be it conservative dentistry, periodontology, orthodontics, prosthodontics, the oral rehabilitation of dental cripples, or post oral cancer patients and many others. We hope that this book will launch many dentists into the exciting and life changing world of dental implantology.
by Dr. Chow Kai Foo
BDS Singapore; FDSRCS England
Cert. of Oral Implantology University of Frankfurt Germany
FICD; Academy of Medicine; National Specialist Register
President of the Malaysian Oral Implant Association 2009-2011
Currently Advisor to the Malaysian Oral Implant Association
