A BRIEF HISTORY OF DENTAL IMPLANTS:    a dream come true

Dr. Chow Kai Foo

BDS Singapore

FDSRCS England

Cert. of Implantology  Germany

A PRECOCIOUS CENTURY

We are now into the 21^st Century. The previous century, the last century of the millenium, the 20^th Century was a precocious century. Precocious because it has superceded the previous 50 centuries of recorded human history and civilization in terms of the accumulation of knowledge. In one quantum leap of a single century, we increased many many times more than all the raw knowledge accumulated in the previous 50 centuries of recorded  history. Today, we can no longer master a subject in a few short years of intense study like in the 19^th century backwards. We can only launch ourselves into the beginning of a lifetime of learning, focusing on the subject or profession of our choice constantly looking out for the sudden breakthrough that may  rearrange all our past knowledge of the subject.. Because knowledge has become so vast and increasing so fast continuously, we cannot afford to stay still, but to keep on and on learning.

A DREAM COME TRUE

In the field of dentistry, it is fitting that the dream of its practioners for thousands of years have at last come to pass in the last century, the audacious century, or some might want to call it the precocious century. Today, a dentist can replace a lost tooth at will and almost as good as new! As dentists, or stomatologists, which is a more accurate term, we are extremely fortunate to be practicing today.

“The goal of modern dentistry is to return patients to oral health in a predictable fashion. The goal of modern dentistry is to restore the patient to normal contour, function, comfort, esthetics, speech and health, regardless of the atrophy, disease, or injury of the stomatognathic system.”     Carl E. Misch

While it remains fresh in my mind may be the best reason why I must blog this particular portion in. At the ITI meeting in Kuching/Malaysia on Thursday May 24th 2012, I was listening to Dr Chatchai Kunavisanut from Thailand speaking on the topic, "Reduced diameter implant: A solution for a narrow ridge", and then giving his opinion on it. He duly showed a case where the lower anterior ridge was very narrow, and he placed two minis to replace two incisors in an "experiment"!?!!  It was a clear contradiction against his own advice not to use minis. On his final slide, he showed pictures of two mini implant cases in which he casually pointed out that they are bound to fail. The conclusion then was, "do not use mini dental implants!".

One look at the two pics and I immediately recognized them to be from my blogspot: smalldentalimplants.blogspot.com.  When it came to discussion on what had been shown, I stood up and readily confessed that those were my cases, one on the upper right and one showing the lower left molars built on mini dental implants. I duly informed the speaker and the audience that contrary to them failing, they were still in my patients' mouths when I last saw them barely a few months ago and after at least 3 years after the minis were placed!!! After checking my blog:

http://smalldentalimplants.blogspot.com/2010/05/blog-post.html

http://smalldentalimplants.blogspot.com/2010/08/bone-climbing-up-mini-dental-implant.html,

I must correct myself, it was the lower right molar, not the lower left.


The mistake that I made was that I went on and on elaborating on why we should not judge minis prematurely and that all serious implant dentists should treatment plan with both minis and conventionals in mind...... and so on.  I should have just set down and let the dear doctor defend what he just said. It was already the end of the meeting and the moderator was pointing at his watch. When I sat down, Dr. Stephen Chen from Australia insisted on replying to what I said. He said that treatment should be evidence based and not anecdoctal and basically challenged me for the studies that can support the wider use of minis and if so proven, he will be one of the first to start using them! In addition, they will even give me a slot in Bangkok to speak at the ITI Congress South East Asia in Bangkok Thailand in May 16-17 2013. I immediately took up the challenge and said that I will get the retrospective study from my own practice and also from the practices of some of my colleagues in Malaysia. Yap, a multi-centre retrospective study! Challenge thrown, challenge taken and the study is going to be ready. Check out the link below as well to read the debate over narrow diameters with an initial query from Carl Misch himself and a final closing comment from yours truly here.

http://www.osseonews.com/narrow-diameter-implants-are-there-absolute-contraindications/

How I Got Hooked.

Before I could bring myself to place in the first dental implant into my patient’s jaw, I had to overcome the difficult mental block of believing that it is actually possible for a missing tooth to be replaced by an artificial implant.

Throughout my dental school training and into my subsequent years of treating various types of dental diseases, the incessant mantra that was emphasized again and again and again was the need to prevent inflammation of the tissues in the mouth, especially the soft tissue. Time and time again, I observed how vulnerable teeth can become once the gums have become inflamed. Inevitably, the inflammation was associated with foreign elements like pathogenic bacteria in plaque attached to teeth and fillings and prostheses. The idea of a foreign element being embedded into the gums and bones, sticking out into the mouth, then expecting them to stay there and undergo continued stress and hoping that they will be maintained there for years was considered a pipe dream.

In order to overcome the mental block, I decided to read as much about dental implants as possible. I paid special attention to the landmark discoveries and writings of Professor Braunemark of Sweden.  I spent a small fortune buying his books and others like it and reading them all. This intellectual exercise helped me to substantially overcome the deep seated skepticism that I felt towards dental implants to the point that I felt that I was ready to take on my first patient. Having convinced my first patient to have dental implants placed in her mouth, I proceeded to do a sinus lift simultaneously with 3 conventional implants placed on the upper left maxilla! I planned carefully and worked down all the steps required and read up all I could to prepare for my first implant surgery.

Then I followed the steps faithfully and stitched up the wound. Four months later I placed in some healing caps and a week later removed them. The sight of the healthily pink and well healed gingiva, like a well formed crater in the gums at the bottom of which I could see the shiny surface of the titanium fixture was something I can never forget. There was little or no inflammation and no bleeding. It struck me convincingly and clearly that titanium is biocompatible with the bone and mucosa of the human body.

From that moment on, I was hooked. Dental implants work!