I have compiled a short list of risk relating to advanced dental treatment. Most marketing material relating to dentistry tends to only show success and how they will improve you health, well being and looks. What they don’t mention is the how long that treatment is going to last and the risk of it not working. It is extremely important that the patient can make an educated decision with their dentist as to the amount of risk they are prepared to accept before staring any advanced dental treatments
The figures are given in terms of Success
Implant placement (after 5 years)
Implant retained crown/bridge 96 in 100 at 5 years
Conventional crown and bridge
Back teeth 95 in 100 at 5 years
Front teeth 86 in100 at 5 years
Resin bonded bridge 87 in 100 at 5 years
Post retained 80 in 100 at 5 years
Treatment to resolve gum disease
Non surgical gum treatment 90 in 100 at 5 years
Surgical gum treatment 80 in 100 at 5 years
Root fill + crown (back tooth) 93 in 100 at 5 years
Root fill only (back teeth) 75 in 100 at 5 years
If you want to read further follow this link to Evidence Based Dentisty
The European Association for Osseointegration meeting opened on Wednesday evening in Dublin, Ireland . The conference theme being ‘Preparing for the Future of Implant Dentistry’.
On the Thursday morning we started with a presentation about the importance of maintaining the bone supporting the teeth and gums after extraction. In a normal extraction we lose 50% of the supporting bone within 4 months. This volume of bone loss can make it difficult to restore the missing tooth later both functionally and aesthetically. Bone loss can however be reduced to about 20% with the immediate use of bone substitutes placed in the extraction socket at the time of extraction making speeding up healing and future restoration of the space more predictable.
The afternoons title was ‘Treatment planning for success-how to get in right.’ and was presented by Dr Mark Pinsky a dentist who is also a commercial airline pilot. The theme revolved around the adoption of airline style checklists to reduce errors in surgery. As a side note we have been using these checklists in the practice for the past two years already and find them extremely useful as treatments and patients medical histories get more complex.
Friday morning we discussed the increasing problem of infection round dental implants and whether it was an infection or just the body trying to reject the implant, the conclusion was that more research needed to be done into this area but both factors were to a degree responsable.
The afternoon covered treating patients with long-term loss of upper back teeth from a quite minimalist approach to major surgery for cancer patients.
By far the most interesting series of lectures was on saturday morning titled ‘Implants in the Aging population’. In a lot of Western countries there are more over 65 year olds than 5 year olds and we discussed the problem of how to manage dental health in the age group 80-100. In fact the population of 100 year olds will increased by 400% in the next 25 years. The biggest problems were dental health, retaining unhealthy teeth into old age and long-term chronic illness. Though this subject is not a political vote winner we do need to acknowledge its existence and positively take charge of the challenges it presents. One strategy was the use of a single implant to stabilise a lower denture which over 10 years has dramatically improved patients quality of life at a significantly reduced cost and level of intervention.I have always found the Saturday morning lectures to be the most thought-provoking and applicable to the real world of dental health.
Yesterday I attended the second dental symposium on surgical microscopy hosted by Zeiss. I think these symposia are great as they bring together some of the most skilled dental surgeons in the world to talk on the advances in micro-surgery. Its quite simple, the better you can see what you are doing the better you can do the surgery.
The first speaker was Prof. Krejci on the ‘Geneva Concept’. In summary decay and gum disease is a highly infectious incurable chronic disease and we acquire the bacteria responsible for it at birth. Therefore since we can’t cure it we need to focus on prevention and conservation of damaged tissues. To quote “There is no such thing as a permanent restoration, they are all temporary until the last one”. The easiest and most cost-effective treatment is early intervention and the use of adhesive materials such as resins and composites. With the use of microscopy we can preserve tooth tissue because it’s so much easier to see small defects and cavities in the teeth and precisely repair them.
Dr Rino Burkhardt’s subject was ‘Minimally invasive periodontal surgery and its effects on wound healing’. In essence success depends on maintaining the microscopic blood supply to promote rapid healing and was best achieved by adopting the skills from the other surgical disciplines such as eye and microvascular surgery.
Dr Domenico Massironi (one of my personal heroes) gave a beautiful presentation on the use of surgical microscopes in aesthetic dentistry. Only with improved vision can we truly assess the quality of our work and achieve the precision that our patients deserve. Check out his video (its only in Italian but that does not matter watch it anyway)
In the afternoon followed three excellent lectures by Prof. Gilberto Debelian, Dr Tony Struttman and Dr Tomas Lang on root fillings, retreating failed root fillings and micro-invasive dentistry. If a tooth can be reasonably saved there are huge advantages to the patient than losing it and hoping that an implant will perform any where as well.This may not have been so 15 years ago but microscopy now allows us to literally look down the root of a tooth which was impossible before then. It’s hard to out engineer nature.
The final presentation was from Oscar von Stetten on using the microscope to document our treatment and communicate what we see down the microscope to colleagues and patients. If our patients truly understand what we as clinicians are trying to achieve the better the treatment outcomes. Below is a picture of a cracked back tooth which helped the patient understand why it hurt every time they bit on it.