Dental Implant Education and Practice in Oral and Maxillofacial Surgery: 25 Years of Progress

EDITORIAL J Oral Maxillofac Surg 66:611-612, 2008

Dental Implant Education and Practice in Oral and Maxillofacial Surgery: 25 Years of Progress No single surgeon can keep pace with all the elements of change in implant dentistry that are evolving. Thus, our residency training programs are challenged to provide education that will make our graduates capable future clinical and investigational leaders in implant dentistry. Without leadership in implant education, research and practice, oral and maxillofacial surgeons cannot expect to lead implant dentistry in the future. What are the changes in the utilization of dental implants and how do oral and maxillofacial surgeons fit into that environment? Implant dentistry is becoming further integrated into comprehensive dental care—routine phase 2 (comprehensive reconstructive) dentistry. Implant dentistry is integrated into other dental interventions as diverse as exodontia, periodontal disease management, orthodontics and other direct and indirect dental restorations. The placement of implants is now expected to be “restorative driven,” with a goal toward optimal esthetics. This has included greater understanding of the need for site preparation and, in some cases, immediate provisional restoration. Our residency programs are challenged to succeed in this demanding clinical arena. Most oral and maxillofacial surgery residency training programs do not exist in an environment of comprehensive dental care. Less than half of our programs are affiliated with dental schools. Many interact only indirectly with general practice residencies, advance education in general dentistry programs, and with other dental specialties. Dental students are now required to both place and restore implants in many dental schools. Programs in prosthetic dentistry, periodontology, endodontics, orthodontics, and general dentistry all offer clinical experiences of varying intensity in implant dentistry. Both periodontology and prosthodontics are substantially invested in their success as being leaders in implant dentistry as these specialties are devoted to the maintenance and reconstruction of the dentition. Without implants as a core of their training and practice, periodontology and prosthodontics will not survive as dental specialties. The procedures that propelled their progress prior to implant dentistry have

Next month the University of Toronto will revisit an event that changed implant education and practice forever, the 1982 osseointegration conference in Toronto. After years of clinical research with PI Branemark, George Zarb organized a program that propelled North American dentistry into the era of osseointegration. A key element of that program was the presentation of 15 years of rigorous clinical research that supported the indications for and uses of implants. Their research supported only very narrow clinical parameters at that time. Those parameters essentially included the treatment of the edentulous mandible, submerged 2-stage implants, 6 months of unloaded healing, machined titanium surfaces, implant placement in native bone, and screw-retained fixed hybrid or overdenture restorations. May 8 through 10, 2008, Asbjørn Jokstad and the organizing committee at the University of Toronto will present, with 72 leading speakers, 25 years of implant dentistry (and 40 years of research) that, when viewed in its totality, is an almost unfathomable expression of progress. The borders of implant utilization in dentistry have been literally and figuratively expanded to include esthetic restoration of hard and soft tissue, tumor and trauma reconstruction, and most importantly for daily dental practice, the universal understanding that implants are the preferred method for reconstruction of the partially and fully edentulous patient. Tissue engineering, soft and hard tissue reconstruction, computer-based planning, immediate loading with new implant surfaces and designs, and image-guided esthetic restorations are but a few of the changes that are propelling dental implant practice forward. Unlike the handful of universitybased investigators of 25 years ago, dental implants are now a multibillion-dollar industry that further expands research and clinical application. Today every dentist is vested in the progress of implant dentistry, thus the level of interest in this seminal conference has been overwhelming. This event, like George Zarb’s program of 1982, may excite new areas of investigation and practice for the future. What role will oral and maxillofacial surgeons have in that progress? 611

612 now diminished sharply due to the impact of the success of implant dentistry. For example, periodontal surgery to preserve the dentition was always a tenuously evidence-based therapy of limited value in saving teeth over time. Prosthodontics was built on multiunit dentition-based fixed restoration. This was also of tenuous value as data indicated that fixed bridges failed at a predicable rate over time. Implant dentistry with its reliable success and lifelike restoration has been a near panacea that has quickly overtaken the obsolescent periodontic and prosthodontic procedures of the past. Implant dentistry is essential to the success of these specialties. In a different way it is key to the success of oral and maxillofacial surgery as well. How are oral and maxillofacial surgeons positioned to succeed? Surgery is our strength: The broader interests and skills of oral and maxillofacial surgeons are major assets in the quest for excellence in implant dentistry. We are comfortable with major surgical interventions, medical management issues, and pain and anxiety in a fashion superior to anyone in dentistry. We are dentistry’s only true surgeons. Dentistry is our strength: Oral and maxillofacial surgery can only succeed as a dental specialty. The most needed complex surgical intervention in dentistry today is dental implant placement and related procedures. We must continue to demonstrate that oral and maxillofacial surgeons are dentistry’s surgeons. Thus we must strengthen our relationships with our dental colleagues and create collegial alliances, especially with periodontology and prosthodontics that will improve patient care, education, and research. Caring for the sick is our strength: More than any other dental specialty, oral and maxillofacial sur-

EDITORIAL

geons care for the complex patient with odontogenic infection, trauma, facial defects, craniofacial anomaly, and tumor care. Most surgeons with interests in major surgery maintain an active excitement and skill in implant dentistry. This is a major asset for the future. For implant dentistry to advance in the next quarter century it must demonstrate its importance in advancing human health. Oral and maxillofacial surgeons are in the best position to achieve that success. Our faculty are our strength: Two decades ago few oral and maxillofacial surgery faculty were prepared to provide implant education. Effective programs by AAOMS and the implant producers have created a cadre of surgeons in every program to provide implant education leadership. Over 10,000 implants per year are now placed in OMS programs, over 100 per program per annum, certainly enough to achieve substantial surgical educational experience. In continuing education, our faculty speakers at the annual AAOMS implant conference are offering cutting edge, evidence-based, and clinically excellent techniques that support our leadership in implant dentistry. With our specialty’s broad reach and broad interest in implant dentistry, its future achievements are bound to be inestimable. While the findings of the 2008 conference will be amazing, why not look forward to 2033? The findings of the 2033 Toronto implant conference and the role of oral and maxillofacial surgeons in those advances can only be imagined, and hoped for, and planned for. LEON A. ASSAEL, DMD

© 2008 American Association of Oral and Maxillofacial Surgeons doi:10.1016/j.joms.2008.02.002