As the dental community is well aware to the fact that implant restorations don’t ever achieve a 100% success rate and therefore when they fail, the patient is left wondering if they should have pursued such a treatment option in the first place. Couple this with the fact that they lost their natural teeth that possibly could have been utilized as a treatment alternative to implant treatment, is definitely a recipe for patient disappointment, frustration, and anger. This dental prosthodontist expert has frequently observed this clinical scenario when natural teeth with a decent prognosis were removed in order to splint multiple implants together for improved anchorage support. This is especially pertinent today with the popular trend in the dental implant treatment application referred to as immediate load multiple implants “ teeth in a day”.
This is where all of the natural remaining teeth are removed in either of the upper or lower jaws and from 4 or more dental implants in each arch are immediately placed and an initial provisional fixed hybrid bridge is provided. Many times, decent natural teeth are removed to conveniently splint all of the implants together for proper support of the restoration according to the protocol of this procedure. In general, success rates are at a 90-95% level for a five-year follow- up period. However, if a failure rate occurs at a 5-10% level and the patient is part of this classification, that patient often does not care about the so-called high degree of success if improperly informed about the downside to the procedure.
Because all implant treatment is considered to require the coordinated involvement of both a surgeon and a restorative dentist, this does not happen as frequently as this professional would expect or has observed. An elaborate and detailed written informed consent needs to be provided to the patient from both a surgical and restorative dentistry points of view. Along with the informed consent, a written risk-benefit analysis with both alternatives to implant treatment and prognosis to each of these substitutes needs to be discussed thoroughly with the patient “before” any anticipated implant treatment is “initiated.” Any violation to this critical aspect to the preliminary phase of any implant treatment plan is considered gross negligence as it relates to the standard of practice in any dental community. It has been observed over many years that both of the necessary surgical and restorative aspects to dental implant treatment remains incompletely documented because either the surgeon proceeds alone without any input from the restorative dentist to complete the treatment or a restorative dentist that provides both the surgical and restorative phases to treatment, is many times insufficient and does not meet the threshold to adequate dental community standards.
In conclusion, all levels of dental implant treatment should always be part of a treatment alternative to any anticipated patient tooth loss as a matter of standard of dental practice. However, any dental implant treatment always requires a very high level of co-ordination and documentation. Again, Premature removal of any remaining natural teeth with a decent long term prognosis as a matter of convenience, in order to simplify a long span implant restoration, should be frowned upon and justified only through a very thorough evaluation by additional dental specialists such as from a periodontist(gum specialist) and/or an endodontist (tooth/pulp specialist). Simply put, when doubt exists as to whether the current status and prognosis of the existing patient dentition is in question in part or in total, the dentist should always refer to appropriate dental specialists before any dental implant treatment is ever contemplated or started.