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The concept of permanently replacing lost teeth
has been pursued over the course of the last few centuries, but
the methods and results were highly unpredictable. Many descriptions
and articles can be found in dental and medical journals dating
from the 19th and 20th centuries.
Implant dentistry was considered a fringe, renegade branch of the
profession from the 1950’s through the 1970’s, with
a few dentists placing a variety of dental implant devices in the
mouths of desperate patients. Some were successful, but many caused
painful, disfiguring failures. Within the profession, there was
incomplete understanding of the biology involved, there was no consensus
on the criteria for success, and the documentation was weak and
inconsistent. After 5 years, successful retention rates for some
of these implants reached only about 50%.
In the late 1970’s and early 80’s, solid scientific
evidence emerged from Sweden and Switzerland demonstrating that
as long as certain principles and procedures were followed, implants
could be placed and retained successfully in over 95% of the cases.
This was a great leap forward for implant specialists, making the
choice of implant dentistry both a practical and reasonable option
for patients to consider.
Several different schools of thought emerged regarding the recipe
for success for these new implants. Some advocated burial of implants
under the gum for several months before fitting them with teeth;
others believed that they could be visible. Many doctors called
for an operating room environment, while others demonstrated success
performing these procedures in their offices. A vocal group of doctors
were convinced that implants could only be placed into a healed
jawbone, while others showed success placing them in recent tooth
extraction sockets.
From a patient’s perspective, the most clinically important
issue emerged in the discussion of how long implants had to heal
before using them to support teeth. It was initially believed by
some dentists that implants placed in the upper jaw required up
to 9 months of healing, while those in the lower jaw needed up to
6 months before teeth could be “loaded” onto the implants.
However, as early as 1986, others reported achieving nearly a 100%
success rate when they “loaded” new provisional teeth
on the implants at the same time as they placed implants.
Articles began to appear in dental journals in the early 1990’s
documenting similar success rates for immediate loading (immediate
use of the implants to support teeth) as for conventional procedures.
Initial studies focused on patients who had all of their lower teeth
(or a full lower denture) replaced with implant-supported fixed
bridges.
We were aware of these reports in 1997, when we performed our first
immediately loaded full lower implant procedure in response to a
patient’s desperate plea to avoid wearing a lower denture
during the healing process. While the procedure was (and still remains)
100% successful, the process was cumbersome, technically difficult
and uncomfortable. It also required significant patient time in
the dental chair and several appointments during the first week
following the procedure.
As a growing number of subsequent patients expressed their strong
desire to avoid dentures, more were treated using the immediate
load technique. During this time we refined and streamlined the
process. In 2001, having completed 27 similar cases at the Institute,
we published the results in the world’s leading dental implant
publication, the International Journal of Oral and Maxillofacial
Implants. At the time of publication, our study represented
the largest group of similar patients with the greatest number of
implants (186), the highest success rate (99.4%) and the longest
average follow-up (25 months) to be published to date. That same
year, we created the name TeethToday® to describe this technique
as the procedure of choice.
Given our success with patients missing lower teeth, we began to
expand our use of immediate
load implants for use with other conditions. As colleagues around
the world reported success with single tooth replacement, we followed
suit. We then took the next step, expanding to several-tooth TeethToday®
procedures. The data documenting our success in these cases was
submitted by a leading dental implant manufacturer to gain full
FDA clearance of their implant system for use in virtually all immediate
loading applications.
Finally we progressed to the more challenging condition of full
upper tooth replacement. After meeting with success in all of these
cases, as well, we evolved to full-mouth TeethToday® treatment
capability. Now, individuals coping with either full upper and lower
dentures or with a mouth full of deteriorating teeth can have them
all predictably replaced at one time and in one day!
It is still not possible to replace every missing tooth with TeethToday®
dental implants. But as implant designs, procedures and experience
improve so will the opportunities to shorten all treatment times.
Our standards and objectives remain the same: to achieve 100% success
for comfortable, esthetic and painless tooth replacement. TeethToday®
has been perfected in hundreds of patients, nearly 1000 implants
(as of 12/2003) and through years of analysis, innovation and creativity.
Our commitment is to continue on this path of originality and predictable
excellence.
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