Editorial (Volume 2 - Oct 2010)


Over the last decade dentistry has seen a paradigm shift from removable to fixed implant restorations and from bridges to implants. today more and more patients ask for replacement of their teeth that look feel and function like natural teeth. though man cannot challenge mother nature these artifical roots have come soo close to nature that we clinicins are in a dilemma to save or to extract a tooth with questionable prognosis. with a lot of flaps and graftings where in their is to be a five year prognosis and eventual bone loss we sometimes wonder wheather its better to extract - implant and save the bone . but untill such time we have enough evidence to support we will still follow conventional treatment procedures
Unlike earlier days todays dentist is faced with a patient who is more informed about the pros and cons of any dental treatment or the drugs prescribed. blame it on the google era or thank google more and more patients walk into our dental office asking for implants. thanks to the stronge indian economy and the weak global economy we have a lot of NRIs turning indian. all these factors have suddenly increased the indian health care industry.

medical and dental tourisum have become a reality today. this has also led to patients demanding better esthetic and functional restorations clinicians today face the challenge of not just getting implants integrated but to give a state of the art optimal perioprosthetic restoration- school of dental implants , the first surgical and prosthetic implant training programme in twin cities has been getting the best academicians, clinicians and researchers in the field of oral implantology . so that the participants get the best training ,knowledge and skill to handle any challenge independently.

we have hade some of the best know academicians and clinicians to have braced the school.from prof. dr. E.G.R.Solomon father of gnathology in india to prof. dr. murlidhar of university of new jersy , an academician par excellence and author to many textbooks to have imparted a very good knowledge to us 3years down since we have started and with 6 completed batches the school has also moved from basic implantology traing to advanced training, planning using guided surgery software ,etc. being a non commercial programme the participants get exposure to a multitude of implant systems and can choose one that best suits them.

Dr. Venkat Ratnanag catches up with Dr. Carl Misch at Kuala Lumpur International Convention Centre, 64th MDA/FDI International Centre, Scientific & Trade Exhibition, June 2010.

Dr. Venkat : Which are the key implant locations to restore a partially edentulous patient?

Dr. Carl Misch : There are over 100,000 combinations of missing teeth, with various bone volumes in the edentulous sites. As a consequence, treatment planning to replace missing teeth has been an art form. However, today bone augmentation procedures can usually regenerate residual bone to more ideal conditions. Therefore an assumption in an ideal treatment plan should be there if adequate bone is present in the edentulous sites to insert dental implants.

In any fixed prosthesis replacing two or more adjacent teeth, there are locations which are more important than others, from a biomechanical perspective. These specific locations may be called “key” to restore the patient. “Key” implant locations are important enough to do a bone augmentation procedure if inadequate bone is found at this site.

When the missing teeth in a partially edentulous patient are to be replaced with dental implants,

there are four guidelines to establish the key implant locations:

1. No cantilever
2. No 3 pontics
3. The canine rule
4. The first molar rule

Cantilevers are force magnifiers. Three adjacent pontics not only overload the adjacent abutments, the flexure of the metal is 27 times the flexure of a 1 pontic prosthesis. The canine and first molar sites are key positions for an arch, and whenever messing should be replaced with an implant (rather than a pontic).

Once these key positions are determined, the additional implants required to restore the patient are considered based upon patient force factors and the bone density in the edentulous sites.