Anesthesiology in OMS: Past, Present, and Future

In recent decades, office-based surgery has become more and more common as the medical landscape changes to accommodate a cultural shift toward preventive care and an increase in elective medical procedures. While medical specialties like plastic surgery and gastroenterology have only recently begun providing office-based surgery, dentistry—specifically oral and maxillofacial surgery (OMS)—has been providing the service for over 150 years. In that time OMS has developed industry-leading safety protocols for office-based anesthesia administration and an anesthesia-related safety record that is second to none. But how did it all start?

The Discovery of Anesthesia and Its Effect on Dentistry

An illustration of Horace Wells’s first nitrous oxide experiment, wherein he allowed his partner, John Riggs, to extract one of his own teeth after Gardner Quincy Colton administered nitrous oxide. (Source)

Pain is often the reason patients seek dental care, but the fear of pain is also one of the reasons why many patients avoid dental care. It was this close relationship between dentistry and pain that motivated Horace Wells (1815–1848), an American dentist, in his discovery of anesthesia. As the famous story goes, Dr Wells attended a nitrous oxide demonstration in Hartford, Connecticut, where he witnessed a participant bang his legs into a bench accidentally but without experiencing any pain. The next day, Dr Wells tested the effects on himself—he asked a colleague to remove one of his teeth while he was under the influence of nitrous oxide. A few weeks later, he demonstrated his anesthetic method at Massachusetts General Hospital by administering nitrous oxide to a medical student prior to extracting the student’s third molar. His use of nitrous oxide earned him the credit for discovering anesthesia.

Dr Wells’s discovery sparked an era of innovation as other dentists rushed to offer anesthesia for their patients and discover new methods for anesthesia administration, including local anesthesia. Before the 1930s, when dentists began using local anesthesia on a larger scale, patients in need of extractions or similar procedures migrated to practices that had access to general anesthesia. A distinctive divide developed between dentists who provided general anesthesia for their patients and those who did not; the cohort of dentists who did provide general anesthesia, mainly exodontists, eventually developed into the OMS specialty. This divide culminated with the formation of the American Society of Exodontists in 1918; today, this organization is known as the American Association of Oral and Maxillofacial Surgeons (AAOMS).

Anesthesiology Spreads to Medicine

While dentistry grappled with its own identity crisis with regard to anesthesiology, the broader field of medicine also began questioning the role anesthesiology should play in the practice of medicine. Daniel L. Orr II, an oral and maxillofacial surgeon based in Las Vegas, Nevada, explains: “After safe, reproducible anesthesia was discovered by dentistry in 1844, dentists were the primary operator/administrators and providers of the service for others, including physicians in hospitals, for most of the 19th century. It wasn’t until the 20th century that medicine also began to embrace anesthesia, beginning with the precursor of the American Society of Anesthesiologists (ASA) in 1905.”

When the ASA started, it was a small organization of just nine physicians based in Long Island, New York. It would still take a few more decades before physicians across the country caught on. In an article published in 2013 by the Oral and Maxillofacial Surgery Clinics of North America, Dr Orr identifies the catalyst that elevated anesthesiology into the broader spectrum of medicine:

[The 1940s were] significant in that anesthesiology changed from what was often deemed an insignificant afterthought. . . to an area that began to be embraced as essential by dentistry, medicine, veterinary medicine, and nursing.
The remarkable growth of anesthesiology in the 1940s was brought on by 2 major factors. First, it was the decade that recognized the 100th anniversary of the discovery of anesthesia. . .
The second factor influencing the remarkable recognition of anesthesia was World War II itself. In fact, wars did much to promote the art during the previous century. [William Taggart Green] Morton provided 3,000 anesthetics during the Civil War.7 The American Association of Nurse Anesthetists traces its founding to the same conflict. However, World War II was the first time that the military formally planned for the provision of anesthesia during surgery. . .

After World War II, anesthesiology took off as a designated field of medicine. But, despite dentistry’s contributions to both the discovery and the development of anesthesiology, contention developed between the two fields over dentistry’s use of anesthesia.

Surgeons and an anesthesiologist performing surgery during World War II in a makeshift surgical bunker. (Source)

Dentistry Versus Medicine, Office-Based Anesthesia Versus Hospital-Based Anesthesia

The original Baltimore College of Dental Surgery, the first dental college in the world and the birthplace of the DDS degree. The dental college was incorporated into the University of Maryland in 1923. (Source)

For a detailed history of how dentistry developed separate from medicine, take a look at The Long Climb: From Barber-Surgeons to Doctors of Dental Surgery by Philias Roy Garant (Quintessence, 2013). For a quick and simplified explanation, we can trace the root to 1837 when two dentists named Horace Hayden and Chaplin Harris proposed that the medical faculty of the University of Maryland add dentistry to their medical program; the faculty responded that “the subject of dentistry was of little consequence and thus justified their unfavorable action.” So the two dentists opened their own dental school, the Baltimore College of Dental Surgery, and formal dental education has remained separate from medical school ever since. This separation would later lead to the parallel development of two fields of anesthesia: office-based (dentistry) and hospital-based (medicine).

“Perhaps the most important development that can be attributed to dentistry,” Dr Orr explains, “is office-based, out-of-hospital, outpatient surgery and anesthesia. Because dentists worked from private offices, they couldn’t admit patients the night before surgery, operate the next day, and release them on the third day. Dental procedures done using general anesthesia were completed in a matter of a few hours, portal to portal—a concept unheard of at the time in medicine.”

Meanwhile, medical surgeons did have access to those resources. They had admitting privileges at hospitals with anesthesiologists and nurses. Moreover, their procedures were often covered by their patients’ health insurance, so the cost of those resources was not antithetical to the existence of their practice.

“Anesthesiology has been controversial in dentistry and medicine since it was first discovered,” Dr Orr laments. “But there are situations unique to dentistry that are interesting. Until 1950 dentists were able to be unrestricted members of the ASA.” (Now, membership for dentists, veterinarians, and other non-physician administrators of anesthesia is restricted to educational membership.) “The ASA even had dental officers and at least one dental president, Charles Teeter. The International Anesthesia Research Society (IARS) still accepts dentists as full members. The American Dental Society of Anesthesiology (ADSA) was founded in order to provide a platform for dentist anesthesiologists, including OMS, after the ASA option was lost.”

In his 2013 article, Dr Orr recounts a moment from his residency at the University of Utah Medical Center Department of Anesthesiology that exemplifies the tension between medicine and dentistry on the subject of anesthesiology:

In early 1976 the opening of Utah’s first outpatient surgical center was announced to university anesthesia residents at rounds. It was explained that this was a facility where patients could be admitted in the morning, receive an anesthetic for a surgical procedure, and return home on the same day! The anesthesia faculty discussed in an animated fashion whether this new model was safe and questioned if it would even survive. One of the dental residents then commented that dentistry had been doing the same thing for 100 years (actually since December 1844), out of private dental offices in fact, causing consternation for the physician anesthesiologists in the room.

Just as education was the first step toward the professionalization of dentistry, education also forms the foundation of anesthesiology in OMS, and it is only through organized effort that the OMS community has been able to protect this foothold. Later in the article, Dr Orr describes this event from 1990:

Historically, there were more than 150 anesthesia residencies that had allowed dentist residents through the decades. In June 1990 the ASA was advised about the numbers of dentist anesthesiologists that had been trained in medical residencies through the years. The ASA then contacted the Accreditation Council for Graduate Medical Education (ACGME) and opined that residencies that deigned to train dentists should not be accredited. The ACGME then contacted all accredited anesthesiology residencies and iterated that if dentists continued to be rostered, programs might lose accreditation. Almost overnight, all but a handful of medical residencies determined to no longer admit dentists for training. The AAOMS, however, was able to negotiate continued rotations on anesthesiology services for OMS residents.

Even while hospitals and medical specialties were implementing treatment protocols designed by OMS (outpatient anesthesia and surgery, office-based anesthesia and surgery), the medical community still seemed to reject OMS’s place within their community. We can only imagine how different history would be had the University of Maryland accepted Drs Hayden and Harris’s proposal: How quickly would anesthesia have been implemented by the entire medical community, and how early would outpatient surgery have become an option for patients outside of the dental clinic?

The Safety of Anesthesia in OMS

The legacy of and reasoning behind continuing anesthesiology in OMS isn’t just based on the discoveries and innovations of prior centuries, despite the noteworthiness of the office-based surgery model. OMS has also developed a team approach to anesthesia that has contributed to an anesthesia-related safety record that even beats that of hospitals for comparable procedures. There are many possible reasons for this: the lengthy history of anesthesiology in OMS, the team-based approach of OMS versus the individual approach of hospital-based surgery, and the overall emphasis by the industry on safety. Because OMS faced increased scrutiny and discrimination by the medical community from the beginning, the industry has developed safety protocols to protect their patients and, consequently, the industry’s legacy.

No one expects to die at the dentist’s office, making it all the more shocking when an adverse outcome is made public. However, statistics show that anesthesia in an OMS clinic is quite safe. Studies by the Southern California Society of OMS in the 1960s showed that while hospital mortality for tonsillectomy and adenoidectomy was 1 in 12,000, removal of third molars under general anesthesia in dental offices was less than 1 in 400,000. According to the Oral and Maxillofacial Surgery National Insurance Company (OMSNIC), between 2000 and 2014 oral surgeons covered by the OMSNIC administered office-based anesthesia 42,792,419 times, which is about 666 administrations per oral surgeon per year. Out of the total number of administrations, 415 anesthesia-related claims for complications were reported to the OMSNIC and included 121 deaths. This equals 1 death for every 353,657 administrations.

How to Protect a Legacy

As patients live longer and with more comorbid diseases, the field of anesthesiology as a whole, whether hospital-based or office-based, must adapt their models to include thorough assessments of each individual patient. This challenge is what motivated Matthew Mizukawa to develop his new book for clinicians, Anesthesia Considerations for the Oral and Maxillofacial Surgeon (Quintessence, 2017).

“In residency, you are constantly encountering complex patients who are difficult from an anesthesia standpoint,” Dr Mizukawa explains. “You become accustomed to managing those patients, all while under the supervision of a faculty surgeon—someone who will always be there to back you up or get you out of a bind. In private practice, you don’t have that safety net. The buck stops with you. On top of that, over time you start to forget some of the principles of managing comorbid diseases when you see them less frequently. You begin to lose the information you need to answer the questions of: Is it safe to perform office-based anesthesia on this patient? Why, or why not? What additional information do I need to make this decision?

“The complexity of each anesthetic case,” he continues, “is dictated by the patient’s age, medical history and current medications, past anesthetic experiences, airway anatomy, and degree of procedural anxiety. Each patient must be evaluated thoroughly, and the provider personalizes the anesthetic plan based on those careful assessments. This book guides the anesthesia provider along their decision tree and ultimately gives insight to the question of whether office-based anesthesia can be safely provided for each patient.”

The contents of the book are divided into three sections: Section 1 covers the principles of anesthesia, Section 2 provides a review of each major organ system and related diseases/disorders, and Section 3 addresses anesthetic considerations for special patient populations. Dr Mizukawa gives an example of a patient he treated and explains how the book can assist clinicians in similar cases:

A 78-year-old man presented for consultation prior to having his remaining teeth extracted. His medical portfolio included coronary artery disease, atrial fibrillation, asthma, type 2 diabetes, hypertension, hyperlipidemia, chronic kidney disease, and morbid obesity with associated obstructive sleep apnea. He was taking myriad medications to manage these conditions. In addition, poor experiences receiving dental treatment in the past had made him extremely anxious around the dental and surgery setting in general. “This scenario may have been an outlier a few decades ago,” Dr Mizukawa says. “However, with the rate of current advances in medicine, patients like these come in every day.”

So, is it safe to perform an office-based anesthetic for this patient? Dr Mizukawa explains how the book can be used to answer that question: “To tackle the coronary artery disease first, the clinician can review the section on ischemic heart disease in the cardiovascular system chapter. Here, the book provides refresher information on the pathophysiology of coronary artery disease to help the clinician determine the severity of the patient’s disease, a general review of how coronary artery disease is medically managed to help evaluate how well the patient’s disease is currently controlled, and information on how coronary artery disease is worked up to help the clinician communicate with the patient’s cardiologist. The chapter then discusses anesthetic considerations for coronary artery disease. The renal chapter provides the same information regarding the patient’s chronic kidney disease, with an additional section on recommended changes in anesthetic drug dosage based on kidney function. This process can be repeated for each of the patient’s comorbidities with the goal of determining how to most effectively and safely manage this patient’s needs, whether that be through office-based anesthesia or moving the procedure to a hospital environment.

“Once all of the disease processes have been reviewed and assessed for severity and control, additional resources are available to help guide the provider. The chapter on IV anesthetic agents helps the clinician determine which agents to use and which to avoid, as well as whether to modify dosing in light of comorbid disease. The chapter on obstructive sleep apnea (OSA) advises the clinician on how OSA will affect the monitors, particularly the end-tidal carbon dioxide monitor, while the chapter on airway emergencies covers management of the airway in the presence of OSA. The medical emergencies chapter covers myocardial ischemia and infarction, which must be considered in light of the history of coronary artery disease. In the special patient population section of the book, the clinician finds special anesthetic considerations that must be appreciated regarding geriatric patients and patients with morbid obesity and obstructive sleep apnea.

The STOP-BANG questionnaire as it appears in the book.

Sample pages from the chapter on geriatric patients and anesthesia considerations for their safe treatment.

“And finally: Patients with multiple comorbidities will likely have a very long medication list,” Dr Mizukawa concludes. “All medications modulate the normal physiological processes of the human body to some degree. For some medications, these changes are insignificant, while some medications have serious effects on anesthesia. Appendix A of the book provides a comprehensive list of commonly prescribed medications, their mechanism of action, indications for use, and their effects on anesthesia. While not a complete index of every drug that exists, it is a list of drugs commonly encountered while evaluating patients.”

A sample from Appendix A in the book.

As for the patient above: Dr Mizukawa was able to safely anesthetize him in office. After consulting with the patient’s primary care provider and specialists and reviewing the information he would later include in the book, Dr Mizukawa developed an anesthetic plan personalized to address the patient’s individual needs. The book takes initially overwhelming cases like this one and provides a simplified, structured guide for the clinician in creating an anesthetic plan.

The Future of Anesthesiology in OMS

“My hopes for the future of anesthesiology in OMS are threefold,” Dr Mizukawa explains. “I hope that we are able to not just maintain, but strengthen the margin of safety of office-based anesthesia by reducing the number of complications and deaths—despite the rising number of total anesthetics provided each year, and despite the increasing complexity of patients encountered. I hope that we continue to be leaders and innovators in anesthesia progress and develop evolving techniques and devices that make office-based anesthesia more safe and efficient. There are some who feel that the OMS model, where the surgeon also functions as the anesthesia provider, is not safe. My last hope is that OMS, by strengthening our margin of safety and innovating office-based anesthesia, will prove that our model is both safe and efficient.

“The biggest obstacle we face regarding our continued use of anesthesia is distinguishing OMS from other dental anesthesia providers,” he says. “The anesthesia training that we receive is sound. I feel that, though they are not an ADA-recognized specialty, dental anesthesiologists also receive sound training. But there are other specialties and general dentists who receive minimal training—sometimes only a 1- or 2-week course—who are then able to provide anesthesia to their patients. There is a growing concern in the public that dentists who perform anesthesia are dangerous. Even though I know there is no comparison between the anesthesia background and training in OMS and these other groups, the public at large cannot distinguish us from them. Our ability to distinguish ourselves from these groups is critical in preserving our ability to practice the surgeon/anesthetist model. This underscores my motivation behind this book.”

The unique organizational structure of Dr Mizukawa’s book makes it an invaluable and practical supplement to the clinician’s personal knowledge and expertise. It aims to quickly and effectively provide pertinent information to the anesthesia provider and assist in making decisions regarding anesthesia care and, in doing so, help preserve and strengthen the exceptional margin of safety of office-based anesthesia in OMS. The hope is that any group providing office-based anesthesia—whether oral and maxillofacial surgeons, periodontists, dental anesthesiologists, certified nurse anesthesiologists, gastroenterologists, or myriad others—can use this book to safely and efficiently provide anesthesia to their patients. The goal of anesthesia has always been to safely manage patient pain, and Dr Mizukawa’s book furthers this goal in a nonpartisan way for anyone willing to use it.


Anesthesia Considerations for the Oral and Maxillofacial Surgeon

Edited by Matthew Mizukawa, Samuel J. McKenna, and Luis G. Vega

Although office-based anesthesia administration has been essential in the evolution of outpatient surgery, it is becoming more complex as people live longer and with more comorbid diseases. The purpose of this book is to strengthen the margin of safety of office-based anesthesia administration by helping practitioners determine whether the patients they treat are good candidates for office-based anesthesia. This book is organized into three sections. The first section provides a review of the principles of anesthesia, including the pharmacology of anesthetic agents, local anesthesia, patient monitoring, preoperative evaluation, the airway, and management of emergencies and complications. The major organ systems of the body are reviewed in section two, and the most common comorbid conditions that affect these systems are described in terms of their pathophysiology, diagnosis, management, and anesthesia-related considerations. Section three reviews patient groups that warrant special consideration in the administration of office-based anesthesia, such as geriatric, pediatric, pregnant, and obese patients. Spiral-bound and featuring tabs for quick and easy reference, this important book belongs on the shelf of every clinician who provides anesthesia in the office setting.

482 pp; 101 illus; ©2017; ISBN 978-0-86715-713-0 (B7130); US $168

 

Matthew Mizukawa, DMD, is Assistant Clinical Professor in the Department of Oral and Maxillofacial Surgery at the Vanderbilt University Medical Center in Nashville, Tennessee. He obtained his dental degree from the University of Nevada at Las Vegas and completed his oral and maxillofacial surgery residency at the Vanderbilt University Medical Center, where he was awarded Best Consultant from the Department of Emergency Medicine. Dr Mizukawa is board certified by the American Board of Oral and Maxillofacial Surgeons and is a member of the American Association of the Oral and Maxillofacial Surgeons, the American Dental Association, the Utah Dental Association, and the Southern Utah Dental Association. He is co-editor of the book Anesthesia Considerations for the Oral and Maxillofacial Surgeon (Quintessence, 2017) and maintains a private practice limited to oral and maxillofacial surgery in St George, Utah.

 

Samuel J. McKenna, DDS, MD, currently serves as Professor and Chair
of the Department of Oral and Maxillofacial Surgery residency at the Vanderbilt University Medical Center in Nashville, Tennessee. He received his dental degree from the University of California, Los Angeles School of Dentistry and completed his medical degree at the Vanderbilt University Medical Center, where he served as director of the oral surgery residency program. His research includes temporomandibular joint surgery, oral manifestation of systemic disease, and virtual surgical planning in the management of skeletal facial deformities. He is co-editor of the book Anesthesia Considerations for the Oral and Maxillofacial Surgeon (Quintessence, 2017). Dr McKenna lectures within both the dental and medical communities and is a member of the American Medical Association, the American Dental Association, the American Association of Oral and Maxillofacial Surgeons, and the Cumberland Pediatric Foundation.

 

Luis G. Vega, DDS,
 is Associate Professor and Residency Program Director in the Department of Oral and Maxillofacial Surgery at the Vanderbilt University Medical Center in Nashville, Tennessee. He received his dental degree from the University of Costa Rica and his certificate in oral and maxillofacial surgery from the University of Alabama at Birmingham. Dr Vega’s clinical practice covers the full scope of oral and maxillofacial surgery. He is co-editor of the book Anesthesia Considerations for the Oral and Maxillofacial Surgeon (Quintessence, 2017) and lectures locally, nationally, and internationally on the topics of temporomandibular joint reconstruction, orthognathic surgery, obstructive sleep apnea surgery, complex maxillofacial reconstruction utilizing zygomatic implants, and endoscopy in oral and maxillofacial surgery.

 

Daniel L. Orr II, DDS, MS (anesth), PhD, JD, MD, is Professor and Director of Oral and Maxillofacial Surgery at the University of Nevada, Las Vegas School of Dental Medicine. He received his dental degree from the University of South California School of Dentistry and completing both a residency and master of science in anesthesiology at the University of Utah School of Medicine. He is a member of the American Dental Association, the American Association of Oral and Maxillofacial Surgeons, and the American Dental Society of Anesthesiology, among others. In 2011, Dr Orr received the Daniel M. Laskin Award for Outstanding Predoctoral Educator from the American Association of Oral and Maxillofacial Surgeons. He is board certified in oral and maxillofacial surgery, anesthesiology, and legal medicine and contributed a book chapter to Anesthesia Considerations for the Oral and Maxillofacial Surgeon (Quintessence, 2017).

 

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Quintessence Roundup: October

Quintessence 2017 Catalog

Monthly Special


At the Forefront: Illustrated Topics in Dental Research and Clinical Practice

Edited by Hiromasa Yoshie

This volume brings together articles on the topics of bioscience and clinical science, punctuated with striking illustrations. The first half addresses scientific topics such as diagnosis of periodontal disease, tooth regeneration, tissue-engineered bone, correlation of periodontal disease with other conditions, and genetic diagnosis of drug-induced gingival overgrowth. In the second half, the focus is on clinical issues, including dentinal remineralization, whitening procedures, caries detectors, nerve injury, morphologic changes following tooth loss, and identification of vessels and nerves prior to implant placement. A visually stunning and instructively enlightening compilation of reports on the cutting edge of dental scientific and clinical research.

108 pp; 188 illus; ©2012; ISBN 978-0-86715-515-0 (B5150); Special price! US $39

 

New Titles in Books


Introduction to Metal-Ceramic Technology, Third Edition

W. Patrick Naylor

For 25 years, the Introduction to Metal-Ceramic Technology has been an essential textbook, and this revised edition underscores its import to the discipline. The author expertly outlines the history and theory behind metal-ceramic restorations and then guides readers through each step of the fabrication process. Although many students do not realize the esthetic possibilities of metal-ceramic technology, this book illustrates how to achieve esthetic results to rival those of all-ceramic materials through treatment planning, clinical procedures, and dental laboratory steps executed at their highest levels. New to this edition are an expanded illustrated glossary, a simplified four-step buttonless technique, fresh analysis of bonding mechanisms, and a full chapter on the esthetic porcelain-margin restoration. Written specifically for dental technology students, dental students, and residents in advanced technical courses.

240 pp; 617 illus;  ISBN 978-0-86715-752-9 (B7529); Special preorder price! US $78

 

Oral Pathology in Clinical Dental Practice

Robert E. Marx

While most dentists do not perform their own histologic testing, all dentists must be able to recognize conditions that may require biopsy or further treatment outside the dentist office. This book does not pretend to be an exhaustive resource on oral pathology; instead, it seeks to provide the practicing clinician with enough information to help identify or at least narrow down the differential for every common lesion or oral manifestation of disease seen in daily practice as well as what to do about them. Organized by type of lesion, mass, or disease, each pathologic entity presented includes the nature of the disease; its predilections, clinical features, radiographic presentation, differential diagnosis, and microscopic features; and the suggested course of action for the dental practitioner as well as the standard treatment regimen. In keeping with the concise nature of the text, all but the rarest disease entities include at least one photograph to illustrate the clinical condition. This book distills the comprehensive information from Dr Marx and Dr Diane Stern’s award-winning pathology reference text (Oral and Maxillofacial Pathology: A Rationale for Diagnosis and Treatment, ed 2 [Quintessence, 2012]) into practical guidelines for restorative and general dentists everywhere.

376 pp; 425 illus; ISBN 978-0-86715-764-2 (B7642); Now available! $98

Read more about Oral Pathology in Clinical Dental Practice here!

Why Clinical Pathology Should Matter in Your Clinic

 

Anesthesia Considerations for the Oral and Maxillofacial Surgeon

Edited by Matthew Mizukawa, Samuel J. McKenna, and Luis G. Vega

Although office-based anesthesia administration has been essential in the evolution of outpatient surgery, it is becoming more complex as people live longer and with more comorbid diseases. The purpose of this book is to strengthen the margin of safety of office-based anesthesia administration by helping practitioners determine whether the patients they treat are good candidates for office-based anesthesia. This book is organized into three sections. The first section provides a review of the principles of anesthesia, including the pharmacology of anesthetic agents, local anesthesia, patient monitoring, preoperative evaluation, the airway, and management of emergencies and complications. The major organ systems of the body are reviewed in section two, and the most common comorbid conditions that affect these systems are described in terms of their pathophysiology, diagnosis, management, and anesthesia-related considerations. Section three reviews patient groups that warrant special consideration in the administration of office-based anesthesia, such as geriatric, pediatric, pregnant, and obese patients. Spiral-bound and featuring tabs for quick and easy reference, this important book belongs on the shelf of every clinician who provides anesthesia in the office setting.

482 pp; 101 illus; ISBN 978-0- 86715-713- 0 (B7130); Now available! $168

 

New Issues in Journals


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Featured article: Prognosis of Dental Implants Immediately Placed in Sockets Affected by Peri-implantitis: A Retrospective Pilot Study
Eduardo Anitua, Laura Piņas, Leire Begoņa, and Mohammad Hamdan Alkhraisat

Principles for Vertical Ridge Augmentation in the Atrophic Posterior Mandible: A Technical Review
István A. Urbán, Alberto Monje, Jaime Lozada, and Hom-Lay Wang

Ten-Year Nonsurgical Periodontal Treatment Protocol with Adjunctive Use of Diode Laser Monitoring Clinical Outcomes in ≥ 6 mm Pockets: A Retrospective Controlled Case Series
Marisa Roncati, Annalisa Gariffo, Cinzia Barbieri, and Paolo Vescovi

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Comparison of Fixed Dental Prostheses with Zirconia and Metal Frameworks: Five-Year Results of a Randomized Controlled Clinical Trial
Irena Sailer, Marc Balmer, Jürg Hüsler, Christoph Hans Franz Hämmerle, Sarah Känel, and Daniel Stefan Thoma

Post-and-Core Restoration of Severely Damaged Permanent Posterior Teeth in Young Adolescents
Nili Tickotsky, Roy Petel, Yael Haim, Maysa Ghrayeb, and Moti Moskovitz

Additive Manufacturing Techniques in Prosthodontics: Where Do We Currently Stand? A Critical Review
Nawal Alharbi, Daniel Wismeijer, and Reham B. Osman

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Featured article: Accuracy of Cone Beam Computed Tomography Grayscale Density in Determining Bone Architecture in the Posterior Mandible: An In Vivo Study with Microcomputed Tomography Validation
Feng Wang, Wei Huang, Yiqun Wu, Jesus Montanero-Fernandez, Rachel A. Sheridan, Hom-Lay Wang, and Alberto Monje

Thematic Abstract Review: Implants and the Spectrum of Aging
David Chvartszaid

Stability of Grafted Implant Placement Sites After Sinus Floor Elevation Using a Layering Technique: 10-Year Clinical and Radiographic Results
Fouad Khoury, Pierre Keller, and Philip L. Keeve

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Psychosocial Profiles of Temporomandibular Disorder Pain Patients: Proposal of a New Approach to Present Complex Data
Simple Futarmal Kothari, Lene Baad-Hansen, and Peter Svensson

Psychosocial and Behavioral Aspects of Pain and Perception of Oral Health
Miriane Lucindo Zucoloto, João Maroco, and Juliana Alvares Duarte Bonini Campos

Prevalence, Course, and Associated Factors of Pain in the Temporomandibular Joint in Early Rheumatoid Arthritis: Results of a Longitudinal Cohort Study
Jessica P.S. Chin Jen Sem, Marike van der Leeden, Corine M. Visscher, Karin Britsemmer, Samina A. Turk, Joost Dekker, Dirkjan van Schaardenburg, and Frank Lobbezoo

Dental Meetings Quintessence Will Attend in October


AAID 66th Annual Conference: Booth #206
hosted by the American Academy of Implant Dentistry, October 11–14 in San Diego, California

AAOMS 99th Annual Meeting: Booth #1202
hosted by the American Association of Oral and Maxillofacial Surgeons, October 12–14 in San Francisco, California

ADA 2017: Booth #1027
hosted by the American Dental Association, October 19–21 in Atlanta, Georgia

4th Joint Meeting of ISMR-AAMP
hosted by the International Society for Maxillofacial Rehabilitation and the American Academy of Maxillofacial Prosthetics, October 27–31 in San Francisco, California

Posted in Books, Dental Technology, Endodontics, Esthetic Dentistry, Feature, Implant Dentistry, Journal of Oral & Facial Pain and Headache, Journals, Misc, Multidisciplinary, Occlusion & TMD, Oral and Maxillofacial Surgery, Pediatric Dentistry, Periodontics, Promotions, Prosthodontics, Research, Restorative Dentistry, Roundup, Special Offer, The International Journal of Oral & Maxillofacial Implants, The International Journal of Periodontics & Restorative Dentistry, The International Journal of Prosthodontics, What's New | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Why Clinical Pathology Should Matter in Your Clinic

When patients notice something strange in their mouths, they will probably schedule an appointment with their general dentist. Even for potentially serious symptoms, most dental or health insurers require referrals before approving specialist visits. General dentists are and will always be the gatekeepers of patient access to oral health care—and that position carries with it a significant burden.

When Robert E. Marx decided to write a book on oral pathology for general dentists, the need was clear. “One of the obstacles preventing dentists from recognizing oral diseases in their patients is the de-emphasis of clinical pathology in many dental schools today. Pathology courses may not even require or use a textbook for more than ‘suggested supplemental reading.’ This de-emphasis creates dentists who are not trained on how to refer a patient to a specialist for treatment—or even which specialist is best for any particular finding.”

Sometimes the best education comes from hands-on experience. But when it comes to clinical pathology, the stakes can be high. Dr Marx describes some successes and failures of referring dentists.

Successful Diagnoses

A 5-year-old girl presented to a restorative dentist with a mass at the base of her tongue. The mass was difficult to see and required a thorough examination. A radioactive iodine scan confirmed the suspicion that the mass was a persistent lingual thyroid; further, it was the only thyroid the patient had. Had her doctors preemptively biopsied/excised the mass, the patient would have been sentenced to a permanent hypothyroid condition at a critical point in her growth and development.

Persistent lingual thyroid as the entire thyroid gland with no presence in the neck.

In another case, a pediatric dentist noted redness and puffiness of the gingiva on the lingual side of a first molar in an 11-year-old girl. During exploration of the lesion, the dentist provoked a small but pulsatile bleeding that required 5 minutes of pressure to stop. When Dr Marx and his team evaluated the lesion, angiograms identified a large arteriovenous hemangioma where, in his words, “the gingiva represented the crown of a volcano of a potential exsanguinating bleed.” The early identification allowed Dr Marx to embolize the lesion and remove it before it grew any larger; had the lesion gone unnoticed and untreated, the hemangioma could have ruptured and resulted in massive bleeding, as illustrated below in a similar case.

Angiogram of an arteriovenous hemangioma showing large vascular networks.

Young girl in hypovolemic shock from an arteriovenous hemangioma bleed.

 

Squamous cell carcinoma of the lateral border of the tongue.

Dental hygienists are also capable of making these critical finds. One hygienist noticed an area of redness and firmness while performing a dental prophylaxis on the left lateral border of the tongue in a 61-year-old woman. Both the hygienist and dentist were suspicious enough of the lesion to refer the patient to Dr Marx, despite the fact that two physicians had previously identified it as a hypertrophied lingual tonsil. When Dr Marx biopsied the lesion, the results identified a squamous cell carcinoma. With a depth of invasion of 9 mm, the cancer required excision of the lesion as well as selective neck dissection. Thanks in part to the vigilance of the dental hygienist, the now–79-year-old patient is alive and well and continues to enjoy normal speech and eating.

Missed Diagnoses

But if every story had a happy ending, we wouldn’t need to be concerned about the status quo. Sometimes the find doesn’t come soon enough—other times, it comes far, far too late.

In one particularly frustrating case, a 45-year-old restorative dentist on the faculty of a major dental school presented with persistent redness of the anterior maxillary gingiva and frenulum. Despite impeccable plaque control—remember, the patient herself was a dentist—and her request for a biopsy, this squamous cell carcinoma was ignored and local periodontal care and topical antibiotic therapy continued for 2 years. When she was finally referred to Dr Marx, his biopsy identified the cancer that had by then invaded bone. An anterior maxillectomy was required.

Squamous cell carcinoma that was incorrectly diagnosed and treated as gum disease for 2 years, giving the cancer time to invade the bone.

A pyogenic granuloma—or could it be a cancer?

In a similar case, though one in which the patient did not have the advantage of a dental degree, a 42-year-old woman was diagnosed with a pregnancy tumor when a small, red, friable lesion emerged between her maxillary lateral and central incisors. After it was confirmed that the patient was in fact not pregnant, the working diagnosis was changed to a pyogenic granuloma. Over the course of treatment, the so-called pyogenic granuloma was removed twice but not sent for biopsy. By 20 months after her first presentation, the lesion had grown to the size of a tennis ball, and the patient had bilateral lymphadenopathy from squamous cell carcinoma. The required treatment included an anterior maxillectomy and bilateral neck dissections followed by chemotherapy and radiation therapy. The patient remains disease-free a decade later but has undergone five reconstructive surgeries so far.

A final case demonstrates the many levels of care at which patients are vulnerable to misdiagnosis. An 18-year-old girl with a hard mass at the left angle of the mandible was diagnosed by her primary care physician as having mumps, even though the mass was attached to the angle of the mandible, not the parotid gland, and the patient had no fever, malaise, or anything else that would suggest mumps. After 9 months, the physician referred her to a dentist with the complaint of “numb lip.” The numb lip was incorrectly attributed to impacted third molars, and another 6 months transpired before a referral was made to an oral and maxillofacial surgeon. The surgeon recognized the irregular bony mass as a probable osteosarcoma, which Dr Marx’s biopsy later confirmed. Despite surgery and chemotherapy, the patient died from diffuse metastasis shortly before her 21st birthday.

Osteosarcoma of the mandible as seen on a panoramic radiograph.

How to Move Forward

No one can go back in time and change a mistake that was made. What we can do is arm ourselves with the knowledge and tools necessary to do better the next time around. Dr Marx had the stories above in mind when he wrote his book Oral Pathology in Clinical Dental Practice. His goal in writing this book was not to produce a 700-page textbook for oral pathologists or maxillofacial surgeons on every possible finding, with detailed protocols for their management (that has already been done). Instead, his intent was to put potentially life-saving information into a format that would be accessible for the dental hygienist performing a routine cleaning who is in an ideal position to track changes in a patient’s oral health over time; for the general dentist whose gut instinct may be saying that a patient’s lesion doesn’t quite fit the textbook definition for a common condition and warrants a second opinion for ease of mind; and for the specialist who receives a referral for a prosthodontic rehabilitation that has already been cleared by the general dentist, but notices a potential issue that had not been previously managed and is now responsible for addressing it. This book empowers dental professionals across the spectrum of disciplines by giving them the information they need to recognize when something is wrong and to know what to do next.

“Dentists and their dental hygiene team historically have been the great identifiers of oral diseases,” Dr Marx emphasizes. “This book is dedicated to those practitioners who have picked up on diseases and conditions early, thus saving their patients from disease progression, deformity, and at times, even death. But it is also dedicated to those dentists who may have missed the early signs or obvious diseases while focusing exclusively on the dentition. It is hoped that this book will provide examples and guidance as well as the encouragement to be a diagnostician before being a treatment provider.”

Dr Marx’s aim is for his book to help each dentist, dental hygienist, and specialist become a more complete oral health care professional and, in doing so, maybe save a life or two.


Robert E. Marx, DDS, is Professor of Surgery and Chief of the Division of Oral and Maxillofacial Surgery at the University of Miami Miller School of Medicine. He is a well-known educator, researcher, and innovative surgeon who has pioneered new concepts and treatments for pathologies of the oral and maxillofacial area as well as new techniques in reconstructive surgery. The first edition of his textbook Oral and Maxillofacial Pathology: A Rationale for Diagnosis and Treatment (Quintessence, 2012) won the American Medical Writers Associations Prestigious Book of the Year award, and two of his other textbooks, Oral and Intravenous Bisphosphonate–Induced Osteonecrosis of the Jaws: History, Etiology, Prevention, and Treatment, Second Edition (Quintessence, 2011) and Atlas of Oral and Extraoral Bone Harvesting (Quintessence, 2009), have both been bestsellers. His many prestigious awards, including the Harry S. Archer Award, the William J. Giles Award, the Paul Bert Award, the Donald B. Osbon Award, and the Daniel Laskin Award, attest to his dedication and commitment to the field of oral and maxillofacial surgery.

 

Oral Pathology in Clinical Dental Practice

Robert E. Marx

While most dentists do not perform their own histologic testing, all dentists must be able to recognize conditions that may require biopsy or further treatment outside the dentist office. This book does not pretend to be an exhaustive resource on oral pathology; instead, it seeks to provide the practicing clinician with enough information to help identify or at least narrow down the differential for every common lesion or oral manifestation of disease seen in daily practice as well as what to do about them. Organized by type of lesion, mass, or disease, each pathologic entity presented includes the nature of the disease; its predilections, clinical features, radiographic presentation, differential diagnosis, and microscopic features; and the suggested course of action for the dental practitioner as well as the standard treatment regimen. In keeping with the concise nature of the text, all but the rarest disease entities include at least one photograph to illustrate the clinical condition. This book distills the comprehensive information from Dr Marx and Dr Diane Stern’s award-winning pathology reference text (Oral and Maxillofacial Pathology: A Rationale for Diagnosis and Treatment, Second Edition [Quintessence, 2012]) into practical guidelines for restorative and general dentists everywhere.

376 pp; 425 illus; ©2017; ISBN 978-0-86715-764-2 (B7642); US $98

Posted in Books, Feature, Misc, Multidisciplinary, Oral and Maxillofacial Surgery | Tagged , , , | 1 Comment

Quintessence Roundup: September

Quintessence 2017 Catalog

Monthly Special


Oral and Intravenous Bisphosphonate–Induced Osteonecrosis of the Jaws: History, Etiology, Prevention, and Treatment, Second Edition

Robert E. Marx

While many clinicians currently recognize that bisphosphonate usage is associated with ONJ, this book establishes the causal relationship between the two. It presents definitive treatment protocols for patients who present at each stage in the progression of ONJ as well as a simplified staging system and information about the serum CTX test for oral bisphosphonate cases. The book offers a simple method for predicting risk as well as crucial recommendations for preventing the disease from developing when bisphosphonate therapy is indicated. Comprehensive case histories provide direct guidance in managing patients spanning the full presentation spectrum.

160 pp (softcover); 211 illus; ©2011; ISBN 978-0-86715-510-5 (B5105); Special price! $9

 

New Titles in Books


Oral Pathology in Clinical Dental Practice

Robert E. Marx

While most dentists do not perform their own histologic testing, all dentists must be able to recognize conditions that may require biopsy or further treatment outside the dentist office. This book does not pretend to be an exhaustive resource on oral pathology; instead, it seeks to provide the practicing clinician with enough information to help identify or at least narrow down the differential for every common lesion or oral manifestation of disease seen in daily practice as well as what to do about them. Organized by type of lesion, mass, or disease, each pathologic entity presented includes the nature of the disease; its predilections, clinical features, radiographic presentation, differential diagnosis, and microscopic features; and the suggested course of action for the dental practitioner as well as the standard treatment regimen. In keeping with the concise nature of the text, all but the rarest disease entities include at least one photograph to illustrate the clinical condition. This book distills the comprehensive information from Dr Marx and Dr Diane Stern’s award-winning pathology reference text (Oral and Maxillofacial Pathology: A Rationale for Diagnosis and Treatment, ed 2 [Quintessence, 2012]) into practical guidelines for restorative and general dentists everywhere.

376 pp; 425 illus; ISBN 978-0-86715-764-2 (B7642); Now available! $98

 

Anesthesia Considerations for the Oral and Maxillofacial Surgeon

Edited by Matthew Mizukawa, Samuel J. McKenna, and Luis G. Vega

Although office-based anesthesia administration has been essential in the evolution of outpatient surgery, it is becoming more complex as people live longer and with more comorbid diseases. The purpose of this book is to strengthen the margin of safety of office-based anesthesia administration by helping practitioners determine whether the patients they treat are good candidates for office-based anesthesia. This book is organized into three sections. The first section provides a review of the principles of anesthesia, including the pharmacology of anesthetic agents, local anesthesia, patient monitoring, preoperative evaluation, the airway, and management of emergencies and complications. The major organ systems of the body are reviewed in section two, and the most common comorbid conditions that affect these systems are described in terms of their pathophysiology, diagnosis, management, and anesthesia-related considerations. Section three reviews patient groups that warrant special consideration in the administration of office-based anesthesia, such as geriatric, pediatric, pregnant, and obese patients. Spiral-bound and featuring tabs for quick and easy reference, this important book belongs on the shelf of every clinician who provides anesthesia in the office setting.

482 pp; 101 illus; ISBN 978-0- 86715-713- 0 (B7130); Now available! $168

 

The Bicon Short Implant: A Thirty-Year Perspective

Edited by Vincent Morgan

This book is a succinct and accessible compilation of over 30 years of knowledge concerning the Bicon system. It offers not only a history of dental implants and the science of osseointegration but also a vast collection of clinical examples that demonstrate Bicon’s capabilities. Bicon implants provide versatile, reliable treatment for a wide variety of clinical situations; they can successfully be placed in atrophic jaws, in sites that would require extensive bone grafting with longer implants, in tissue that has been compromised by medical conditions, and even in adolescent jaws that are still developing. With its proven track record of success, the Bicon system provides treatment opportunities for the benefit of clinicians, technicians, and patients by offering simple, predictable, and effective techniques. With everything from historical and theoretical origins to detailed step-by-step surgical and restorative guides, this book is a must-read for anyone interested in implantology.

336 pp; 1,800 illus; ISBN 978-0-86715-728-4 (B7284); Now available! US $192

Why the Owner of a Small Dental Practice Decided to Buy His Favorite Implant Line

 

New Issues in Journals


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Featured article: Prognosis of Dental Implants Immediately Placed in Sockets Affected by Peri-implantitis: A Retrospective Pilot Study
Eduardo Anitua, Laura Piņas, Leire Begoņa, and Mohammad Hamdan Alkhraisat

Principles for Vertical Ridge Augmentation in the Atrophic Posterior Mandible: A Technical Review
István A. Urbán, Alberto Monje, Jaime Lozada, and Hom-Lay Wang

Ten-Year Nonsurgical Periodontal Treatment Protocol with Adjunctive Use of Diode Laser Monitoring Clinical Outcomes in ≥ 6 mm Pockets: A Retrospective Controlled Case Series
Marisa Roncati, Annalisa Gariffo, Cinzia Barbieri, and Paolo Vescovi

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Comparison of Fixed Dental Prostheses with Zirconia and Metal Frameworks: Five-Year Results of a Randomized Controlled Clinical Trial
Irena Sailer, Marc Balmer, Jürg Hüsler, Christoph Hans Franz Hämmerle, Sarah Känel, and Daniel Stefan Thoma

Post-and-Core Restoration of Severely Damaged Permanent Posterior Teeth in Young Adolescents
Nili Tickotsky, Roy Petel, Yael Haim, Maysa Ghrayeb, and Moti Moskovitz

Additive Manufacturing Techniques in Prosthodontics: Where Do We Currently Stand? A Critical Review
Nawal Alharbi, Daniel Wismeijer, and Reham B. Osman

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Clinical Performance of Dental Implants with a Moderately Rough (TiUnite) Surface: A Meta-Analysis of Prospective Clinical Studies
Matthias Karl and Tomas Albrektsson

Thematic Abstract Review: Implantoplasty: A Valuable Method for the Management of Peri-implantitis?
Jan-Eirik Ellingsen

Local Application of Growth Hormone to Enhance Osseointegration in Osteoporotic Bones: A Morphometric and Densitometric Study
Elena Martin-Monge, Isabel F. Tresguerres, Celia Clemente, and Jesús A. F. Tresguerres

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Psychosocial Profiles of Temporomandibular Disorder Pain Patients: Proposal of a New Approach to Present Complex Data
Simple Futarmal Kothari, Lene Baad-Hansen, and Peter Svensson

Psychosocial and Behavioral Aspects of Pain and Perception of Oral Health
Miriane Lucindo Zucoloto, João Maroco, and Juliana Alvares Duarte Bonini Campos

Prevalence, Course, and Associated Factors of Pain in the Temporomandibular Joint in Early Rheumatoid Arthritis: Results of a Longitudinal Cohort Study
Jessica P.S. Chin Jen Sem, Marike van der Leeden, Corine M. Visscher, Karin Britsemmer, Samina A. Turk, Joost Dekker, Dirkjan van Schaardenburg, and Frank Lobbezoo

Dental Meetings Quintessence Will Attend in September


17th Biennial Meeting of the ICP
hosted by the International College of Prosthodontists, September 7–9 in Santiago, Chile

Congreso Internacional: Rockin’ Dentistry 3
hosted by the Colegio Mexicano de Prostodoncia de Nuevo León A. C., September 8–9 in Monterrey, Mexico

AAP 103rd Annual Meeting: Booth #311
hosted by the American Academy of Periodontology, September 9–12 in Boston, Massachusetts

Oral Design International Symposium
hosted by the Oral Design International Foundation, September 13–15 in Los Angeles, California

Spear Annual Summit
hosted by Spear Education, September 14–16 in Scottsdale, Arizona

UMKC Dental Implant Symposium
hosted by the University of Missouri-Kansas City School of Dentistry, September 22–23 in Kansas City, Missouri

 

Posted in Books, Dental Technology, Esthetic Dentistry, Implant Dentistry, Journal of Oral & Facial Pain and Headache, Misc, Multidisciplinary, Oral and Maxillofacial Surgery, Periodontics, Prosthodontics, Research, Restorative Dentistry, Roundup, Special Offer, The International Journal of Oral & Maxillofacial Implants, The International Journal of Periodontics & Restorative Dentistry, The International Journal of Prosthodontics, What's New | Tagged , , , , , , , , , , , , , , , | Leave a comment

Why the Owner of a Small Dental Practice Decided to Buy His Favorite Implant Line

Contributed by Dr Vincent Morgan, Jeffrey Lehrberg, and Kristina Pisarik of Bicon Dental Implants

We all have our favorite brands and products that we rely on; however, how many of us believe so strongly in a product that we are willing to dedicate our lives to it? This is the Bicon story.

The Shortest Implant with the Longest History

Dr Morgan’s implant journey began shortly after graduating from dental school in 1970 when he treated a young Irish girl who refused his treatment plan to fabricate two fixed bridges. She held out the hope that one day a dentist would be able to insert two prosthetic posts for her congenitally missing maxillary lateral incisors, but he advised her to abandon this wishful thinking and prepare for bridges instead.

Several weeks after his conversation with the young patient, the dentist with whom Dr Morgan shared his practice lost the last of his posterior maxillary teeth. If he had been a patient rather than a colleague, they would have extracted his remaining anterior teeth and fabricated a denture. However, since he was more than a patient, they decided to purchase two newly marketed Miter titanium blade implants. With no training of any sort and only common sense and logic as their guides, they successfully inserted the two blade implants into his posterior maxilla. Beginner’s luck being what it is, these blade implants remained functional some 20 years later.

Those two successful implants inspired Dr Morgan to become more involved with implant dentistry. His first experience with an implant designed by Thomas Driskell was in the mid-1970s with the Synthodont (Miter) implant. Dr Morgan would encounter another of Dr Driskell’s implants in 1992, and that implant would become the antecedent of all modern Bicon implants.

Thomas Driskell’s Discovery

Mr Driskell’s first PRF implant.

One of Mr Driskell’s early smooth implant designs with a very literal reproduction of the roots of a human molar.

In 1968, the conflict in Vietnam was beginning to escalate. As a result, Thomas Driskell and his team at the Battelle Memorial Institute in Columbus, Ohio, were tasked by the United States Army to develop a rapid and effective solution for replacing missing teeth in a combat or field situation. Driskell’s initial implant designs were smooth and closely mimicked the structure of mammalian teeth, but since they were not consistently successful, he began testing a variety of designs. He discovered that a bifurcated and grooved or finned design resulted in greater bone-to-implant contact than other designs—including screw-root form (SRF) implants. The finned design, referred to as plateau-root form (PRF), permitted occlusal loads to be transferred onto the bone that infiltrated the space between grooves.

After Battelle, Mr Driskell took his PRF implant design to Miter, where it became the Synthodont implant that Dr Morgan would later use. Mr Driskell revised his design further and created a submergible titanium implant with a removable abutment, the Titanodont (Miter). Subsequently, he formed a company called DB Bioengineering and received premarket notification for the DB Precision Fin Implant System in 1985. This implant had a PRF design, locking-taper implant-abutment interface, sloping shoulder, and—most importantly—no screws. Two years after its entry to the market, DB Bioengineering was sold to Stryker Corporation, and the implant was renamed the Stryker Precision Fin Implant.

The Synthodont, a freestanding, nonsubmergible implant made from high-density alumina.

The Titanodont, a submergible titanium implant with a removable abutment.

The DB Precision Fin implant, which later became the Stryker Precision Fin implant.

The Beginning and Future of Bicon

By 1992, Dr Morgan and his colleagues had placed over 2,500 SRF implants and had become frustrated with their inherent shortcomings. When they were introduced to the Stryker implant, it was a perfect fit. At last, they found what they were looking for—a design characterized by logic and simplicity. They soon became the most experienced clinicians using the Stryker implant; however, even they could not have predicted that 2 years later, in 1994, they would become the owners of the implant.

It all started when Dr Morgan attended a dinner meeting with Stryker’s product manager and discovered that he appeared to lack enthusiasm for the implant. At the advice of a patient who had been the CEO of a publicly traded company, Dr Morgan got into contact with Ron Ellenbass, one of Stryker’s presidents. Mr Ellenbass listened to his concerns and later complimented Dr Morgan for recognizing that the product manager was no longer enthusiastic about their implant. In fact, Stryker had decided to sell their implant line. He knew that whoever purchased it would have to work with Dr Morgan because he was their most knowledgeable user. After asking Mr Ellenbass to consider his patients while he would be cashing in his stock options, they politely ended their conversation. Subsequently, Mr Ellenbass called again and encouraged Dr Morgan to purchase the implant. As improbable as it seemed at the time, he did.

Fortunately, Dr Morgan had an attorney friend who provided the startup capital to purchase the implant. “We were dentists, not businessmen,” Dr Morgan explains. “But we knew firsthand the unmatched clinical capabilities and merits of Thomas Driskell’s implant. We knew the implant itself would make up for and overcome our inexperience and shortcomings, and it turns out that we were correct. We started as dabblers in implantology in a small dental practice; we are now an international medical device company in 90 countries.”

A selection of Bicon SHORT implants.

Despite the industry’s preference for screw-retained implants, Bicon continues to thrive with their PRF implants. A professor in Zurich recently greeted Dr Morgan by saying, “I know Bicon is a viable organization, for dead fish cannot swim against the stream. You have been going against the collective beliefs of the profession for decades, and now they are copying your ideas.”

When asked whether we are approaching the ceiling for innovation in implant dentistry, Dr Morgan has this to say: “History tends to mock those who make definitive statements regarding technology or innovation—there is always room for improvement and further innovation. That being said, the Bicon implant is the culmination of almost half a century of innovation and ingenuity. The Bicon implant is currently at a pinnacle; however, we have plans for it to be even better.”

One example of further innovation at Bicon is the implementation of milled telescopic copings used with TRINIA, a metal-free, fiber-reinforced resin material that is lightweight, flexible, durable, and readily modified. The combination of the TRINIA material with the retentiveness of the copings is providing revolutionary clinical treatments for both dentists and laboratory technicians and, most importantly, a stronger, more manageable denture for patients.

As for the future of Bicon and its implants, Dr Morgan says they will continue looking and moving in the best direction they know: forward.


Vincent J. Morgan, DMD, graduated from the Tufts University School of Dental Medicine in 1970. In 1994, he was part of a group that purchased the Bicon Implant System from Stryker Implants. He currently serves as president of Bicon, LLC and as honorary professor at Tver State Medical University in Tver, Russia. He also leads the prosthetic team at the Implant Dentistry Centre located at the Bicon headquarters in Boston, Massachusetts, where he is responsible in part for the development of many of the restorative techniques of the Bicon Dental Implant System.

 

The Bicon Short Implant: A Thirty-Year Perspective

Edited by Vincent Morgan

This book is a succinct and accessible compilation of over 30 years of knowledge concerning the Bicon system. It offers not only a history of dental implants and the science of osseointegration but also a vast collection of clinical examples that demonstrate Bicon’s capabilities. Bicon implants provide versatile, reliable treatment for a wide variety of clinical situations; they can successfully be placed in atrophic jaws, in sites that would require extensive bone grafting with longer implants, in tissue that has been compromised by medical conditions, and even in adolescent jaws that are still developing. With its proven track record of success, the Bicon system provides treatment opportunities for the benefit of clinicians, technicians, and patients by offering simple, predictable, and effective techniques. With everything from historical and theoretical origins to detailed step-by-step surgical and restorative guides, this book is a must-read for anyone interested in implantology.

336 pp; 1,800 illus; ©2017; ISBN 978-0-86715-728-4 (B7284); US $192

Posted in Books, Feature, Implant Dentistry, Prosthodontics, Restorative Dentistry | Tagged , , | Leave a comment