Edentulism deeply affects patients’ quality of life, often with a significant impact to their nutrition, speech, social lives, mental health and facial aesthetics.[i] However, the decision around which restorative treatment to choose can often be a difficult one. For example, in the short-term, rehabilitation of partial or complete edentulism using dentures is less costly than implants, but risks a decline in bone quality at the edentulous site, as well as the health of any adjacent teeth.[ii]
Implants are an increasingly popular and predictable treatment for edentulism and for teeth with a hopeless prognosis. Although they have a number of clinical and aesthetic advantages over dentures,[iii] this treatment is initially more costly than traditional restorative treatment. Where complex surgical interventions, like bone manipulation, are required before implants can be placed, patients’ options can be further complicated by concerns about costs.[iv]
Patient pressures
With higher costs likely, as well as longer treatment times, the pressure for patients can sometimes prove too much, causing them to delay or reject implant therapy.[v] Ensuring patients grasp the short and long-term costs, risks and benefits associated with all restorative options, including implant treatment, is important to help them understand their options, and make an informed decision.
Efficient treatment with fewer surgical and restorative steps, that can reduce chair time for patients can also make advanced treatment more accessible, while offering long-term solutions that can improve their quality of life. Shorter treatment times have less of an impact on a patient’s work, and for many, their income.
This may be a particular factor for the increasing number of patients engaged in precarious ‘gig’-based work, consisting of temporary employment on an informal or on-demand basis,[vi] or those who are self-employed.[vii] The dental and systemic health of many people in these categories can be compromised by a need to prioritise each and every opportunity to earn money over their own wellbeing.
Atraumatic surgical procedures
Where possible, the immediate placement of an implant into a fresh socket can not only help preserve bone and soft tissue, aiding in primary stability and enhancing osseointegration, it can be a more affordable option for patients than delaying placement. Immediate placement is more predictable when there has been an atraumatic extraction, which again reduces chair time and costs for patients.[viii]
Piezosurgery has long been assisting clinicians with conducting minimally invasive surgeries, with a number of advantages over conventional surgical methods – particularly in the atraumatic management of bone.[ix] The ultrasound technology uses low frequency microvibrations, which selectively and precisely cut bone without damaging adjacent soft tissues. In implantology, this is of particular value in sparing delicate structures such as the Schneiderian membrane, mucosa, vessels or facial nerves.[x]
The oscillating tip of a piezo-surgical instrument simultaneously drives coolant which produces the cavitation effect. This contributes to the minimally invasive quality of piezo-surgery by minimising bleeding, removing debris and triggering a cellular response that helps with healing.x Additionally, in many instances, the number of instruments needed to carry out osteotomies is minimised to just the piezo handpiece. This results in less time spent on instrument exchanges.[xi]
Complete graftless rehabilitation
For patients with a severely atrophic maxilla, or other maxillary defects for whom bone grafting is not appropriate or possible, zygomatic implants can offer complete rehabilitation,[xii] with a comparable survival rate to conventional implants. In some cases, prostheses can be fitted immediately after placement, or within a few days of surgery. In some studies, immediate loading has showed a statistically significant increase in survival over delayed loading.[xiii]
With this treatment, many patients who have suffered the trauma of complete edentulism can regain function and aesthetics more quickly than methods requiring bone augmentation, making the implants a valuable investment in a brighter future.
All-in-one surgical solution
Where oral surgeons once required two separate devices, the modular Implantmed Plus surgical solution from W&H allows for the seamless integration of the powerful piezo surgery functions of the Piezomed Module facilitating both conventional and complex implant surgeries. This combination leads to reduced treatment time, costs, preparation, and waste. Additionally, the surgical device can work in synergy with the Osstell Beacon, providing a non-invasive assessment of implant stability to ensure the success of osseointegration.
There are many ways to make advanced treatment more accessible to patients. Education is a powerful tool in properly informing patients of the long-term benefits and cost-effectiveness of various treatments as well as the risks. Building the capacity of your practice to offer the most advanced, streamlined and efficient solutions can help patients further reduce chair time, easing the financial burden of regaining a confident smile.
To find out more about the full range from W&H, visit www.wh.com/en_uk, call 01727 874990 or email office.uk@wh.com
[i] Emami E, de Souza RF, Kabawat M, Feine JS. The impact of edentulism on oral and general health. Int J Dent. 2013;2013:498305. doi: 10.1155/2013/498305. Epub 2013 May 8. PMID: 23737789; PMCID: PMC3664508.
[ii] Pal US, Dhiman NK, Singh G, Singh RK, Mohammad S, Malkunje LR. Evaluation of implants placed immediately or delayed into extraction sites. Natl J Maxillofac Surg. 2011 Jan;2(1):54-62. doi: 10.4103/0975-5950.85855. PMID: 22442611; PMCID: PMC3304239.
[iii] Gupta R, Gupta N, Weber, DDS KK. Dental Implants. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470448/
[iv] Mittal Y, Jindal G, Garg S. Bone manipulation procedures in dental implants. Indian J Dent. 2016 Apr-Jun;7(2):86-94. doi: 10.4103/0975-962X.184650. PMID: 27433052; PMCID: PMC4934094.
[v] Lütfiye Tekpınar and Vahit Yiğit (2024). Cost-Effectiveness Analysis of Implant-Supported Single Crown and Tooth-Supported Fixed Dental Prostheses in Türkiye. Value in health regional issues, 42, pp.11–17. doi: https://doi.org/10.1016/j.vhri.2024.01.001
[vi] Rodriguez F, Sarraju A, Turakhia MP. The Gig Economy Worker-A New Social Determinant of Health? JAMA Cardiol. 2022 Feb 1;7(2):125-126. doi: 10.1001/jamacardio.2021.5435. PMID: 34985492; PMCID: PMC9191840.
[vii] Che X, Sohn M, Moon S, Park HJ. Relationship between Precarious Employment and Unmet Dental Care Needs among Korean Workers: A Longitudinal Panel Study. Medicina (Kaunas). 2022 Oct 28;58(11):1547. doi: 10.3390/medicina58111547. PMID: 36363503; PMCID: PMC9697259.
[viii] Pal US, Dhiman NK, Singh G, Singh RK, Mohammad S, Malkunje LR. Evaluation of implants placed immediately or delayed into extraction sites. Natl J Maxillofac Surg. 2011 Jan;2(1):54-62. doi: 10.4103/0975-5950.85855. PMID: 22442611; PMCID: PMC3304239.
[ix] Rahnama M, Czupkałło L, Czajkowski L, Grasza J, Wallner J. The use of piezosurgery as an alternative method of minimally invasive surgery in the authors’ experience. Wideochir Inne Tech Maloinwazyjne. 2013 Dec;8(4):321-6. doi: 10.5114/wiitm.2011.35144. Epub 2013 May 14. PMID: 24501602; PMCID: PMC3908639.
[x] Agarwal E, Masamatti SS, Kumar A. Escalating role of piezosurgery in dental therapeutics. J Clin Diagn Res. 2014 Oct;8(10):ZE08-11. doi: 10.7860/JCDR/2014/9161.4988. Epub 2014 Oct 20. PMID: 25478473; PMCID: PMC4253291.
[xi] Magrin GL, Sigua-Rodriguez EA, Goulart DR, Asprino L. Piezosurgery in Bone Augmentation Procedures Previous to Dental Implant Surgery: A Review of the Literature. Open Dent J. 2015 Dec 22;9:426-30. doi: 10.2174/1874210601509010426. PMID: 26966469; PMCID: PMC4765509.
[xii] Polido WD, Machado-Fernandez A, Lin WS, Aghaloo T. Indications for zygomatic implants: a systematic review. Int J Implant Dent. 2023 Jul 1;9(1):17. doi: 10.1186/s40729-023-00480-4. PMID: 37391575; PMCID: PMC10313639.
[xiii] Brennand Roper M, Vissink A, Dudding T, Pollard A, Gareb B, Malevez C, Balshi T, Brecht L, Kumar V, Wu Y, Jung R. Long-term treatment outcomes with zygomatic implants: a systematic review and meta-analysis. Int J Implant Dent. 2023 Jul 5;9(1):21. doi: 10.1186/s40729-023-00479-x. PMID: 37405545; PMCID: PMC10322814.
