Unfortunately, my response seems to have been premature! The patterns of success of immediate loading are clearer, but the criteria for predicting integration of immediately loaded implants remain unclear. Ideally, suitability for early loading should be predicted before surgery, perhaps with CBCT or CAT scans.
I use virtual design almost every day, and about 85% of single implant restorations or short-span fixed prostheses on implants are created by CADCAM. The advantage is a less expensive, more customized solution. The cost of buying the technology is high and the risk of buying the wrong technology is also high, but waiting too long for technology to settle out risks losing the whole game.
New implant surfaces shorten treatment time by achieving secondary stability earlier than a decade ago. However, caution is needed as soft and hard tissue must mature before definitive restoration – otherwise tissue may mature unfavorably. Rather than shortening treatment, it may be prudent to investigate improvements in interim restorations, perhaps even using them to gather information about the best design and material for the final restoration.
We will see longer-term data for implants made from titanium/zirconium alloy, which seem to work well. We also expect results for implants and restorations made of zirconia and lithium disilicate, which need full testing. So do new surface ideas like laser scoring on the platform. Experiments to improve integration by adding chemicals or biologics to implant surfaces are likely, and bone morphogenic proteins might begin to outperform traditional grafting materials in some situations. We might also obtain more clarity about peri-implantitis.
Basic research identifies true biologic substitutes as clinically realistic, but no one knows when they will appear commercially. Still, biologic substitutes will decay. Ironically, they might be used to stimulate development of an alveolus and then sacrificed to allow placement of an implant.
The challenge is clear-function, comfort and esthetics have to be integrated. The technique must be simplified so an average clinician treating a patient with average financial means can provide implants with few appointments and one surgical procedure.
If we had as many car manufacturers as we do implant companies, there would be over 10 000 different models of automobiles on the road. Many would have a short market lifespan and no interchangeable parts. This situation cannot be sustained. Patients are damaged when an implant placed in one locale cannot be restored in another for lack of components.
They are essential. Memory is unreliable, so clinicians should keep a log of procedures and outcomes, and compare it with published data.