Christensen: U.S. implant rates are 'pathetic'

2009 02 26 16 25 40 936 Chicago 70

CHICAGO - Of the nearly 180 million U.S. adults who have lost at least one tooth, only 1% of them have received an implant, according to a panel discussion Friday on restorative dentistry led by Gordon Christensen, DDS, MSD, PhD, at the Chicago Dental Society Midwinter Meeting.

During the three-hour discussion, the diverse panel of experts -- which included two practicing general dentists, an endodontist, a pharmacologist, a restorative scientist, and an insurance industry representative -- addressed controversial issues surrounding implants and implant restorations.

"We have about 200 million adults living here in the U.S.," Dr. Christensen said during the meeting's opening. "178 million of them have lost at least one tooth -- think about that for a minute. Only 1% have received an implant. Is that pathetic or what? Are they [implants] economically out of reach? Ineffective? What in the world is the problem?"

He further lamented the fact that 40 million Americans are edentulous, and of them, "90% of lower denture wearers hate their dentures."

“Should general dentists be placing implants? Yes!”
— Gordon Christensen, DDS, MSD, PhD

Despite Dr. Christensen's blunt evaluation of the state of the U.S. implant business, the atmosphere throughout the discussion that followed was that of a lively and cordial scholarly debate, peppered with humorous asides.

When the efficacy of mini-implants was being discussed, M. Nader Sharifi, DDS, expressed his approval for the devices accordingly: "There's a risk of dropping the tiny screw into the patient's mouth, but the greatest risk is dropping it on the floor, asking the staff to bring it into sterilization, and then requesting the 'other' one."

Through it all, Dr. Christensen, who practices in a predominantly lower-income region, kept the dialogue rooted in actionable solutions. "We're back to boutique dentistry. Let's talk about real people," he chided one panelist.

Balancing those realms drove the discussion about the usage of cone-beam CT (CBCT) for even a single implant. While the panel agreed that CBCT allows for a more informed procedure, only about five of the roughly three dozen practitioners in the audience who perform implant procedures said they used it for one implant. "How about multiples?" Dr. Christensen asked. About half of the audience raised their hands, which he called "progress." In fact, the entire panel agreed that CBCT should be used for site assessment purposes in every case.

Bad press from a New York Times article about children's exposure to radiation from CBCT scans at dentist's offices was cited as a factor prohibiting more widespread adoption. Getting patients to pay for an additional step ranging from $199 to $700 for an already expensive procedure also remains a significant obstacle, the panel acknowledged. Cathy Jameson, CEO of Jameson Management, a dental practice management firm, said that changes in insurance may help overcome this. "The big trend is crossover between medical and dental," Jameson explained. "Cross coding is constantly being upgraded."

Dale Miles, DDS, MS, FRCD(C), a panelist with an extensive background in radiographic issues, was asked on more than one occasion to choose a machine of those on the market that is 'the best' or his favorite but he consistently demurred. "Dentists must look at many factors when selecting a machine," said Dr. Miles. Since the price on many has fallen below $100k, Dr. Christensen said that "a practice with three or more dentists can't afford not to buy one."

Disagreement arose during a discussion about standard of care as it pertains to lower dentures. "Should we offer every lower denture wearer a couple of implants?" Dr. Christensen asked the panel. "Weighing all benefits, it should be the primary treatment plan," responded Christopher Wenckus, DDS, an associate professor and head of the department of endodontics at the University of Illinois at Chicago College of Dentistry.

Daniel Nathanson, DMD, MSD, a professor and chairman of the restorative sciences and biomaterials department at the Boston University School of Dental Medicine, agreed but acknowledged that "it's not an easy prosthodontic fit." Some patients simply don't want to deal with pins, another panelist added.

Dr. Sharifi had a different stance. "A two-implant retained overdenture is not the standard of care, because that would mean that conventional dentures are inadequate," he said.

While discussing the justification for administering antibiotics prior to and after an implant procedure, there was no disagreement with the opinion of Harold Crossley, DDS, PhD, a professor emeritus at the University of Maryland Dental School who has a background in pharmacology.

"There's no pharmacological need, so if it ain't broke, don't fix it," he stated. "Antibiotics are being used when what you really need is an anti-inflammatory. Ibuprofen before a procedure is going to have far better post-op result than an antibiotic."

When Dr. Christensen asked how many in the audience prescribed antibiotics for implant procedures, about half raised their hands.

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