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get fibrous encapsulation. By going
around the turn of an arch, just like
splinting loose teeth around the turn
of an arch, the mobility stops because
the fulcrum of rotation is not through
all of the teeth, or not through all of
the implants. The fulcrum of rotation
is in the tongue area in the center. So
if there’s no easy fulcrum to rotate
around, they don’t move, they don’t
rotate and, therefore, they’re stable.
And today it still stands.
I’ll tell you exactly what Lenny told
me. It’s a different understanding of
what we need to do. If you go around
the turn of an arch with a good A-P
spread, during the healing phase the
implants will take. I am very comfortable
saying that.
Schnitman once did a review on this,
presenting his article from 1990 and
my article from 1997, but between
that there’s almost nothing written
on immediate loading in the 1990s.
It’s amazing. There was one article by
some people from the University of
Pennsylvania. Of course, Henry Salama
did one, but that was only one
case report — just an oddball case.
Now there are hundreds of articles.
But it wasn’t until ’97 that it all broke
loose. So I feel good about that. It’s
a long answer, but a meaningful one
because people get into trouble loading
single teeth or straight-line splints.
When they go around the turn of an
arch, they’re going to be cooking. You
go around the turn of an arch and
splint them together (not originally),
and let everything integrate for two
or three months; then you can do
whatever you want. They integrate
at the same percentage rate as everything
else. Everybody knows that
now, of course. But you don’t want
to do a single tooth and then put it
into occlusion. That’s stupid. Let the
other teeth take on the load during
the healing phase. You just want to
avoid lateral forces during the healing
phase. So, as long as you have good
stability, put a temporary on, keep it
out of occlusion, and then let the other
teeth take on the load during the
healing phase, you can do whatever
you want after that.
DC: In 2000, you wrote an article that
has become the widely adopted standard
that remains unchallenged. The
article talks about the spacing between
implants and preservation of the relative
inter-implant bone height. Why did
it take so long for that to be evaluated?
What caused you to look at that?
DT: That’s a great question. What
caused me to look at it was a patient
named Anne-Marie. Anne-Marie was a
patient in my office, and we did two
implants right next to each other. She
had a high smile line, and I didn’t
know any better. Previously, I’d had
patients with low smile lines and I’d
put two in, and if the papilla was a
little short, it never bothered anybody.
As long as you filled it up and the patient
didn’t hiss during their speaking,
they accepted it as long as the lip line
was low. But Anne-Marie had a high
smile line, and then you could see
normal teeth on the right side, but on
the left side the papilla was too short.
And no matter what I did to stimulate
the papilla like I would between two
teeth with my 5 mm rule, I couldn’t
get it to grow 5 mm. It wasn’t happening.
So the problem was right in front
of us but we didn’t see what it was.
So, I did the study with Sang-Choon
Cho and Steven Wallace, and we
started to look at the distance between
implants. 3 The reason why that paper
was very significant was that, up
to that time, we were all looking
at the threads down the side of the
implant. Think of the shoulder of
the implant. Dr. Jan Lindhe, Dr. Bo
Bergman, Dr. Daniel Buser and all the
– Implant Q&A: An Interview with Dr. Dennis Tarnow – 15