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Not only are we
maintaining the bone
between the implants,
we are actually getting
bone maintenance or a
bone gain of up to
2 mm on average
behind the implant.
morbidity come with that when, if somebody had just
told her at the right time that they needed to put some
implants in there to maintain her bone levels, she
would’ve been much better off. Then it’s not a hospital
procedure; it’s an in-office procedure — very simple.
Instead of three days in the hospital, you have three
hours in the dental chair.
BB: Are there any studies or any research coming out
of UAB School of Dentistry that are related to being
able to maintain that bone level, or even in some cases
potentially increase it?
MM: Yes. And we did see an increase in bone levels,
surprisingly to me, in a study that was done by the
periodontists at UAB, which was a prospective clinical
trial, long-term, about eight years. And we restored
these patients with five implants in the anterior mandible
and a very traditional Brånemark style, with about
3 mm between the prosthesis and the edentulous
ridge. We noticed over time — this was back in the
nineties — that the tissue would proliferate and touch
the bottom of the bridge. The periodontist thought
we had better clean that up or take that down, so the
patient would have access to clean. When they went in
there to remove that soft tissue, it wasn’t soft tissue; it
was bone. So we measured that as part of this clinical
trial, and we saw 1.5 mm, some patients 2 to 3 mm,
of bone gain distal to the implant. So not only are we
maintaining the bone between the implants, we are
actually getting bone maintenance or a bone gain
of up to 2 mm on average behind the implant. So as
we are adding stress back to this system, the bone is
responding by increasing in volume and density.
BB: That leads into one of your other primary interests:
talking to patients about bone loss, and giving them
solutions that are affordable. Maybe you can share
with us a little bit about what you’ve done at the school
as far as low-cost options for restoring these patients.
MM: Certainly. I do think that is critically important. If
we believe that implants are important, as we do as a
profession, then how can we help more of our patients
get into implants? How can we assist our patients,
let them experience implant dentistry and enjoy those
benefits? At the school, we have developed a lowcost
program that we have offered to our patients.
Of course, keep in mind it’s a dental school, and we
have students working on these. But we have provided
the two-implant overdenture, which is just a basic,
entry-level implant prosthesis. We give them the two
implants, the two dentures and the two attachments
for around $1,500. Most people we find can get into
that with a little bit of desire. Most patients are very
satisfied with that price point, and we are able to help
them maintain their bone, get rid of a complete denture
and move into an implant-supported prosthesis.
BB: I believe you’re also doing some ongoing work
with 3 mm diameter implants?
MM: We are. To me, this is an interesting potential solution
to some of the costs associated with traditional
implant systems: single-piece overdenture implants.
These are available generally in different sizes, around
3 mm or a little smaller. We wanted to make sure that
this treatment modality was going to be successful
for our patients. We did a clinical trial with about 45
patients, and we randomized those to two, three or
four 3 mm diameter implants in the mandible. I was
really surprised at the results. I’m generally conservative
when it comes to loading protocols, time and so
forth. Obviously, with a one-piece implant, you can’t
have delayed loading. So we had immediate loading at
the time of placement, and we had a relatively smalldiameter
implant. Clinically, the results were excellent.
I’m gaining much confidence in this treatment
modality.
BB: I know the results haven’t been published yet, but
do you have a preference for the number of implants
— two, three, four? Typically when we start getting into
the smaller diameters, they’re saying four implants in
the symphysis. What is your take on this?
– Implant Q&A: An Interview with Dr. Michael McCracken – 17