Future Trends in Implant Dentistry: Full-Arch Rehabilitation and Desktop 3-D Printing(one)

Our implant editor, Dr. Michael Tischler, interviews Dr. Michael Scherer—a self-described computer nerd, an experienced clinician, and one of Dentistry Today’s Leaders in Continuing Education—on a variety of hot topics dealing with contemporary implant treatment, digital dentistry, products, and other clinically related matters.

Dr. Tischler: Thank you for your time Michael! We know you well with the articles you authored and published in Dentistry Today on full-arch reconstruction, implant overdentures and fixed prostheses, and digital technology, to name a few topics. Please briefly tell our readers about your background.
Dr. Scherer: I thank you and Dentistry Today for this interview. It is a pleasure working with you and the team!
I was intrigued by the power of what we, as dentists, can do to improve the quality of life of our patients by providing them with comfortable teeth. In dental school, the first patient I treated was a lady who has been a part of our family since before I was born. Her name is Eula. I described her journey in my book: Lost Your Teeth, But Not Your Appetite. She came to me with broken teeth, decay, and infection, and we treated her with implant overdentures. Fifteen years later, she is using her same denture and LOCATOR abutments and inserts (Zest Dental Solutions). In fact, every time I go home to visit I bring my overdenture kit to check her inserts to see if they need to be replaced; amazingly, in more than 10 years, this hasn’t happened yet!

That is a great story! Please tell us more about your book.
Dr. Scherer: Absolutely! I can tell you that I have personally seen, or been part of, the treatment of thousands of patients with full-arch reconstructions with implant overdentures or fixed restorations during my time in both private and academic practice. The biggest challenge has always been with the consultation examination and explaining all the differences between the treatment options. Clinicians know what I’m referring to: “I have some bad news. Your teeth are in terrible shape and need to come out, so let’s chat about the options.” Then most of us will pull out pamphlets and models and talk to the patients for an entire appointment about their choices. In the end, all they have heard is, “Oh my! I’m going to lose all my teeth?” So, I wanted to help by sending them home with something to coach them through their decision-making process. It took me several years to write it, but now I have a book that clearly describes every detail from a patient’s perspective. It is written so that it doesn’t confuse patients, and it is easy to give to them before leaving the office. With this book, patients can now review, in detail, all of the options they have in implant dentistry. They now come in for the second visit—which is often the financial consultation visit—with copies of my book highlighted, circled, and usually with questions written in the margins.


Figure 1. Standard Diameter 2-Implant           Figure 2. Narrow-Diameter 4-Implant  LOCATOR Overdenture (Zimmer Biomet).      Overdenture with LOCATOR Overdenture                                                                                        Implant (LODI) System (Zest Dental                                                                                                    Solutions).


Figure 3. The LODI system.                               Figure 4. Intraoral scanners 3M True                                                                                                  Definition (left)and 3ShapeTRIOS


Figure 5. One of the first 3-D prints                Figure 6. Using intraoral scanning and 3-D generated from 3M’s True Definition Scan     printing to wax-up and make a provisional  and Form1 3-D printer (Formlabs).

Is your practice focused on implant treatment? Please tell us more about what a typical day is like for you.
Dr. Scherer: I practice in a small and semi-rural area of California. I love full-arch reconstruction and, yes, especially treatment plans that involve implant dentistry. While I treat patients from many backgrounds and with many treatment needs, I have a reputation for doing excellent dentures and implant bridges. My typical day is like every clinical practice: we have hygienists seeing patients and patients on my schedule for restorative needs. Other dentists within the community refer patients to our office specifically for dentures and full-arch reconstruction. In addition, I have many days where I don’t touch a tooth and work almost exclusively with full-arch cases.

What type of full-arch reconstruction do you perform the most and which do you like best?
Dr. Scherer: Personally, I love discussing and treating patients with any of the treatment options for those who are edentulous or will soon be missing all of their teeth. I still do a tremendous number of complete dentures, especially maxillary dentures, without implants. However, for the mandibular arch, I rarely treat patients with conventional complete dentures anymore. Implants are a proven modality with a long-term success rate that makes the treatment wonderful. Across my entire practice, implant overdentures make up the majority of the cases done.

Why do you think that is?
Dr. Scherer: I have found that there are 3 big limitations to treatment acceptance. First and foremost is the financial reason. The cost of treatment is many practice’s primary road block, and it’s no different at my office. The major affect our office can have to increase treatment acceptance is to provide affordable options for our patients. Typically, most offices push full-arch fixed restorations, such as All-on-4 (Nobel Biocare), because it’s considered by many to be the elite treatment. It also comes at an elite price—typically between $25,000 to $30,000 an arch! While I do have some patients who can afford this type of dentistry and will greatly appreciate it, many of my patients just simply can’t afford those prices. I do my best to give affordable options in between the $4,000 to $10,000 range; generally, the options in this price range are overdentures with 2 to 4 implants.
Secondly, some patients have a tremendous amount of surgical anxiety associated with implant procedures. Even if cost isn’t an issue, I’ve had many patients indicate to me that they’re afraid of treatment, either due to medical history complexity or the perception that they “don’t have enough bone for implants.” Several consults per week deal with patients who have been told by multiple clinicians, “You don’t have enough bone; you will suffer with dentures.” Talk about scary! I like to discuss how predictable implant procedures are in the anterior mandible with my patients.
One thing that we don’t discuss more often in dentistry is the lack of awareness of treatment options. Most patients have heard about dental implants, especially with the marketing campaigns of corporate implant practices around the country offering same-day implant treatment. Many patients feel this “sounds too good to be true” or “my dentist probably can’t do that for me.” As clinicians, we get comfortable with one method of treatment and typically only offer the one protocol that we are most familiar with, such as a fixed bridge, when other treatment options, such as implant overdentures, could also exceed the patient’s expectations.

So, do you think that one treatment is better than the other?
Dr. Scherer: This is a tricky question. They all can work extremely well but we strive for patient-specific treatment. It’s my job to figure out which option is best suited for that patient. It cannot be a one-size-fits-all approach. However, it’s imortant to note that it’s my job to lay the treatment detail out and let the patient decide. I never push a patient into a decision.

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