2000-2-Editorial - Saudi Dental Journal

ISSN (Print) 1013-9052
EISSN 1658-3558

The Saudi Dental Journal,
P.O. Box 52500,
Riyadh 11563,
Kingdom of Saudi Arabia

Tel.	966-1-467-7328
Fax.	933-1-467-7308 / 966-1-467-7534
Email	saudidj@ksu.edu.sa

Editorial

Towards optimized treatment outcomes for dental implants

My recent visit to Saudi Arabia provided me the opportunity to make several new friends. It also enabled me to experience first-hand the impressive accomplishments of my Saudi colleagues. I hope that my lectures' message (as summed up here) was a fair exchange for the many benefits which I gained from my visit.

The five simple tools-the lever, wedge, wheel and axle, pulley, screw- have existed for millennia. Each of these tools and their underlying principles have been refined, improved and combined in various ways to produce other tools and engineering principles (no longer simple), which in turn have revolutionized the application of modern dental techniques. This process has been particularly important in the disciplines of surgery and prosthodontics. Archimedes, in the third century BC, understood the operation of the mechanical screw, which represents a basic tenet of endosseous stabilization, albeit limited in its time, and biologically dependent efficacy and effectiveness.

A scientific transition in the nature of interfacial screw-host bone behaviour involving commercially pure titanium implants was reported by Per-lngvar Branemark in 1977, and the field of dental implants entered a new era of therapeutic possibilities.¹ Interestingly, Branemark's results and success criteria proposed by a National Institutes of Health consensus conference in 1979 were published almost simultaneously.² The latter document, a well-intentioned synthesis of largely retrospective observations, was quickly eclipsed by Branemark's and others'emerging confirmatory results. Consequently, in 1986, in collaboration with Tomas Albkretsson, Philip Worthington and Andrew Ericsson, we proposed success criteria,³ rather than mere survival statistics in our description of desirable treatment outcomes for osseointegrated implants. Our clinical yardstick and subsequent "fine tuning" versions⁴ ⁵ underscored the clinical nature of the induced interfacial response, together with the subtle yet profound clinical implications of such tooth abutment analogues: they had to be painless, immobile, surrounded by bone in a steady state, and capable of being employed for diverse prosthodontic solutions, from single crown support to retention of extensive maxillo-facial prostheses.

We sought to include strict success criteria in the context of patient-mediated concerns regarding absence of pain, discomfort and infection, as well as the additional caveat of a satisfactory appearance. In retrospect, patient concerns were perhaps insufficiently emphasized, at least in a quantifiable context. Nonetheless, over the years, we were gratified to note that several prospective studies in leading refereed journals adopted our yardstick. However, not all reports on new implant systems did so. Commercial claims insidiously undermined scientific standards as celebrity groups of osseointegrated implant proponents emerged to compete with the scrupulously constructed scaffolding of international scholarship that was emerging. Sloganeering and self-promotion have traditionally sought inroads into the science of dentistry; but the advent of osseointegration elicited an unparalleled commercial culture that sought to usurp the commitment to evidence-based management of the sequelae of oral diseases. The most glaring example was the profession's new-found fascination with cosmetic dentistry, which provided the rhetoric to market services of dubious health necessity. Oral renovation began to replace oral health as the profession's clarion call for the decade. And dental implants as a prosthodontic treatment alternative inevitably spawned surgical techniques and restorative hardware which ran the risk of becoming an end in themselves.

George A. Zarb, BChD, DDS, MS, MS, FRCD(C)
Professor and Head of Prosthodontics,
Associate Dean, Clinical Sciences,
Faculty of Dentistry, University of Toronto, Toronto, Canada