This gem is from Scott Ganz. When you hear or read it your reaction will probably be; well, of course…duh.
It isn’t particularly new or seemingly even insightful. It seems too obvious to be insightful. However the fact that it should be obvious and yet is hardly ever mentioned or practiced makes it such a gem.
Far too often implants are all about the implant design, the surgical technique and the placement; wherever the surgeon decides it should go. The tooth is an afterthought.
Dr. Ganz says no,no,no the implant procedure starts with the tooth. Implant placement must be restoratively driven.
In the early days of implants this hardly ever happened. Surgeons flapped the ridge, picked out a fat section of bone and bam placed the implant. If the implant was in an embrasure or out of the occlusal table, well the answer was always; “that that’s where the bone was.”
Sadly even today we find implants placed in positions that are restoritively useless. Dr. Ganz and other implant lecturers have countless examples of recent, poorly placed implants. The surgeons excuse continues to be; “that’s where the bone was.”
Cone Beam CT has changed that completely. Now we know exactly where the bone is, how dense it is and where the nerve is before we touch the tissue. And with treatment planning software we can simulate tooth placement virtually. Here is a new system X-Nav that uses CBCT to treatment plan the case and then uses on screen targeting to help the surgeon place it exactly right without the need for a surgical guide.
There is really no excuse any more. If an implant can not be placed in a position that allows proper tooth restoration it simply should not be placed. The goal of an implant is not the implant it is the tooth we replace. Simple.