Why Invent a New Dental Implant?
By Dr. James C. Grant
Founder/Inventor Proximerge Dental Implant
As a dentist, we all have our list of why we chose this profession; I suspect that somewhere on your list is, “Helping people.” We take people out of pain; we change patient’s lives by creating a smile that gives them a new confidence. We give patients a healthy mouth that perhaps they never had before, and hope to assist them in maintaining oral health for the rest of their lives. Even some patient’s gain the ability to chew their food better and gain benefits from nutrition they weren’t aware was missing. For me, the satisfaction of all these and knowing that I did my best to improve the life of my patient is my first goal.
Six years ago I became compelled to do something to change the way dental implants are restored, being motivated by a recurring complaint from my patients. They made me aware of a common problem, to which I could not offer a solution, because there was not one available. I began an evidence-based journey using my own resources, spending countless hours contacting various adjunct manufacturers of dental implants, major implant companies, notable researchers and experts. It resulted in prototyping my own solution, manufacturing it, and finding suitable clinical patients for my own clinical trial. After 3 years, I secured my first patent and with the help of Angel Investors started the Proximerge Dental Molar Implant System. We are currently placing and restoring the implant system by outstanding Implantologists and surgeons in the UK. Why did I bother to incur this time consuming, not to mention expensive project in the first place? It is a complex answer, where I shall start with my philosophy on this journey.
Dentistry is in the most exciting period that I have ever known in the 35 years I have been involved, a sort of renaissance. The availability of Digital Imaging and Communications in Medicine is a standard of care that makes transmitting, storing, and printing dental information commonplace. From X ray images to digital impressions with accuracy as impressive as 10 microns are now everyday tools. The use of Computer Aided Design and Computer Aided Manufacturing (CAD/CAM) and Virtual Design is standard software in dental laboratories and at the chair. Custom same day design and milling in the dental office that offers a crown in about an hour is remarkable technology. Additive Manufacturing or 3D printing has applications in the dental lab and stereolithography has impressive accuracy with future applications for expansion. The routine use of laser’s for hard and soft tissue in dentistry makes the procedure less invasive and impressive results. The lists go on with new drugs, materials, techniques, quicker, faster and safer methods are being introduced on a regular time frame.
I had a dental instructor who use to say, “You can’t diagnose what you don’t know.” It was true when I was in school, but in today’s world of social media and computer information the availability of data and access to Internet research makes any undiagnosed question a click away. On-line forums with other professionals who can write an opinion and give advice from their experience and carry on conversations are an invaluable tool for every complex case or patient problem. This adjunct to a clinical situation and diagnosis will only make for a more accurate treatment option. We as dentists must expand and increase our range of standard of care beyond the teeth and gums. It is required of us to become doctors of the entire body specializing in the oral cavity. A simple saliva test can now identify a patient’s DNA, Genome Map, specific bacteria and the diseases associated with them. This information allows us to identify and prevent specific systemic diseases where the oral connection can be actively recognized.
It has been suggested (Everett Rogers) that about 15% of the population is a combination of Innovator and Early Adopter of new technology. These people think with their limbic brain often having a “gut feeling.” They seek out ideas that challenge the dogmatic and pragmatic thinking of the day. I think most of us have some of this attitude in certain situations where we follow our gut instincts, and maybe can’t define why we are doing something other than it feels right. Dentistry is a little more cut and dried. We are taught to examine and apply the tried and true knowledge where our best judgment is used for the situation. Some of this is taught to us, but the majority is compiled from our curiosity for published research, continued education or evidence based experience. The debate as to which has more value takes on the bias from each perspective, I feel there is value from both and each is just as necessary. The famous sayings, “You must think outside of the box,” and the definition of, “Insanity, doing the same think over and over, but expecting a different results” are what the 15% Innovators and Early Adopters use as their mantra. It is important to keep asking, “Why” and pushing the envelope to inspire original thinking.
My hope is that I leave the dental field better than how I found it and my patient’s lives enriched in any small way from my ability to improve a life. So when my dental implant patients who were experiencing a similar problem and complaint with their molar restorations, I knew that I must look for a solution. I was compelled to ask the major implant companies about their solution to what my patients viewed as a real irritation. I knew that for this patient’s it was potentially far more than just a nuisance or being over critical, but a problem that could initiate disease and tooth loss. These patients were unknowingly uncovering an ignored violation of dental principles we were fundamentally taught in school. It is understandingly the natural evolution of the procedures we have found to work the best in dental implants and the speed of change to accept implant treatment. It is easy to recognize the many benefits of choosing an implant whenever the situation warrants over traditional treatment choices of the past, even when the easier acceptance of insurance, cost and convenience seems more attractive. The benefits of replacing one tooth with another root shaped implant makes for the best treatment option given to the patient. During my career and the use of dental implants, I have seen the success rate increase with the advancement of research and technology. Better instruments and techniques along with higher manufacturing tolerances, custom component designs, and new ideas pushing the critical thinking outside the norm benefits the patients. With over 200 dental implant manufactures all looking for the new and better paradigm to attract the dental customer has made for some interesting variations in a fairly pragmatic field. Yet, in my experience and listening to my patients, I found that there was something omitted and over looked in the development of molar implants that needed to be addressed.
According to the dental labs I have talked to estimate that somewhere between 65-70% of the crowns they fabricate on implant teeth are in the posterior area, mostly molars. These are the functional grinding teeth and not necessarily the esthetic zone ones, which is not usually what I see when I attend lectures on implants. Rarely are the molars featured in the lectures, it is usually the “sexy” front teeth that get the attention where we start with a visibly compromised mouth and after the implants the patient has a new beautiful smile, new hairdo and less wrinkles. It makes me proud to be a part of a profession that can change a person’s appearance and confidence to that extent, however we must not forget that the majority of implant crowns are produced for missing molar teeth. I asked myself, “Why is it that these lectures I attend rarely show photos and x-rays of molars?” I believe that part of the answer has already been stated above, but in my opinion the real answer is more basic.
If we look at a clinical photo of a restored implant molar in the mouth, there appears the lab does a remarkable reproduction of the missing tooth. However, an x-ray shows the real image of the restoration. Using an implant as large as possible that the available bone allows, still produces a morphology that does not resemble a tooth anywhere else in the dentition. Even to a non-dental observer the implant crown and replaced implant root are not representative of the natural shape of the missing tooth. The dis-similarities are obvious with glaring omissions. Generally, molars have 3 roots, a wide CEJ at bone level, and a rectangular occlusal table. When they are replaced by implants, which I believe they should be whenever possible, the 3 roots are replaced by 1, and whether the abutment is a manufacturer’s stock or a custom abutment made to follow the emergence profile of the tissue, the resulting crown ends up over contoured and resembles an “apple on a stick.” An x-ray of this implant system and components, which varies little from company to company, does not biomimic a natural tooth, but because it is the only choice we have as dentists, it has come to be accepted as the norm and “Standard of Care.” This is what I asked many of the major implant companies worldwide by visiting them personally at their North American Headquarters or writing to the President’s and expecting some sort of a reply. More often I received a not interested courtesy letter, a referral to some other department, or instructions on how to submit a New Product Idea. I followed up on every replay I received, called whoever I could get to respond, journeyed to meet with Chief Scientists, VP of New Products, Head of Marketing, Research and Development, even a Key Opinion Leader from a major university supported by the one of the largest dental implant company. The Professor is a well-respected international lecturer who granted me 10 minutes after one of his presentations at the request of my friend the National Sales Manager. Many of the sales people who are in the field and interact regularly with clinicians practicing dentistry on real patients saw the value of my questioning why there was not an alternative to the molar design, and the advantage of my prototype idea. The meeting with the Professor lasted about 11 minutes, which was long enough for me to purpose my idea for a solution to the clinical complaints and dilemma we face in treating some of our patients. Unfortunately, he was not impressed, and in fact called it a “radical” idea and way “outside of the box.” To which I responded, “ Actually, I am thinking inside of the box.” Referring to the round peg of a molar implant, being placed inside a square or rectangular space of the missing molar. He wasn’t amused and probably never knew that his comment was the highest compliment he could have paid me. I felt I was coming up against the academic dogma and my limbic part of my brain is what was compelling me to continue with this gut feeling that we can find a better solution. I struggled to discover an alternative treatment for the patients who trusted me to offer the best solution for their missing molar, the dental laboratory technicians who I rely on to fabricate the best crown possible, but finds it frustrating to achieve a biomimic molar using 1 implant when replacing 3 roots, and the dental hygienist who has the professional responsibility to maintain and instruct the patient in the care of the implant, crown, and surrounding tissue to keep it all healthy as the day it was places. This is why I continued to develop a platform for this circle of support for the patient, including the implant surgeon, restoring dentist, dental lab tech and hygienist. I was committed then to finding a solution, and am committed to continue to develop and refine any product we develop for the clinical benefit of the people we help….
Link to Part 2 - Part 2: How I developed what I believe is the solution.
James C Grant DDS is a clinical dentist in Colorado Springs, Colorado USA.