Full-Arch Restoration - Mission Possible
There is great debate and exuberance in the field of full-arch restoration related to the concept of, "Immediate Load." In this 4th episode of "Full Arch Restoration, Mission Possible", Dr. Frank LaMar will discuss the indications and contra-indications doctors should consider when utilizing an immediate load protocol.
Listen to the Hybridge Podcast:
Episode 4 - Perspectives On Immediate Load
Watch the Hybridge Podcast Video: Episode 4 - Perspectives On Immediate Load
Randal: Thank you for joining me today Dr. LaMar
Dr. LaMar: Glad to be here as always, Randal.
Randal: In the dental industry today, there’s great debate and exuberance around the topic of immediate load. How do you address that concept with your full arch patients?
Dr. LaMar: Somebody recently referred to this exuberance as the sizzle of full arch, which I thought was funny and it’s true. I mean, we've been doing immediate load in our practice here in Rochester, New York since 2001, and we've done it pretty effectively, even in the early days and it really showed us a lot about the ability of implants to be able to support teeth at the time of surgery. Now, I think that has been sort of taken to a new level over the last 15 or so years, and marketing has been the focus. When we talk about the sizzle of full arch, it’s all about talking to a patient regarding their fear of leaving an office after extraction of their natural dentition, and what are they going to walk out with? Of course, we would never let him walk out without teeth, but patients don't really know that. So, these immediate load protocols are a great way to satisfy that big question or to make them feel more comfortable with their fear of being without teeth. What I would say is, like anything else, there's always an indication and a contraindication to doing something.
Dr. LaMar: And when the market, especially, you know there's a lot of newcomers to the full arch space. A lot of doctors, I think have a perception that immediate load is an absolute on all cases. Which, it's really not. There are a lot of complexities to doing immediate load. First of all, the mandible and the maxilla are two different situations completely, and immediate loading the mandible is much easier than immediate loading the maxilla. When we talk about immediate load, also, at least in my mind, we’re making an assumption. We’re making an assumption that we’re taking a patient from wherever their pre-treatment situation is, and that day we're going to load some sort of an interim prosthesis. But, for example, in the maxilla, when you have somebody who's fully dentate, and there's not an abundance of bone in the maxilla, so, you have in that premaxilla, which is our good real estate, there's teeth there. There are teeth with big fat roots, big wide diameter teeth, sometimes there's bone loss, sometimes there's large periapical pathology. So, that good real estate is not good real estate until it's healed sometimes. So, this idea that you can take teeth out all the time and place implants in immediately and do immediate load, I think those that haven't done a lot of full arch, I think they think that that's the thing. It's really not. So, you know what I would say to somebody who’s interested in learning more about full arch, is be really sure of when immediate load is indicated. When is it easy and when is it not a good idea? And then the next thing is, then ask yourself, is it important to the case to do it? Just because you can do something, doesn't mean you have to do it.
Dr. LaMar: And when these treatments used to take nine months to do from start to finish, putting a patient into an immediate load prosthesis, or a conversion denture, converted day of surgery, was really kind of powerful because the patient didn't have to wait 9 months of wearing a denture. The fact is, that if the focus is maybe more on going to definitive quickly—our current Hybridge XD protocol takes a dentate mandible to final definitive restoration in two weeks. So, the idea of putting somebody into a an interim prosthesis and spending all of the time it takes to fabricate that day-of surgery, and all the adjustments and maintenance that has to happen, is really time spent by the clinician that's wasted, because we're going to get them and we can hold them in an interim complete denture for 2 weeks. The patient is happy to save the money where they don't have to spend on another separate process, and more focus on doing things efficiently, really fast, and because we're doing it fast we do it for less. And so, there's a lot of win-win to trying to avoid immediate load if you can.
Randal: That’s excellent insight into this topic, because it really is a hot topic now in dentistry.
Dr. LaMar: Oh, I know it is.
Randal: And, I think you’ve given it the right perspective. I appreciate that.
Dr. LaMar: Thanks, Randal.
Randal: Thank you ladies and gentlemen, for joining us today on Full Arch Restoration: Mission Possible.