PREFACE

The history of dentistry resembles that of other areas of medicine. Many researchers and practitioners contribute to the growth and depth of the field. The field expands in numerous, sometimes seemingly unrelated, directions, and then scattered bits of evidence crystallize into a concept that becomes a tremendously important and exciting landmark in the field. For some time now, investigators working in various areas of specialization have been developing their ideas and making small but important contributions to the field of implantology. Now comes a unifying concept—the endosseous implant.

The endosseous implant is the most exciting idea in modern dentistry. It is the herald of a new era that can benefit esthetically, psychologically, and physically most of the partially and many of the totally edentulous patients. The idea is to put into bone an implant designed to complement the natural forces operating in the health and welfare of the jaws. The implant is accepted by the tissues in which it has been set and is tightly bound there, providing a tenacious abutment to which a permanent or a temporary prosthesis may be attached. This gives the patient a prosthesis that is closer to the look and feel of natural teeth than any other artificial appliance to date. It is radically different in concept and totally exciting in its potential benefits.

The history of dentistry has also been plagued by the needlessly slow recognition and acceptance of a startlingly different idea. Despite ample proof that a new technique will immeasurably benefit a patient, there is a tendency to stick to traditional methods. This is understandable, for many operators prefer to repeat familiar techniques with predictable results

rather than to experiment with the unfamiliar. How-ever, this attitude should be objectively evaluated.

The ultimate goal in dentistry is maximum benefit to the patient, not the continuance of merely adequate methods for the convenience of an operator. Granted, the procedures involved in implantation are more radical than current procedures for providing removable dental prostheses. Granted, the techniques require a great deal more clinical skill on the part of the operator than do current conventional approaches. Yet the benefits to the patient are so much greater that the ethics of dentistry demand that a new technique be carefully judged and evaluated in terms of its inherent merits.

Of course an endosseous implant technique can-not be performed on all patients. Because the implant must be set in alveolar bone, those patients with extensive bone resorption are not suitable candidates. However, they may be candidates for a subperiosteal implant. Some patients, because of overall poor health—such as those with uncontrolled diabetes—can never be candidates for any kind of implant intervention. Others, such as a patient with a temporary condition, may be restored to good health and become candidates. Of all presenting patients, from 70% to 85% may be candidates for some type of implant intervention, either endosseous or subperiosteal.

To date, I have treated well over 1,200 cases involving endosseous implant interventions, and together with those cases completed by my co-author, Dr. Raphael Chercheve, the figure exceeds 2,000. Although many of the early attempts were unsuccessful—primarily as a result of inappropriately de-signed implants and lack of experience in placing the

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