Dear Fellow Periodontist,
I was pleased to see this week (July 6, 2011) that The American Academy of Periodontology picked up the recent article about NeXsmile and ran it in their This Week in Perio weekly news brief.
I am using this event as my excuse to talk with you about the future of our specialty, something that has been on my heart now for a number of years. I believe periodontists are well equipped to work in the area of full-arch surgical implant placement utilizing the new technology developed here in San Antonio, Texas.
Back in 2006 I began working with prosthodontist Stephen M. Schmitt DDS MS around technology he had been developing over the previous ten years that uses a patient’s CT scan data, scanned dental model data and a digital smile picture to create not only a powerful 3D composite image for diagnosis and treatment planning, but also to rapidly manufacture devices in acrylic and titanium. The result was a quick and effective way to restore patients using implant supported artificial teeth. A recent high point of our work was having our company Voxelogix receive an internationally recognized award from Frost & Sullivan. I have been told that this is the first award given by Frost & Sullivan to a dental company in North America in its 50 years.
Voxelogix was presented this award for basically two reasons. First, this is ground breaking and disruptive technology that transforms CT imaging from primarily being useful for diagnosis and treatment planning to actually automating the manufacturing of customized patient-specific dental devices in both acrylic and titanium. Secondly, the dental procedure known as NeXsmile® addresses a problem faced by about one million adults a year in the U.S. who will lose all their teeth.
The purpose of this letter is not to discuss the technology in detail. This information is available by clicking the links at the end of this post. Rather, I would like to explain why I believe it fits within the skill set of periodontists.
Right now there are patients in periodontal practices that fall into the category described in the classic article by Hirschfeld and Wasserman (1978) as Extreme Downhill. We have done everything in our power to help them yet we know it is only a matter of time. The transition to implant support while there is still enough bone is an important consideration. Periodontists are continually tasked by referring dentists to solve complicated full-mouth problems. The ability to utilize 3D digital technology helps bring dentists, dental laboratories and patients together around a comprehensive treatment planning process that is easy to understand and explain to patients.
As one myself, I do understand and appreciate our conservative nature as periodontists. We are famous for taking the long view of therapy and it bothers us to give up on teeth that might have a little more time left. However, in an age where the dental implant has proven to be the most effective and longest lasting restoration in the entire dental arsenal, we need to think very carefully about effective alternatives to simply continuing periodontal therapy when it isn’t working. Just as there is a time when it is no longer wise for the endodontist to perform the root canal on the compromised molar, there is a time when the periodontist needs to consider the full-arch implant hybrid. Obviously until now the complexity of such a procedure seemed outside the capabilities of most of us. For this reason, most full-arch dental implant procedures have been accomplished by oral and maxillofacial surgeons.
NeXsmile, having been developed by a prosthodontist and a periodontist, requires a meticulously executed surgical approach well within the capabilities of the periodontist. NeXsmile utilizes surgical guides that take the guess work out of shaping and removing an adequate amount of bone. This assures there will be enough room for both the titanium frame as well as the white teeth and pink acrylic gums. Also the guides provide the correct angulation for dental implants so that they will not interfere with the esthetic requirements of the case. Unlike Nobel Guided Surgery, the NeXsmile procedure does not require special surgical instrumentation and does not place dental implants through fixed tubes. Also, when possible, the NeXsmile procedure transitions patients in one appointment from their failing dentition to a mandibular prosthesis screw retained to implants and usually (there are exceptions) a maxillary transitional denture over dental implants. After adequate healing, the initial sets of provisional teeth are replaced by a custom-made titanium frame and teeth that are attached by small screws to dental implants.
The NeXsmile gives periodontists an opportunity to co-treat complicated patients with their referring dentists in a way that simplifies restorative care while giving their dental colleagues the ability to treat and manage more complicated patients effectively.
If you are interested in learning more about NeXsmile and how it might be used within a periodontal practice please consider taking one or both of the following steps.
1. Please recommend to those in charge of regional and national periodontics meetings that they invite Steve Schmitt and/or me to come and teach this new technology. We are already presenting to the restorative side having presented at the 2010 ADA Annual Session and the 2011 TDA meeting in San Antonio.
2. If you are already attempting to tackle these full-arch implant cases or perhaps you have worked around guided surgery (and therefore appreciate the problems associated with that method), I invite you to contact me to discuss how we might train you using in a live-patient care approach. Most of this training is accomplished here in San Antonio. Call or write me if you would like more details.
Links to learn more about NeXsmile technology:
About 6 months ago I was invited to write a blog for MySA.com. This is the Express News website. It gives me an outlet to post material that is either focused on San Antonio or a little outside of the purpose of my material here. I hope if and when you have time you take a look and tell me what you think.
My last post was announcing that Steve Schmitt and I were to speak at the annual meeting of the Texas Dental Association here in San Antonio. My hat is off to all the dentists, event staff (and office personnel the dentists roped in) who helped plan and then produce this huge event.
