The Latest Techniques to Make Implant Placement Smoother

  • by Eric G. Jackson, DDS, MAGD, FICOI, FASD, FICD, FADI
  • Jul 18, 2022
As part of the July AGD Impact cover story, Eric G. Jackson, DDS, MAGD, FICOI, FASD, FICD, FADI, owner of Jackson Family Dentistry, Downers Grove, Illinois, discusses some of the latest methods to help implant placement, such as the socket shield technique, and ways to prevent complications like peri-implantitis.

AGD Impact: Are there any techniques that general dentists should be using to make implant placement easier? 

Jackson: “How do I get into dental implants?” “How do I do more dental implants?” “What are your favorite dental implant techniques?” These are questions that I’ve continually been asked throughout my career. My answer is always the same: Start with a sound educational foundation. 

We practice dentistry in an amazing age, where high-quality instruction on dental implants is readily available to all dental professionals via a variety of means and media. Amazing multiday in-person courses on implant dentistry with hands-on learning provide unparalleled educational opportunities and techniques. Due to the COVID-19 pandemic, top-notch live and prerecorded webinars are more plentiful than ever. Virtual media offers amazing access to a plethora of viewpoints and techniques from international experts that are accessible to any dental professional with an internet connection. Lastly, textbooks on implant dentistry often go overlooked as extremely useful tools to both the new and seasoned dental professional. I’ve always called dental implant textbooks my “secret weapon” when answering these three classic questions. This is because textbooks minimize the cost of entry into the world of implant dentistry while providing stellar comprehensive information on all aspects of the field. Not every dental professional has the time, financial resources or availability to attend in-person courses. Textbooks fill this void, and the authors are often some of the most prominent educators in the field. I definitely recommend reading several textbooks because each prominent author provides his or her own unique viewpoint and philosophy. 

What tips can minimize hurdles to complete socket grafting at time of extraction? 

Healthcare in general can be unpredictable, and one of the best ways to maximize predictability is to have a commanding knowledge of the subject at hand. I’m a planner by nature and have always found the adage “proper planning prevents poor performance” to be a sound bit of advice. My biggest tip to minimize hurdles would be to have an intimate understanding of both extraction technique and graft materials, as well as a well-conceived surgical and restorative plan. Each extraction and socket graft is similar and yet, at the same time, completely unique. Common questions will often have different answers depending on the case at hand. 

What type of graft material best suits the needs of the case? What type of membrane is anticipated? Is the addition of platelet-rich fibrin or similar adjunct techniques indicated? 

Combining the requisite knowledge and skills with preoperative visualization and team communication is certainly a sound start to a successful procedure. Visualization is a classic technique used in the sports world, and I find it to be extremely useful in dentistry. Prior to any dental procedure, take a few moments to visualize the entire procedure in your head. Be as detailed as possible. Try to anticipate any potential hurdles and how you might overcome them. Once complete, loop in your team. I like to briefly go through the anticipated steps and approaches I will take with my team prior to the patient getting in the chair. This review informs everyone of my anticipated master plan and allows us to be both efficient and flexible should hurdles arise. 

What are the best strategies to prevent peri-implantitis? 

Implant dentistry is no different than other subsections of our field in that the highest rate of predictable success is usually attained via excellence from the practitioner as well as the patient. This concept is a major pillar of my dental practice, and, to reinforce it with patients, I often compare long-term dental success to long-term successful car ownership. We discuss the importance of quality automobile design and construction as well as the importance of maintenance and upkeep. In my opinion, patient education and understanding are the most important steps to take to prevent periimplantitis. So many dental implant patients unfortunately operate under the assumption that “implants are forever” and that they require zero maintenance. We discuss periimplantitis and other implant complications at length and review the importance of top-tier home care. We recommend electric toothbrushes, oral irrigators, nonalcoholic rinses and custom acrylic nightguards for all our patients, but especially those with dental implants. Reduced intervals between dental hygiene appointments are also discussed for those cases where it is indicated. 

What is the socket shield technique, and how is it useful? 

The socket shield technique is a “newer” technique that is quite interesting. I place newer in quotes because, even though papers have been published about it for over a decade, surprisingly few general dentists have even heard of it. The technique is traditionally employed during immediate implant placement in the anterior region to preserve the integrity of the periodontium and the thin buccal bone that lies beneath. In a nutshell, the socket shield technique involves completing the tooth extraction via bisecting the root and preserving the buccal two-thirds of the root in the socket as a type of shield. Implant placement then takes place behind the protection of the socket shield with the intention of minimal disruption to the buccal plate and associated anatomy. Variations of the technique can be employed to preserve interproximal or palatal bone as well. A quick internet search will yield a variety of published articles that will certainly do more justice to this interesting technique then I can do so briefly. 

Are there techniques that general dentists should not attempt? When should they refer? 

General dentists, as well as specialists for that matter, should perform procedures they feel comfortable with. This feeling of comfort is usually derived from completing sufficient education and practicing sound case selection during the planning phase. Simply put, referrals should take place whenever a clinician’s comfort level is not met. I don’t complete every dental procedure, and I’d be willing to bet none of you do, either. Having enough knowledge to know when a case would benefit from being referred to a specialist is often just as important as having the knowledge to complete a different case from start to finish. 

Eric G. Jackson, DDS, MAGD, FICOI, FASD, FICD, FADI, owns and operates Jackson Family Dentistry in Downers Grove, Illinois.