ACP President Dr. Frank Tuminelli Talks Implants

Inside Dentistry spoke with Frank J. Tuminelli, DMD, FACP, president of the American College of Prosthodontists, about implant dentistry.

ID: The American College of Prosthodontists (ACP) revised their position statement on dental implants in April 2015. Can you share some of the key takeaways from the position statement?

Dr. Tuminelli: The American College of Prosthodontists (ACP) position statement on Dental Implants (www.gotoapro.org/assets/1/7/Dental_Implants_-_RevisedApril18Affirmed.pdf) reminds us all as oral health providers that the placing of dental implants is a procedure, not a dental specialty. Implants belong to dentistry as a whole. That’s very different than the position of other specialties, and limiting does a disservice to more than 100 million patients who are missing teeth.

“Placement of dental implants is a procedure, not an American Dental Association (ADA) recognized Dental Specialty. Dental implants like all dental procedures require dental education and training.” –ACP Position Statement, Dental Implants

ACP supports general dentists placing implants if they are properly trained, and as a prosthodontist we can help train them. We define our specialty by improving patient outcomes that are personalized to address each patient’s individual oral health issue and propose the best treatment plan to achieve optimal oral health. Why limit ourselves as dentists or specialists to help patients by letting any one specialty be defined by a procedure?

In terms of proper training, ACP is not in favor of an individual taking a course over the weekend and then going into the office on Monday and placing a dental implant, as this is surgery, and like all surgery, proper training is in the best interest of improving patient outcomes. We are in support of an individual general dentist or dental specialist who wants to dedicate the time to learn surgical placement and do it in their practice. Proper implant placement can lead to a huge quality of life improvement for millions of Americans missing teeth today. Long-lasting outcomes are our shared goal and a 29-year study of dental implant placement outcomes from a global audience published in the Journal of Prosthodontics by prosthodontists at the Mayo Clinic—the longest and largest retrospective study to date on dental implants—demonstrates the need for proper placement as well as follow up care after an implant is placed to ensure it will be long lasting.

ID: Why does the position statement include suggested questions for patients to ask their clinician?

Dr. Tuminelli: The College’s position is that the patient should feel educated and comfortable. We are trying to empower the patient population so they feel comfortable with their health care provider, and that there is transparency in that relationship.

For example, patients should know if an implant is going to be cement or screw retained, if their health care provider has placed them in the past, and if the provider has experience placing them in the back of the mouth.

The ACP message to patients is: If your general dentist is placing implants and you are comfortable with your general dentist and they have proper training, then have them do it. That’s ultimately going to improve that patient’s quality of life—what all dentists and specialists want to see. If the patient has any hesitation, the patient should be comfortable asking for a referral, perhaps to a specialist—a prosthodontist or other dental specialist.

There is an enormous need for dental implant therapy. More than 100 million Americans are missing 1 or more teeth and 35 million are missing all their teeth in one or both jaws. That’s huge. Prosthodontists can help inform the public that oral health providers are here to help patients replace missing teeth. We are here for education, improving the quality of life through outcome assessments, and giving them back the feeling that they are a complete person again. Patients can then go back into society and not think about their teeth—that’s our ultimate goal.

ID: What is new in implantology from the prosthodontic perspective?

Dr. Tuminelli: Probably the newest and most exciting development is the application of digital technology to implant placement and restorations. As prosthodontists, we can gather so much information from a cone-beam CT (CBCT) scan before we even touch the patient. We know the exact anatomy of what we are dealing with before surgery. We can plan the implant surgery virtually on the computer and place the implants exactly where they need to be placed for a perfect fit and long lasting function that appears natural.

It’s how we visualized it to be. Then we can design the final prosthesis digitally. It is all done in a well-planned, efficient manner.

Some patients who cracked a tooth before their morning coffee can be back to eating a salad with a client for lunch just hours later due to digital technology. It’s incredible.

As a practicing prosthodontist, I’ve treated patients who go from no teeth in the morning and leave with a fixed, screw–retained restoration that same day; this applies to a single tooth and larger restorations. Even though it won’t be a permanent restoration, it’s a provisional that gives that patient immediate function and esthetics. It changes their personal outlook and improves the quality of their life immediately. That is the most exciting advancement of the past few years or so.

ID: Speaking of using technology for treatment planning, how important is that stage of placing implants?

Dr. Tuminelli: To be successful in restoring or placing an implant, understanding treatment planning comes first and the surgery is secondary. Prosthodontists specialize in treatment planning. ACP believes it’s critical to understand where that implant needs to be, precisely placed, so the relation to the final tooth or teeth will be optimized. It sounds simple yet it’s complex, especially if the patient lost a tooth years ago. We know that teeth shift and drift, so planning is essential. Our commitment to improving patient outcomes involves getting the diagnostic information, deciding where the teeth go, and aligning that tooth where the implant placing goes.

ID: What do you see coming in the future in terms of advances in implantology?

Dr. Tuminelli: The whole field of biotechnology, implant technology and all the things we can do today in terms of growing bone and tissue and grafting—all of that is so rapidly changing. From where it was 5 years ago to where it is today, there has been a huge progression.

The most exciting part right now is the completion of the mapping of the human genome. You can grow enamel. You can grow certain types of biological tissue today. It is not that far away, the day may come when we don’t use titanium as a replacement and we use something that is your own. All the information in one’s genomic map can be acquired from a sample of the buccal mucosa. We would use your genetic code and grow your own enamel It’s still in the future, yet it’s not that far away. Just like all the things that we utilized in the past, we think, “Look what they did then!” The day will soon come when we’ll say, “Oh, they put screws in bone?” It’s not that far fetched, as I recall a lecture with PI Branemark 30 years ago where I told my graduate professor, “Everything’s been invented already” after his lecture. My professor replied, “We can’t even predict or imagine what’s coming next in dentistry.”

For references, see the following:

Sadowsky SJ, Bedrossian E. Evidenced-based criteria for differential treatment planning of implant restorations for the partially edentulous patient. J Prosthodont. 2013;22(4):319-329. doi: 10.1111/jopr.12014.

Drago C, Carpentieri J. Treatment of maxillary jaws with dental implants: guidelines for treatment.J Prosthodont. 2011;20(5):336-347. doi: 10.1111/j.1532-849X.2011.00717.x.

Cooper LF. The current and future treatment of edentulism J Prosthodont. 2009 Feb;18(2):116-22. doi: 10.1111/j.1532-849X.2009.00441.x.