INTRODUCTION TO ZERO BONE LOSS CONCEPTS
I will start with the first questions I ask during my courses and lectures: Do you have crestal bone loss around implants that you place and restore? Are you here because you want to understand why this sometimes happens? Most people I speak to respond in the affirmative: Many of their implants have some degree of bone loss. This is a major issue that can be encountered in any practice. However, crestal bone loss does not have to occur. With this idea in mind, I createdzero bone loss concepts: the protocols to achieve the status of zero bone loss.
Zero bone loss is achievable—not just months after prosthetic delivery but years after completion of treatment.Figure 1 demonstrates an extraordinary case with results for which we constantly strive. The inevitable questions are: Why was this case so successful? What can we do to attain these outstanding results?
Fig 1(a) Maxillary implant in 2013.(b) The same patient in 2018.
This is the question that I hope to answer with this book, using concepts taken from two realms: clinical practice and scientific research. However, each of these, taken individually, has its shortcomings.
Clinical Practice
There are many books that show very successful clinical outcomes, but they are frequently based only on the authors’ experiences. The results are great, but just because one clinician reports these results, it does not mean that readers will have the same outcomes. The unfortunate response is the well-known phrase, “It works in my hands.” Readers may try to mimic the results with less than desirable outcomes and then become discouraged. Usually, those readers or course participants may begin to blame themselves, questioning their ability to perform contemporary treatment. In the speaker’s world, there is a new term,podium dentistry, which refers to clinicians presenting only their good experiences rather than the entire picture, including complications.
Scientific Research
It can be a challenge for strict science to be taken seriously by the clinical world because it is often viewed as too far removed—or even boring. Evidence-based implant dentistry is of course the ideal situation, but it is seldom achieved, because the truth is that clinical studies are very difficult to perform correctly and without bias. Another challenge that arises is that ethical rules are becoming stricter, and patients are becoming more and more reluctant to take part in clinical trials. These factors have made it more difficult to get approval from ethics committees and conduct clinical trials. The result is a situation where the scientific and clinical worlds start to distrust each other, which is the worst outcome. Therefore, true success is achieved when treatment is performed based on clinical evidence with the appropriate logic and technical skills.
Integration of Science and Clinical Practice
The purpose of this book is to combine these worlds—scientific and clinical—into one. This gives clinicians exactly what they need: clinical procedures backed by solid clinical evidence. That was the idea behind the development of the zero bone loss concepts.
I was once confronted by a colleague with the argument that it is not possible to have zero bone loss around implants. Of course, I agreed, but explained that we must do our best to move in that direction. We are making great progress, because one of the studies demonstrated only 0.2 mm of crestal bone loss—almost zero!1
I strongly believe that it is possible to achieve bone stability with different implant systems, surfaces, implant-abutment connections, and prosthetic solutions (Fig 2).