Surgical considerations in implant dentistry

Standardized prospective clinical trials are uncommon in implant dentistry. Aside from the Branemark and staple trials; both restricted to edentulous jaws, and two blade trials in their early and as yet inconclusive stages, most implant studies are retrospective. As such, they lack uniformity in patient selection, methodology, evaluation, and definitions of success and do not yield the information needed for critical clinical decisions. There are data to compare treatments for edentulous jaws, but virtually none for the partially edentulous patient. Decisions, out of necessity, involve retrospection and interpolation. In the absence of a definitive data base, added attention must be paid to patient safety and informed consent. Patient selection, implant selection, site selection, and surgical and prosthetic management--all of which influence implant efficacy and safety--are highlighted. It is the opinion of this author, based upon the benefit/risk information reviewed, that osseointegrated root forms are the implants of choice when adequate bone is available, and that blade implants and subperiosteal implants are indicated when bone space is restricted. Prospective clinical trials must be given the highest priority in planning for implant research.