Stefan Ihde - Principles of BOI: Clinical, Scientific, and Practical Guidelines to 4-D Dental Implantology

Zahnrztliche Klinik, Dorfplatz 11, CH-8737 Gommiswald

When too many people agree on the same subject, it is high time to call it into question. Few other areas of medicine are better characterized by this statement than dental implantology. Why? Because both academic researchers and practitioners focus their efforts solely on crestal implants. In other words, they completely ignore any designs or concepts other than screws and cylinders, which guide the masticatory forces, into bone areas that mainly consist of cancellous tissue. If the available vertical bone supply is insufficient, measures are taken to rebuild the morphology of the bone tissue whether by transplantation, by augmentation or by induced growth. Unless aesthetic considerations play a major role, these modifications of the bone situation are performed solely to facilitate the use of crestal implants, which would be impossible to insert otherwise. In many cases, these adjuvant measures are considerably more time-consuming and more expensive than the patient can afford. Meanwhile, no implant treatment is performed whatsoever , and the patient is left without an adequate fixed restoration. At the same time, the focus of dental implant treatment tends to shift away from the dental offices as these adjuvant measures gain respectability, towards the specialists capable of performing them. Due to the additional cost of these adjuvant measures, many patients are unable to afford adequate implant treatment. The consequence is that their masticatory function cannot be restored in a truly comprehensive manner.

The implant technique of basal osseointegration (BOI) has been developed with a view to addressing the situations outlined above, among other problems. In this book we are going to explain why lateral access to the jaw bone should be the standard technique in dental implantology. Conventional implant designs can occasionally be used as additional treatment options.

Some dental experts, sharing neither the vision nor the experience of BOI users, have in the past raised vocal opposition to this system. It is not uncommon for traditionalists, who once rose to fame by using specific methods, to eagerly oppose the obsolescence of their knowledge by obstructing progress actively. In their capacity as court-appointed experts, they can literally boycott new treatments for a long time.

Due to an almost religious belief in scientific medicine it has been argued that this belief is a substitute for religion itself (Ltz 2002) patients are often unable to inform themselves in a realistic manner about novel treatment modalities. Nevertheless, BOI implants have become increasingly popular in recent years. As a result of the high degree of patient satisfaction, the patients ultimately vote with their feet.

No doubt, treatment with BOI implants can only be performed and its outcome evaluated in a competent manner by users who have been thoroughly trained in the technique and are up to date on the current experience. Anyone rejecting the technique out of hand will of course never be able to acquire and master it. We shall therefore present the BOI technology in this book, demonstrate its practicability, and document its successful outcome based on specific case reports.

Dentists who perform BOI treatments are still required to have additional solid training. What we are currently observing is that more and more universities are becoming active in this field, having first acquired the technique themselves. Since the universities raison dtre is the propagation of knowledge, this development of course deserves praise. By contrast with most current teachings in the realm of crestal implantology, the propagation of knowledge about the real-life properties of bone and its behaviour play a prominent role in BOI. Of equally great importance are prosthodontic concepts and the teaching of how to restore the human masticatory function. Many universities were too late getting on the BOI train. One might well ask how this could have happened several factors come to mind:

During my BOI-related travelling activities, I have found that fellow dentists in the ex-Communist countries are much more familiar with the basics of bone physiology and mastication therapy than dentists in the former Western countries. However, interdisciplinary training seems to be scarce at some institutions.

According to Scortecci (2001), 99% of patients not eligible for treatment with screw implants can be treated by BOI without bone transplantation. This high success rate is in accordance with our own experience.

At present, insurance companies are beginning to find out that BOI treatment is by far more safe, faster and cheaper than conventional bone augmentation followed by crestal implantation. On the other hand, the appearance of BOI on the stage means that more patients will undergo treatment more readily: a great number of patients who have toyed with the idea of implant treatment before but shied away from bone transplantation or prolonged chair times are beginning to see a realistic chance of obtaining fixed restorations on implants within an acceptable timeframe.

It is necessary and fair to mention that disk implantology and the BOI technique, like all dental implant techniques, went through an early phase of treatment failures with implants and prosthetic superstructures being lost. The same learning curve had to be mastered in the development of all other implant techniques or, for that matter, any other medical treatment. Many problems in connection with basal osseointegration arose from the fact that a number of views on procedures, believes and treatment approaches were adopted from untested crestal implantology. They were adopted without knowing the reasons why the original technique had actually worked, or not worked, in specific cases. In our view, some of the rules that evolved from the literature on crestal implantology are definitely wrong. Some of them cannot be generalized but are based solely on empirical observations that may possibly apply to crestal implants. Anyway most of them had to be revised in the past decade.