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Master Series in Advanced Implant Dentistry

I first started placing dental implants in the fall of 1989  just a few months after joining a private OMFS practice in Miami, Florida with one of my professors, Dr. Steven Holmes, a highly regarded orthognathic surgeon. Our practice primarily focused on performing maxillofacial surgery in a hospital environment including; orthognathic surgery, maxillofacial trauma, TMD/TMJ disorders and treatment of oral pathology with associated jaw reconstruction. As such our office oral surgery practice was very limited.

Although I had experienced some exposure to dental implants in dental school and I was aware of the quality of life improvements that implant dentistry could provide patients suffering from edentulism or failing dentition. During my oral surgery residency training I gained some practical experience placing a few implants. Nevertheless, as the medical insurance environment for hospital based oral surgery was rapidly changing, I became motivated to develop a presence for our office oral surgery practice. Consequently, I wanted to attend an implant course that would provide a solid knowledge base  in implant dentistry and provided “hands-on” experience and mentoring beyond the typical scientific and clinical lecture presentations. Eventually, I was fortunate to get a seat in a Branemark course  hosted in Boston. My instructor was Dr. Ulf Lekholm, an original member of the Branemark team. In that course, I learned about the instumentation, procedural steps, incisions and flap designs and guidelines for osteotomy preparation and implant placement. Although I gained confidence in my ability to place dental implants and I experienced a a high percentage of  osseointegration comparable to that achieved by the Branemark team in both the mandible and maxilla. Nevertheless, I learned very little about diagnosis and treatment planning and adjunctive soft and hard tissue procedures for implant dentistry.

As I began to place more and more implants, I received positive feedback from a local laboratory technician, Mr. Peter Kuch.  He visited my office and complimented me on how well I placed the implants in the cases that he was working on thereby simplifying the restorative- laboratory process. He asked me if I had studied prosthodontics in addition to surgery? I responded that I had not, but that I had focused my studies on important concepts of restorative dentistry and occlusion during dental school and my OMFS residency at the University of Miami.

“He responded by telling me that he was sure that I would have a very successful career in implant dentistry and that soon I would have one of the largest implant practices in Miami and possibly the country as a result of my application of restorative knowledge to guide implant placement.”

I continued to focus on our hospital based maxillofacial surgery practice. Despite Mr. Kuch’s high hopes,  I did not experience significant growth of my implant practice for the next five years. I concluded that my implant practice was not likely to grow because I was primarily a hospital based maxillofacial surgeon not so closely tied to the dental network other than working closely with orthodontists. In addition there were  established specialists in the area who had been placing implants years before I entered practice.

As a result, I decided to try and grow my implant practice by expanding the services that I could provide for my patients to include intra-oral bone grafting.  As an oral surgeon, it was natural that I sought out training in bone augmentation procedures for reconstruction of deficient alveolar ridges that would set the stage for successful dental implant rehabilitation.  I learned  the concepts and procedures for performing guided bone regeneration using barrier membranes, block bone grafts for lateral ridge augmentation and sinus lift bone grafting using a Caldwell Luc lateral window approach.

I achieved excellent results with dental implants placed simultaneous or delayed following sinus lift bone augmentations with very few complications. Nevertheless, our results with lateral ridge augmentations with autogenous particulate and block bone grafts were not favorable and resulted in an unacceptable number of early and late complications characterized by graft shrinkage and/or failure, implant exposure or accelerated loss of crest peri-implant bone.

“Furthermore, as a result of these poor outcomes,  I now had fewer implant referrals and patients and numerous implant complications to take care of.”

Then I had my first AHA moment !  It was a momentary insight that changed everything and re-directed my approach to reconstruction of deficient alveolar ridges for implant dentistry. I realized that all I had to do to be successful was extrapolate and apply the principles of soft and hard tissue maxillofacial reconstruction that I learned under my professor, Dr. Bob Marx, to implant site development. We performed jaw reconstructions with allogenic cribs filled with trabecular bone harvested from the  posterior hip with simultaneous rotation of a myocutaneous flap to provide optimal coverage  over the bone graft. Doing so supplied the necessary bulk of healthy vascularized  soft tissues to enhance the incorporation and maintenance of the bone grafts virtually eliminating bone graft exposures or failures.

Then I had my second AHA moment!  When analyzing  my implant complications at recall visits, I realized that the majority of these patients had thin gingival and mucosal tissues with insufficient vascularity failed to nourish underlying peri-implant  crestal bone or to aid with incorporation and volume maintenance of autgogenous bone graft during remodeling.  I think we can all agree that failures and complications provide the greatest learning opportunities! Fortunately  the majority of these patient’s complications were resolved by staged soft tissue grafting to re-submerge the implants followed by additional bone grafting performed 3-4 months later. After abutment connection I learned that the soft tissue grafts should have been performed prior to or simultaneous with the bone graft and implant placement. Using this biologic approach to surgery we were able to successfully treat the complications and the patients wound up with stable, healthy and maintainable implant restorations.

Then I had the third AHA moment!  Upon reflecting on the above experience, it occurred to me that the sequence of my implant educational experiences was not conducive to achieving my primary goal of successfully providing bone augmentation procedures for patients presenting with deficient alveolar ridges. I first attended numerous bone grafting courses followed by a soft tissue grafting course when the soft tissue training should have preceded the bone graft augmentation courses. This played a  big role in the number of unnecessary complications that my implant patients had experienced. Despite having prior knowledge of the important biologic role that soft tissues play in ensuring optimal  bone graft healing in maxillofacial jaw reconstructions, I initially failed to apply this important principle when treating my early dental implant patients. Although, these principles were never discussed in any of the numerous dental implant and bone grafting courses that I attended, I failed to apply my maxilofacial reconstructive knowledge base in the treatment of these early implant cases.

Once again, the importance of developing adequate  soft tissue volume to enhance underlying bone graft healing or to maintain  peri-implant crestal bone is one of the most important concepts for achieving long term success of implant restorations!

As such, I sought out periodontal plastic surgery training and revisited and revised my bone augmentation procedures to be based on the biology of alveolar bone regeneration and bone graft healing. This always included development of an ideal soft tissue envelope to nurture and maintain bone graft volume under function. Since then, I learned to properly sequence soft tissue augmentation prior to or simultaneous with alveolar ridge bone augmentation procedures thus achieving tremendous success for our patients. Despite treating a high number of  complex bone augmentation and esthetic  implant cases we reduced our complication rate to less than 2 %,

As a result of learning from our early implant case complications, I experienced  exponential growth of my implant practice beyond what I could imagine. I gained recognition as the expert implant surgeon in my region and developed one of the most successful implant practices in the US and abroad.

Then I had a Fourth AHA moment! Upon reflecting about what I had learned from our early failures and how important it was to think about biologic principles when treatment planning for implant dentistry, I realized that I must share my knowledge and skills with my colleagues to empower them to learn and apply much of what I have learned along my personal implant educational  journey.

This inspired me to develop the Sclar Center Master Series in Advanced Implant Dentistry  that provides a series of unmatched educational experiences for the doctors who have intermediate to advanced knowledge and experience with dental implant surgery but are looking to master the knowledge and skills required to successfully implement advanced soft and hard tissue grafting procedures for implant site development.  This series should lead my colleagues to further leverage the knowledge and surgical skills they gained to successfully treat some of the most challenging implant cases including esthetic implant  therapy and full arch immediate function implant.

At Sclar Center; Your Success is Our Inspiration!

The Key to Building the Implant Practice of Your Dreams Lies Below:

Sclar Center Master Series Immersion™ Courses in Advanced Implant Dentistry

Immerse yourself and enjoy our unique interdisciplinary education with ground breaking teaching methodologies that support a highly interactive, effective, and confidence boosting learning environment uniquely recognized as a Sclar Center Immersion™ Course Experience

Sclar Center limited attendance immersion course are designed for 16 clinicians who desire to achieve mastery of: The clinical and scientific knowledge, diagnosis, treatment planning, patient consultation/case presentation methods and surgical skills required to successfully implement Advanced Implant Dentistry procedures in your practice. Each course features;

1. Interdisciplinary scientific & clinical presentations bolstered by extensive edited procedure videos

2. Case treatment planning sessions to help you select the best treatment approach in every case

3. Intensive hands-on training to improve your surgical skills in our state-of-the-art simulation lab with one to one mentoring by Dr. Sclar and his team

4. Interactive live procedure observations captured by quad robotic HD video cameras and broadcast to our ultra-comfortable multimedia classroom where participants enjoy procedural details and nuances from multiple viewing angles emulating the operating surgeon’s point of view.

5. In addition to attending the general sessions, team member who attend the course receive additional training on the course topics thereby facilitating immediate procedure implementation in your practice

Sclar Center Master Series Immersion™ Courses in Advanced Implant Dentistry

1.   4 Day Soft Tissue Immersion: Periodontal and Peri-implant  Plastic Surgery

2.  4 Day Advanced Bone Grafting  & Tissue Engineering  Immersion

3.  4 Day Esthetic Implant Therapy Immersion:

Surgical,Restorative & orthodontic  Implant Site development Protocols

4.  3 Day All-on-4® Immediate Function Immersion:

Surgical, Restorative & Laboratory Treatment Protocols

 

 

 

 

 

 

 

 

 

 

 

 

 

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