Interview: “The most challenging part has been getting people to believe that it is even possible”
Motivated by his desire to simplify the treatment process for patients, Dr Philip Tan has developed a full-arch implant-retained prosthesis for completely or partially edentulous patients which can be placed in a single session. The specialist in prosthodontics provides clinical care in two practices in Melbourne in Australia and lectures globally on implantology and digital dentistry. He talked to Dental Tribune International about his reasons for developing the AuDentes implant-retained prosthesis, its advantages and limitations, as well as his hopes for the future of the procedure.
Dr Tan, what does the name “AuDentes” mean?
Audentes is a Latin word and means “confident”. We chose this name because patients repeatedly mentioned how much the change had improved their confidence. To be able to smile and talk to people again made them much happier. The other reason for the name is that, when you take the word and split it, you get “Au”, which usually stands for Australia, and “dentes”, which is the Latin word for “teeth”.
What has been your motivation in developing this implant-retained prosthesis?
The initial concept and the product were born out of the desire to make the patient experience as easy and simple as possible. In past years, immediately loaded prostheses used to take six, nine or ten months. It has become faster, for example with All-on-4, but patients still need to return for treatments. This was rather frustrating for the patients; they asked why it couldn’t be done immediately. With AuDentes, the patient receives his or her permanent prosthesis at the end of the surgery, meaning that, after approximately 2 hours, the procedure is finished. This makes it simpler for the patient and reduces the cost, because by compressing the process, we remove some of the costs for dentures and additional surgery time.
Hence, the greatest advantage is the reduced treatment time?
From the patient’s perspective, yes. We collect the information, and when the time comes, we perform the surgery, place the prosthesis, and that’s it. The patient has to come back for check-ups, but essentially, he or she receives the prosthesis in one go.
“During the surgery, we extract the teeth, recontour the bone, place the implants using guided surgery and then screw the prosthesis in.”
Could you explain the exact surgical procedure?
The first step is to make sure that we understand what the patient wants and needs. Therefore, we do a diagnostic wax-up—except it is not a real wax-up; it is all virtual. We take an intra-oral scan, photos and videos, and we do a virtual set-up so that we can establish what the patient wants. The second step is to get a CT scan and merge all the information of where the teeth are now and where the teeth should be. After that, we can plan the implants and the prosthesis. The third stage is the treatment, for which the patient usually receives some sedation or general anaesthetic. During the surgery, we extract the teeth, recontour the bone, place the implants using guided surgery and then screw the prosthesis in. This is all done in one visit. Two or three days later, we check the situation and then check again after two or three months and torque the implants.
It almost sounds too good to be true. What is the trick behind the shortened treatment time?
The key is to change or optimise the guided surgery. All current systems for guided surgery, no matter which implant company the system comes from, still leave room for tolerance—meaning they are not completely controlled. I took different systems, including those for planning, manufacturing and actual surgery, considered all the separate parts and then optimised them. I made small changes to move some of these tolerances and sort of incrementally improved them in order to get the right result. It took several years to do.
I take it that the product is only available in your dental practice so far? Are you planning on partnering with companies?
Correct; so far, it is only available in my surgery, but hopefully, it will be offered globally. I have been in negotiations with different companies and individuals. I think the most challenging part has been getting people to believe that it is even possible, because so many people say this cannot be done, even though they have tried to.
“We have had 22 patients who received about 150–160 implants in total, and of all of those, we’ve had only one implant that didn’t integrate.”
How long have you been treating patients with the AuDentes implant-retained prosthesis, and how many patients have received it so far?
We have been doing this since May 2018. I don’t do this for all of my patients, so the numbers aren’t huge. We have had 22 patients who received about 150–160 implants in total, and of all of those, we’ve had only one implant that didn’t integrate. However, all the prostheses work fine. Since this is a fairly new procedure, we tend to be a bit more conservative when planning the surgery and we insert one extra implant. Therefore, if one implant doesn’t work, it doesn’t matter; the prosthesis still functions just fine.
How many implants are needed for the prosthesis?
It depends on the patient and how many teeth he or she wants. Some patients may only need ten teeth, and then we’ll place only four implants. Some patients, however, want all 14 teeth in their lower or upper jaw, so we then place six implants. It is quite flexible, since it is not restricted to a particular number of implants. We do it for either the upper jaw or lower jaw or both.
We’ve heard about the advantages of the product. Are there also any limitations to it?
The biggest limitation, to my mind, is if the patient is not healthy or is not going to look after the prosthesis. In that case, we ought to leave it until the patient changes his or her mindset and is ready to commit. In fact, this would apply to any sort of prosthesis.
In the case of higher-risk patients, such as smokers or people with osteoporosis, it can be beneficial to do one step at a time, because if one step doesn’t work, you haven’t made everything else. You can just go back and redo the one step. It is a big commitment, and if your patient is high risk for any of the steps, it is better not to do it.
And I would say that the last limitation is that patients cannot physically see and feel the new teeth in their mouth before everything is finished, because all is done at once.
How old were the patients who received the AuDentes prosthesis?
All of my patients were adults; the youngest patient was 42 and the oldest patient was 81. Besides my practices, I work at the Royal Children’s Hospital Melbourne, and we have been talking there about possibly doing this for children who are born without teeth. However, this is very challenging because they are still growing and changing, so I am not sure it is a great idea. Since the prosthesis is fixed in place, it might change or restrict how the jaw grows.
“I hope that this can be offered to more patients so that we can help more people.”
Is there anything else that you would like to add?
The only thing, really, is that I hope that this can be offered to more patients so that we can help more people, because at the moment, it is still restricted to me. It is not for every single patient, but I think that there are a significant number of people who could benefit from it.