Interview

A Career in Implantology

Steven A. Gold, DDS

Copyright 2001 Journal of the California Dental Association.

here are few dentists who don’t marvel at the ability to replace missing teeth with metal and porcelain. Yes, implant dentistry has arrived in California, rooted in decades of scientific research that has made such technology possible. The art and science that is implant dentistry was forged in the laboratories and clinics of Sweden, advanced and refined throughout Europe, and finally brought to the shores of North America. As the Journal posed the question, "Who were the leaders who helped integrate implant dentistry into everyday practice?" the name Mel Schwarz was among those that came up consistently. A look into his representative career and philosophy is a look into the positive role implants play in the lives of dentists and patients everywhere.

Dr. Schwarz is a periodontist in Torrance, Calif., who has limited his practice to the surgical placement of dental implants since the earliest days of osseointegration in the United States nearly 15 years ago. During this period, he has become part of a well-known international community of distinguished individuals devoted to dental implantology. At the time of this interview, Dr. Schwarz had just completed his term as president of the Academy of Osseointegration, regarded by many throughout the world as the foremost purveyor of scientific information on dental implants. Journal associate editor, Steven A. Gold, DDS, interviewed Dr. Schwarz for this issue.

Steve Gold: I have heard a colleague describe you as an "archetype for the successful, happy dentist." What advice would you share with a young dentist who seeks success and happiness in his career and personal life?

Mel Schwarz: (laughs) I’m not sure I have any of the answers, but there are two things I have learned in my career that I wish I could have learned years ago. First, I’ve learned that one of the biggest keys to happiness is giving to others. When we’re young and we want to build our reputations, and we want to acquire some material possessions, and we’re trying to build an empire, the focus can sometimes be about what’s in it for me. The time you really get happy in your personal and professional life is when you appreciate that you are making a contribution to others. In dentistry, this means that the dentist must stay focused on doing what’s in the best interest of the patient.

The second thing I’ve learned is that dentistry is a very lonely field. I would have been burned out a long time ago if I didn’t have the relationships I have with the dentists that I work with. What I’ve done in my career is develop real tight working relationships with other dentists. We work together. We share ideas together. That’s what’s made it exciting and interesting for me and kept me turned on to dentistry through the years. They challenge me. They tell me what’s wrong, and I try to find solutions for them.

SG: Give us a background of your professional training and how you made the transition from student to teacher.

MS: I was mentored by teachers who were world leaders in the field of occlusion and restorative dentistry. Great leaders like Dr. Rex Ingraham were instrumental in my dental school training as they were in guiding the profession to where it is today. While at USC, I was introduced to Dr. Nate Friedman who was a tremendous influence on my decision to pursue advanced training in periodontics. I was fortunate to receive this training at Boston University School of Graduate Dentistry because it gave me a different perspective on dentistry. Under the tutelage of individuals such as Dr. Jerry Kramer, I gained a greater appreciation for the biological foundation of dentistry. When I came back to Southern California to begin practicing, I began to look toward integrating the technical aspects of occlusion and restorative dentistry with the biologic principles I learned in Boston.

I believe that the specialist can be a leader and educator for his or her dental community. Throughout my 36 years of practice, I have constantly provided educational opportunities for the South Bay dental community so that we could explore new ideas and grow together. I know that there are other specialists that do this as well. I felt it was necessary to provide the dentists with whom I worked this type of orientation -- an approach to dentistry that integrated the restorative aspects with the biologic aspects. I arranged for my restorative dentists to go back east to the University of Pennsylvania to receive this type of training. Meanwhile, I became rather heavily involved in teaching in both the periodontics and occlusion departments at USC for awhile.

SG: How did implants fit into this philosophical approach you were developing?

MS: As a periodontist, my practice was primarily surgically based. Yet I understood the importance of the relationship between restorative dentistry and the periodontium. When implants arrived on the scene, it was only natural to apply this integrated approach to this technology as well. If implant dentistry were to be a successful treatment modality in everyday dentistry, it was clear to me that it must be a restorative-driven procedure. Thus an integrated restorative-surgical approach was mandatory.

SG: For a dentist who is perhaps inexperienced in restoring implants, what skills are necessary to provide successful implant restorations?

MS: Restoring implants today is, in many ways, easier than restoring teeth, if the implants are placed in the correct position. Problems arise, mostly, from implants that are not positioned correctly. When the position is correct, restoring the implant is really simple. You don’t have to do any tooth preparation. You don’t have to pack cord. Impression copings allow you to capture margins easily. The restorative process really becomes enjoyable.

SG: How did you help restorative dentists begin to master the skills necessary to provide successful implant dentistry?

MS: First of all, I am fortunate that I came to work with a group of dentists who were highly motivated and were interested and driven to achieve excellence. I mentioned before about their willingness to attend continuing education to constantly better themselves and I have always been impressed by their dedication. For the past 15 years, I have brought leaders in the field of implant dentistry to this area so we can learn together. I make it very convenient for the dentists I work with to obtain the continuing education they need to achieve excellence.

Dr. Braden Stauts, a prosthodontist, was instrumental in developing training courses with me in the early days of implant dentistry. We practiced together in this office and set up a training operatory where dentists could bring their own patients and receive certification and training as they provided treatment.

SG: What role did you and your team have in helping dentists communicate better with the surgeons placing implants?

MS: First of all, we developed the DentaScan, which was the first CT scan program designed to aid in the diagnosis and treatment planning of implants. This helps determine where the implants should go and in what direction they should go.

Second, we took the concept of a radiopaque stent and developed it into a real discipline that would facilitate better communication from the restorative dentist to the surgeon. With such a stent, the surgeon could more easily place the implants in the position most suitable for the restorative dentist.

SG: After an implant is placed, what do you as the surgeon do to facilitate the restorative portion of the procedure?

MS: I began to develop lists of all of the restorative components required for the different implant systems. Due to the number of different systems and components, there seemed to be a lot of confusion in dental offices when it came time to order and organize these restorative components. What we do now is place the abutment for the restoring dentist and send all of the necessary components with the patient back to the dentist. We want this to be a user-friendly process.

SG: What is the biggest obstacle to greater acceptance of implants as a viable option for replacing a missing tooth?

MS: It’s the fact that implants have not traditionally been taught in dental school to the level where young dentists feel comfortable restoring them. Fixed prosthodontics and endodontics are taught to that level, so for many dentists, those become treatments of choice, even when implants may provide a superior result and one with a greater long-term prognosis.

SG: Where can dentists receive the training they need to provide implant dentistry for their patients or to improve their current skill level?

MS: There are generally three sources I would recommend. One is courses provided by the implant manufacturers. A second is continuing or graduate level training at dental schools. Finally, there are a lot of independent courses and meetings that provide excellent training in implant dentistry. The group I have been involved in, the Academy of Osseointegration, has an annual meeting with intensive three-day programs with tracks in diagnosis and treatment planning, restorative technique, or surgical technique. AO is unique in that it is 100 percent focused on providing education for implant dentistry and it is completely multidisciplinary.

SG: How did the Academy of Osseointegration originate?

MS: Osseointegration was brought to North America in 1982 by George Zarb, a prosthodontist practicing in Toronto who is now professor and chair of the Department of Prosthodontics at the University of Toronto. He became aware of Brånemark’s work in Sweden. He put together a conference in which he invited representatives from all of the dental schools plus representatives from other professional organizations. Out of that meeting, a study club formed in the Northeast to exchange ideas and information about osseointegration; and that group grew into the Academy of Osseointegration in 1986. It now has members in 72 countries.

SG: What’s in the future for implant dentistry?

MS: I see two main areas of focus that will probably be developed further. The first is immediate loading of implants so that the waiting period between placement of the implant and placement of the restoration will be drastically reduced. The second is advances in bone grafting and regeneration, which will allow us to better place implants in the proper position for restoration.

Beyond that, I think that implants will someday be replaced by genetically engineered teeth. I don’t know how far away that will be, but there is some research being done in that area.