This is a publication that aims to expand a dental clinician’s view beyond simply a further contribution to the knowledge and understanding on the replacement of teeth using implant dentistry. A comprehensive text, it provides a significant contribution in detail and topic coverage extending well beyond what the title would lead the reader to expect.
Professor Stajcic has collected a vast and detailed volume of clinical and scientific material in text, complimented with an equally vast collection of clinical images and illustrations. This is further enhanced by electronic links to a range of video recordings of actual clinical procedures, to present an atlas reflecting his extensive surgical expertise. This level of expertise has been acquired after formal training and several decades of clinical patient management. This offers the reader a unique combination of information on both implant dentistry (ID) and tooth preserving surgery (TPS).
The author’s philosophical approach to patient care reflects his stated belief that knowledge gained through appropriate formal training and the development of expertise through experience with careful and critically evaluated documentation and review of outcomes, is required to reach the most appropriate treatment plan. Next is to have the skill to execute the required clinical (surgical) procedures in a manner to create the desired outcome whilst limiting morbidity and unwanted post-operative sequelae. This is eloquently stated in the first chapter, in the discussion of complications related to the surgeon: “Performing new procedures on humans without previous experience or knowledge can be regarded as an ‘experimental’, unethical action, which can be very costly because if anything goes wrong there are no legal or professional means to defend oneself.”
For the less experienced surgically trained reader, or general dentist with some knowledge and understanding of dental surgical procedures, the entire second chapter extensively discusses surgical procedures related to both ID and TPS. This extends to a comprehensive discussion of the ‘Common Obstacles’ that may be encountered. It is this extension of the text, enhanced by the clinical images, that brings the extent of the experience and acquired expertise of the Author to the reader. This truly defines the value of the contribution of this work to the provision of dental care in this field.
The complications and failures related to implant dentistry are well categorized, (Biological, Mechanical, Prosthetic and Non-Implant Related) and discussed. Not only does Professor Stajcic provide sufficient information for the pre-operative elevation of the patient to assist in the avoidance of a complication, but in addition often provides detail and systematic operative steps to manage the complication. It is well recognised in the literature that often a surgically derived complication can precipitate a considerably less than ideal ultimate restorative outcome. As I am a Prosthodontist with some knowledge and understanding, but devoid of expertise of the surgical elements, the information is born of wisdom and insight that only an experienced surgeon can offer.
Of equal merit is the comprehensive discussion around the re-visitation of TPS. Such an analysis of multiple clinical presentations are often reserved for publications limited to this topic alone. There are detailed technical descriptions of surgical technique, clearly from an extremely experienced surgeon who has developed expertise from years of careful and critical evaluation of the documented outcomes of his own procedures and techniques.
A concise yet practical summary of the decision between TPS and extraction and ID is found within the statement: “If the natural tooth has a favourable prognosis for more than 10 years, it should be included in the treatment plan. A less than 5-year prognosis despite restorative or periodontal therapy justifies extraction of the tooth and implant placement”.
Emphasis on the SAC Classification – stressing the importance of a recognition of the required level of competence and the clear educational directive to utilize the assistance of colleagues where the clinical or procedural challenge is likely to exceed the primary operator’s competence, is found throughout the text. I support the Author’s assertion that many professional colleagues, even with considerable experience, would be well advised to heed this advice.
And in the most outstanding summary of a text I have had read, encompassing both the Author’s ethical and professional positions on knowledge, communication and professionalism in appropriate patient management, Professor Stajcic challenges the reader: “The best management of a complication is to avoid it. You cannot avoid something you do not know it exists. What would get you into difficulty is that what you don’t know.”
I commend this practical Atlas – a record of a significant body of clinical work, carefully documented, analytically evaluated and scientifically supported.
Dr Anthony J Dickinson OAM
BDSc MSD FRACDS