IM0210

Sincerely Dr Rolf Vollmer editorial _ implants I implants2_2010 Dr Rolf Vollmer _I am seeing more and more misadventures dealing with complex implant cases. In particular, in the lastseveralmonthsIhaveseennumerousloadingproblemsdealingwithfullarchrestorations.Byandlarge, thevastmajorityoftheseissuesrelatetoafailureintheinitialdiagnosis. Weknowfromourexperiencein continuing education courses that diagnosis and decision-making are always the most difficult things to teach and convey. Implant dentistry is now an integral part of many dental practices, however most den- tists receive their education in implant dentistry after graduation, with little emphasis on the identifica- tion of the complexity and risks of treatment. IrecentlybecameinterestedinaconceptcalledtheSACclassification.SACstandsforStraightforward, Advanced, and Complex. The SAC classification was first described by Sailer and Pajarola in 1999 as a method to categorize degrees of difficulty in oral surgery. In 2003 SAC underwent extensive review and was adapted for implant dentistry; it was also the topic of the ITI Consensus Conference in 2007 to stan- dardize their application. The basis of the SAC classification is that clinical situations in implant dentistry present with varying degrees of complexity. The SAC classification has applications in esthetical, restorative and surgical situa- tionsbutcanalsobehelpfulinallformsofimplantdentistry.Knowinginadvancehowcomplexanimplant case is can ensure there are no surprises in the course of treatment, or if necessary, can allow you to refer the case to someone who is better able to perform the risky portion and return the case to you for the easy treatment. Usage of the SAC classification can assist practitioners in avoiding difficulties in implant and prosthetic cases as well. Itis,therefore,vitallyimportantthatweaspractitionersarewillingtoacknowledgethatsomecasesare more complex or difficult than others, and that we may need experts to deal with such cases. Finding an appropriately qualified colleague to manage a particularly complex case can prevent the case developing catastrophic complications and can avert a poor outcome. Complexcasessimplycannotbetreatedwithastraightforwardapproachof“opentheflapandseewhat wecando”.Forthesetypesofcasesmoreofa “reverseplanning”approachisrecommended—i.e.determine the plan of treatment by starting at the end-point. Generally, working forward from today incorporates neitherresourceimplicationsnorintegrationneeds.Wearementallysoaccustomedtothetraditionalform ofthinkingthatweoverlookimportantitemsandneeds,andmakesubconsciousassumptionsthatarenot necessarily valid. Instead, periodic “reality checks” of the content of our plan of action and its implemen- tation should occur. Regardless of how well planned cases are, ‘things’ never work out quite as envisaged —alltoooftenreal-timedevelopmentsleadtodetours.Tominimisesuchoccurrences,modernimplantol- ogy diagnostic tools like DVT and computer assisted planning are very helpful in complex cases. Establish the goal, begin at the end and work backward! If done correctly, we will have an ever-evolv- ing, reality-based, integrated plan that will actually work to achieve our patients aims. Currently we, as an expert scientific implant association, are happy to offer our colleagues the possi- bility of undertaking company-independent implant training courses including masters programs at uni- versities. Many dentists involved in the surgical or restorative aspects of implant care obtain continuing education in implant dentistry and belong to professional implant organizations like the German Associ- ation of Dental Implantology (DGZI). Our continuing education programs (e.g. our basic curriculum and our Annual Meetings) are some of the best I have ever attended, nationally or internationally. I hope to see many of you later this year in Berlin from the 1st to 2nd of October to celebrate our fortieth anniversary with an outstanding scientific and social program. Straight forward or backward planning?