The success of treatment depends upon several factors and if we wish to understand this we need to look at some of these factors.

1. The Host:
In the work that we do we are totally dependent upon the healing of the host, that is the patient. Normal healthy people will heal uneventfully. There are several conditions which will delay or compromise healing, typically smoking is known to interfere with normal healing and to reduce long term success. It will also depend on whether a simple procedure is carried out or whether the treatment required more complex procedures.

2. Initial Healing:
In order to make the treatment as predictable as possible we design what we do based on those healing processes that take place naturally, such as extractions and healing of fractures.

3. Sterility:
We also need to ensure that the treatment is carried out under sterile conditions, this is to reduce the chance of an infection taking place. It is for this reason we work in an environment that is like a hospital theatre.

4. Ongoing success:
If an implant heals and is incorporated into the body there is little to go wrong as long as all the factors remain the same. Some of the factors we need to look at that will affect ongoing success are listed below.

5. Wear and tear:
Implants and crowns are mechanical devices and are subject to wear and tear as we eat and chew. Porcelain can wear or chip despite it being the strongest aesthetic material that we know. Accidents can occur and component parts can break particularly if the forces exerted are too great.

6. Ongoing care:
Although implants provide the same function as teeth there are one or two differences that should be noted. These are that implants do not get decay. They are attached directly to the bone which is different from teeth which are connected by a ligament. Good oral hygiene is nevertheless essential, this is to prevent any infection or peri-implantitus which is like gum disease that takes place around teeth. This would result in bone loss which would need remedial treatment. It is therefore important to ensure that the implants are monitored regularly. It is also possible that recession will take place around an implant as it does around natural teeth. In which case it may become necessary to change the crown. The recession that takes place does not necessarily affect the health of the implant but more the appearance.

7. Success rate:
In a paper that we published three years ago we reported on the survival of implants that were placed in our practice and which have been carefully monitored over fifteen years. In looking at over three thousand implants we noticed that only 2% had failed, some early which had been replaced and others later. This provides us with a survival rate of implants over this period of time of 98%.

This information related to all the patients that had been treated. This included patients with potential health problems and those where there was not sufficient bone to start off with.

Professional statement:
“It is a sad reflection on medical science that the outcome of a disease does not often depend upon the nature of the disease, but where the treatment is undertaken.” Education in the medical sciences must therefore focus on achieving a consensus which enabled us to predictably treat our patients.

We need to identify those procedures that are likely to produce the desired outcome, understand and learn the technique that the success outcome will depend upon and develop the skills to be able to carry it out for the benefit of our patients.

We need to be able to exercise our judgement in applying these procedures and to be able to predict the best response for the specific patient that we are dealing with.

“For what good science tries to eliminate good art tries to provoke mystery – which is lethal to one and vital to the other.” John Fowles.