August 4, 2016
University of Illinois at Chicago (UIC) College of Dentistry Dean Dr. Clark Stanford, UIC Distinguished Professor, led a task force of 120 global clinicians and scientists (including many at UIC) in the establishment of the first set of evidence-based Clinical Practice Guidelines (CPGs) for the dental community on how to manage patients with no teeth in the upper jaw.
Dr. Stanford provides information about the just-released report with two lead articles published in Volume 31, Supplement 2016, of the International Journal of Oral and Maxillofacial Implants (IJOMI), resulting from his work as Chair of a summit to develop new clinical practice guidelines for the edentulous maxilla.
The articles are “Academy of Osseointegration’s Summit on Clinical Practice Guidelines for the Edentulous Maxilla: Overview, Process, and Outcomes—Changing the Face of Implant Dentistry,” and an editorial, “Current Best Evidence for Management of the Edentulous Maxilla.”
With the publication of the guidelines, “The next step is to gain approval by the National Guidelines Clearing House, which provides a formal policy-based stamp of approval to help drive adoption across the profession,” Dr. Stanford said.
In 2012, the Academy of Osseointegration (AO) initiated planning for a summit to develop clinical practice guidelines (CPGs) for management of the edentulous maxilla. Dr. Stanford was asked by the AO Board of Directors to work with Dr. Ole Jensen, an oral and maxillofacial surgeon in Denver, CO, in the planning committee and to create a work plan based on five domain areas to be addressed by the summit.
The five areas were the roles of: (1) grafting for ridge development for implant placement, (2) implant design and systems in management of the edentulous maxilla, (3) imaging to guide implant placement, (4) biologics to assist in ridge development, and (5) prosthetic management.
In order to “assist dentists in making choices that best utilize current research to improve the quality and efficiency of patient care, the AO in August 2014 brought together more than 120 of the world’s leading scientists and clinicians,” Dr. Stanford explained.
Their mutual goal was to expand current clinical practice guidelines to include management of the edentulous maxilla.
As new technologies make implant therapy possible for a growing number of patients, the responsibilities for clinicians also multiply.
“However, new materials and techniques are developed faster than can be objectively evaluated,” Dr. Stanford said. “The decision-making process for clinical management of the edentulous maxilla requires familiarity with current best evidence on far-reaching topics.”
These include bone augmentation for implant site development, implant designs and the way oral implants are used in various anatomic sites leading to important system designs, the role of advanced imaging procedures, biologics, and an interdisciplinary approach to prosthetic management. All play key roles in patient-oriented outcomes of care.
“Today, there are many novel ways to manage distinct clinical situations and an array of treatment options requiring advanced training and experience,” Dr. Stanford said.
Based on a systematic review of the current literature, clinical information, and accepted treatment approaches, the summit created guidelines to serve as an educational tool for dentists and to facilitate their ability to communicate about treatment planning with patients.
“We wanted to develop new CPGs for people who have no teeth in the upper jaw—who can be up to 20% of the population over age 65,” Dr. Stanford said. “Under the World Health Organization definition of ‘health,’ the lack of teeth is considered a disability (although there is no active disease). If dentistry has a range of treatments but there is insufficient data to diagnose and understand the outcomes of a range of interventions, this leads to opinion-based, not evidence-based treatment.”
Experts looked at such areas as grafting, design of implants, guiding via imaging, biologics growth factors, and types of dentures.
The summit came up with CPGs on how to use evidence to best diagnose the condition and apply treatment.
“There is no doubt that technology will continue its rapid pace in providing dentistry with enhanced diagnostic tools, improved materials, and better prosthetic options for managing the edentulous maxilla,” Dr. Stanford said. “Up-to-date guidelines, as proposed by the worldwide leaders in the field, will enable all dentists to make judicious use of current best evidence and ongoing advances for their patients.”
Dr. Stanford added, “Patients benefit by getting a better treatment therapy and better safety. The College of Dentistry is leading the way in applying these practices.”
To see the IJOMI articles, log on to www.quintpub.com/journals/omi/journal_contents.php?journal_name=OMI¤t=1#.V2K99_krK72.
To see this article in the Word of Mouth publication, log on to uic.1kcloud.com/edlv_nhTfs/.
Photo: Dr. Clark Stanford, at right.