AO expands Clinical Practice Guidelines to cover management of the edentulous maxilla
By Clark M. Stanford, DDS, PhD
The edentulous maxilla often presents with a range of challenges and solutions that can be difficult for individual clinicians to navigate. To help them make choices that best utilize current research – and improve the quality and efficiency of patient care – AO has expanded its current Clinical Practice Guidelines (CPG) to include management of patients with no teeth in the upper jaw.
Advanced technology has provided dentistry with enhanced diagnostic tools, improved materials, and better prosthetic options for managing the edentulous maxilla, making a growing number of patients eligible for implant therapy as opposed to a traditional denture. Responsibilities for clinicians treating the edentulous maxilla with oral implants have also multiplied, which is why AO sought to define the issues, develop a process and create a model that can be applied to practice.
To arrive at these Guidelines, AO brought together more than 120 of the world’ s leading scientists and clinicians in an August 2014 Consensus Summit, including representatives from the American Association of Oral and Maxillofacial Surgeons (AAOMS), the American Academy of Periodontology (AAP), and the American College of Prosthodontists (ACP). Co-chairs were Drs. Clark M. Stanford, Chicago, IL, and Ole T. Jensen, Greenwood Village, CO. Based on a systematic review of the current literature, clinical information, and accepted treatment approaches, the resulting guidelines will serve as an educational tool for dentists and facilitate their ability to communicate treatment planning with patients.
Results of this Summit, including supporting systematic reviews and detailed CPGs, are now available in a special edition of the International Journal of Oral and Maxillofacial Implants (IJOMI), Volume 31, Supplement 2016. This 200-page publication was included with the last issue of IJOMI as a membership benefit to all AO members. AO members can access this supplement by signing into the member section of the Academy’ s website, osseo.org
The next step in this process 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. The Guidelines cover five domain areas defined as: (1) role of grafting for ridge development for implant placement; (2) role of implant design and systems in management of the edentulous maxilla; (3) role of imaging to guide implant placement; (4) role of biologics to assist in ridge development; (5) role of prosthetic management.
These domains address key questions clinicians should consider for each specific patient, including: What is the maxillary/mandibular ridge relationship? What is the quality and quantity of available hard and soft tissue? Can the patient maintain adequate oral hygiene? Do habits or disease put this patient in an at-risk category?
As new technologies make implant therapy possible for a growing number of patients, the responsibilities for clinicians also multiply. The profession is ultimately charged with providing the best available patient care. However, new materials and techniques are often developed faster than can be objectively evaluated. The resulting lack of consensus can burden individual clinicians, who still remain responsible for providing treatment based on current best evidence. That is why a Consensus Summit is so important.
The decision-making process for clinical management of the edentulous maxilla requires familiarity with current best evidence on far-reaching topics including bone augmentation for implant site development, implant system design, advanced imaging procedures, biologics, and an interdisciplinary approach to prosthetic management.
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. Subsequently, 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.