Implant prosthodontics: current perspective and future directions.

I the 35 years since the concept of osseointegration was first applied to human patients, there have been many advances in the understanding and application of implant dentistry as a method for the replacement of missing teeth. Osseointegration as first defined by Brånemark is a scientific milestone that delineates a certain sense of separation of the old from the new in implant dentistry. Osseointegration was a watershed event that has forever changed the way dentists view their options when confronted with a patient requiring tooth replacement. While dental implant therapy was an option for tooth replacement for many years prior to the publication of Brånemark’s work, he gave the field a scientific basis and a sense of respectability it had lacked previously. This was particularly true in academic institutions, where dental implants were largely ignored as a viable choice for tooth replacement. Dental implants are now a major focus of didactic and clinical education in 3 dental specialties and soon will likely become mainstream in undergraduate dental school clinics. Osseointegration is the single factor that has most dramatically changed the discipline and specialty of prosthodontics since the introduction of fluoridated water. The evolution and change seen in basic science and the surgical understanding of dental implant therapy have perhaps been more far reaching than parallel advances in knowledge of the restorative aspect of dental implants. As the 20th century draws to a close, it is appropriate to review the significant advances and changes in implant prosthodontics that have occurred over the past 2 decades and, more importantly, describe future directions of investigation that are paramount to the advancement of dental implant therapy as a beneficial treatment modality.