By: Dental1 StaffDr. Steven Present was born and raised in Brooklyn, N.Y. He is a graduate of the University of Wisconsin and Temple University School of Dentistry. He did postgraduate studies in microbiology and immunology at Thomas Jefferson Medical College and completed a program for the treatment of oral facial pain and temporomandibular disorders at The New Jersey College of Medicine and Dentistry. He has been restoring dental implants since 1988 and lectures on advanced and complex implant reconstruction.
Dr. Present has been a lecturer and clinical instructor at Manor College’s Expanded Function Duties Dental Assistant Program since 1988. In addition he is The National Dental Advisor for Health Advocate Inc., a health advocacy and assistance company. He is also a dental consultant for Intercorp Inc., providing independent medical evaluations for the insurance industry (primarily trauma related).
Dr. Present is a member of The American Dental Association, The Pennsylvania Dental Society and the Montgomery Bucks Dental Society. He is also a member of The International Team for Implantology and the ITI faculty, The Suburban Implant Study Club, The Academy of Osseointegration and its Subcommittee for Clinical Innovation. The recipient of numerous awards, Dr. Present received the Alpha Omega Award for the senior student with the highest grade point average over his four years at Temple University’s Dental School and was elected into Omicron Kappa Upsilon Dental Honor Society. He has been in partnership with Drs. Hal Hershman and Ronald Klein for the past 27 years, with an emphasis on implant reconstructive dentistry and temporomandibular disorders.
Dental1: Can you explain how your practice completes a full implant procedure?
Dr. Present: The initial consultation with the patient is primarily educational. We explain to the patient the benefits of dental implants, if they are a candidate, and what preliminary procedures would be required (study models, iCAT, consultation with the implant surgeon, etc.). Since I have photographs of every implant case I have completed from the past few years, I can actually show the patient cases that correspond to their particular restorative needs. Although we have additional educational material such as videos and brochures, nothing communicates better and instills patient confidence than showing cases you have actually completed. I highly recommend dentists purchase a high quality digital intra-oral camera and start documenting their implant cases. The last item discussed are the fees. If it is a relatively simple case, I will give the patient the fee at this time. If it is an advanced or complex case I tell the patient the fee will be determined after I discuss the final treatment plan with the implant surgeon. Impressions for study models are usually taken at this initial appointment and the referral is made to the implant surgeon. An initial treatment plan with sequencing is formulated, and a report is sent to the implant surgeon. Following a team approach, the final treatment plan is formulated after consultation with the surgeon and any other dental specialists as required (orthodontist, endodontist, periodontist, etc.). The patient is then reappointed; the final treatment plan and fees are discussed along with payment options. If the patient agrees to proceed, surgical guide stents along with any necessary provisional restorations are fabricated.
It is important for each member of the team to know each other’s treatment philosophy, ability, and limitations as well as having a systematic way of immediate communication. Treatment planning is the most important aspect of implant dentistry. If a case is treatment planned with attention to detail and a concept of the desired final result, treatment will progress in a seamless fashion.
Dental1: Regarding tooth replacement, how importance is appearance to your patients?
Dr. Present: Regarding the importance of appearance, it varies with the individual. With some people it is extremely important and to others it doesn’t matter. Personally, I am more demanding than any of my patients.
Dental1: What are the most common questions patients ask and how do you answer them?
Dr. Present: The most common questions are:
How long will the whole process take? I explain it all depends on the complexity of the individual case. However, as part of some recent clinical studies in which I have participated utilizing Straumann’s SLActive implants, we have gone from fixture placement to final restoration within three weeks.
Will I have to go a long time without my teeth? I explain that in most cases we can provide an immediate temporary restoration.
Will it hurt? I explain that the procedure is usually done under local anesthesia and many patients report only minor postoperative discomfort.
How much will it cost and is any of it covered by my insurance? I explain that it all depends upon the plan that their employer purchased. However, we do have various payment plans available. Although finances are a consideration, implant dentistry is not insurance driven. Once people become aware of the improved function, the preservation of bone and adjacent teeth, the value of implant dentistry becomes clear.
Dental1: What do you find to be the biggest challenge in your practice?
Dr. Present: The biggest challenge in my practice regarding dental implants today is restorations involving multiple adjacent missing teeth in the maxillary anterior and the preservation and/or regeneration of the interdental papilla. I think future implant research will focus on the fixture’s ability to attract and integrate gingival fibers. This will allow for a biologic attachment and the support for the interdental papilla.
Dental1: Do you think we will reach a point where dental implants replace traditional crown and bridge as the standard of care?
Dr. Present: I personally think we have reached the point where dental implants have become the standard of care for the replacement of missing teeth and standard crown and bridge. In fact, if the restorative dentist does not present dental implants as a treatment option, he/she would be committing malpractice.
Dental1: Is there anything else you would like to share with the Dental1 community?
Dr. Present: Remember that successful esthetic implant dentistry is a total team effort involving: a cooperative patient, a restorative dentist, an implant surgeon/periodontist, an orthodontist, an endodontist, an excellent dental technician, a dental hygienist, and an implant company representative.
See Dr. Present's office information.
