An implanted dilemma

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implant procedures an implanted dilemmaShould all dentists be permitted to perform implant procedures or should the practice be restricted to dentists with specific expertise? Angela Tufvesson investigates.

Currently, any qualified dentist can perform implant procedures because the discipline isn’t a registerable speciality. As such, everyone from general dentists to specialist periodontists and oral surgeons perform implant procedures as part of their day-to-day practice.

The trouble is that not everyone in the profession agrees that this is the best approach. Some dentists who specialise in implants—formally as part of a recognised speciality or informally in self-restricted practice—believe fitting is done best by dentists with specific skills and training.

Some would like to see the profession create an implant speciality. As advertising specialist skills in a non-registered speciality isn’t allowed by the dental board, dentists working in this area are unable to promote their skills.

At the other end of the spectrum, many general dentists believe their close,
long-term relationships with regular patients make them best placed to perform uncomfortable and intimidating implant procedures.

So should the profession stick with the status quo or restrict implant procedures to dentists with specific—or even specialist—expertise?

The case for: Dr David Lee, principal dentist at My Hills Dentist

“The dental board doesn’t put restrictions on general dentists placing implants, so the dentist or specialist needs to be accountable and responsible for the treatment they provide.

“It really depends on the individual as to whether they’re capable of performing an implant procedure or not. We all go to the same universities and learn the same material, yet when we graduate from university, not everyone is capable of performing certain procedures. I think it really rests with the dentist, and what they feel confident about performing.

“At a technical level, there really shouldn’t be a difference in skills between a general and a specialist dentist when it comes to implants.” – Dr David Lee, principal dentist at My Hills Dentist

“At a technical level, there really shouldn’t be a difference in skills between a general and a specialist dentist when it comes to implants. It comes down to how much experience the practitioner has had. I’ve been placing implants for over 12 years and the number of implants I’ve placed is probably equivalent to the number of implants a specialist would place in approximately a three-year period. It’s taken me longer to get to that experience level, but there’s probably not much difference in my skill level.

“Ultimately, it’s about providing the best possible care for patients. If patients who are desperately in need of implant treatment are not receiving that because they have to see specialists, and due to varying constraints they’re unable to, those patients aren’t being looked after. So if their general dentist is able to perform the procedure, isn’t that providing an excellent service?

“There seems to be a push from patients for their general practitioner to place their implants. The general dentist has built up a relationship and trust with their patient over a period of time. It’s hard enough for many patients to let their general dentist work on them, so it represents another level of trust to allow that of someone else.

“That said, there are some very specialised implant procedures that, I believe, should only be carried out by specialists in the relevant field. For example, any implant procedure that needs to be carried out under a general anaesthetic should certainly be managed by a specialist.”

The case against: Dr Alex Fibishenko, owner of the Centre for Aesthetic & Implant Dentistry

“My friends at uni used to joke around that I thought an implant was the solution to every kind of dental problem, but in every joke there’s always a little bit of truth. I certainly spent the majority of my undergraduate years following research on implants.

“My practice became exclusive to implants because a lot of my [general dentist] colleagues were referring to surgeons, periodontists and various other specialists—as well as to me. Having a clearer insight was seen as advantageous by my colleagues. I had more and more referrals and eventually had to restrict my practice because there was no time for anything else.

“Dentists who are well trained and have a sound background in implants should be the ones performing these procedures. In terms of skills and knowing the complications that can occur, it’s definitely an advantage to have a focus in this area where you do these procedures daily.

“Dentists who are well trained and have a sound background in implants should be the ones performing these procedures.” – Dr Alex Fibishenko, Centre for Aesthetic & Implant Dentistry

“The profession should look at developing an implant speciality, although I’m not sure it would be possible as there would be lobbying from periodontists, oral surgeons and every other speciality that incorporates training in dental implants. Because of that training, these specialities feel that they are the right people to perform implant procedures. They would strongly object to an implant speciality because it would cut into a lucrative part of their business.

“However, I believe there is a definite need to have an implant speciality where training paths are defined by people who have the knowledge, skills and experience. Having been in a self-restricted practice exclusive to oral implantology and dentofacial surgery, for many years now, I have been fortunate enough to work in an implant-surgical capacity with some of the top dentists in Australia and abroad.

“Many dentists and specialists have come through the training at my practice. I can see that, once people get an insight into what’s involved—not just in single tooth replacement but also in full set replacement—they transform and change their views about how to perform implant procedures and about who should be doing them.” ∗

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