Who should perform your dental implant surgery?

The obvious answer is you want someone who has had a lot of experience with dental implant surgery as well as general oral surgery. A Periodontist or Oral Surgeon is an obvious choice. Both of these types of dentists complete 2 – 6 year post doctoral residencies in the surgical disciplines of dentistry. But today, many general dentists are undertaking the surgical placement of dental implants. The fact is that all periodontists and oral surgeons start off as general dentists, so dexterity is not an issue for a general dentist to place implants. It comes down to experience and consistency.

A simple analogy that I like to use is that it is like playing golf. The more you do it the better you get at it. You develop consistency and instincts that guide your play. Placing implants is similar. If it is a discipline that you engage in day in and day out your results become consistent. That is not to say someone with a great deal of experience will never make mistakes its just to say that they will not be made as often.

General dentists perform a myriad of procedures and are responsible for having acuity in many of the disciplines of dentistry, they are typically the quarterback of the patients dental treatment. The onus is on the general dentist to decide on which procedures they will undertake and which procedures will be referred out to the surgical specialist.

In the past the majority of dental implant therapy was carried out under the guise of the team approach. The general dentist would refer the placement of the dental implants to a surgical specialist. Once that treatment was completed, the surgical specialist would refer the patient back to the general dentist’s office for the restoration of the dental implants. The team approach is the most ideal model for dental implant therapy because all the aspects of the patients treatment are handled by the most qualified professionals – surgery performed by surgeons, restorations performed by dentists. So what has changed today that many general dentists are starting to place implants?

Economics would be the primary driving force behind this decision. The tooth decay rate has been declining. This is due the success of water fluoridation, and better awareness by the general public to seek routine care and prevention. Subsequently, this has reduced the need for primary care – dental fillings and crowns. In conjunction with this the numbers of dentists have increased. So reduced need coupled with increased competition has motivated general dentists to seek alternate revenue streams. Dental implant companies started reaching out to general dentists to start placing dental implants instead of referring them out. They would put on weekend courses that general dentists could attend to begin to learn dental implant surgery.

Another factor is computer assisted dental implant surgery or guided dental implant surgery. This is something that I as a surgeon have embraced myself. While there is a lot of planning involved, under ideal circumstances it can simplify the placement of dental implants as well as increasing the accuracy. There are many posts on this website about the technique. Thus guided surgery has removed some of the surgical obstacles that otherwise would have discouraged a general dentist from placing dental implants.

Lastly, implant dentistry has become more mainstream, and this follows with the above. In the past if a patient was missing a tooth and there were adjacent teeth, then the dentist would make a bridge over the two remaining teeth. This would require three crowns one over each of the remaining teeth and false one in-between. The standard today is to replace the missing tooth with a dental implant which only requires one crown. Amongst other things reducing the need for dentistry.

Given the above many general dentists are now getting involved with the surgical aspects of placing dental implants. The implication to the consumer, is that you may not be given a choice to see a surgical specialist as opposed to being treated by your general dentist.

In conclusion, experience in dental implant surgery, should be the major criteria in who should perform dental implant surgery. Experienced defined as several hundred implant placements if not over a thousand and someone who does it routinely. 3d cone beam or similar technology should be used for diagnosis and treatment planning. Anyone can play the game of golf but not everyone can golf like a pro. When it comes to any procedure in dentistry, not just dental implant surgery, a dentist or specialist who performs the procedure routinely and has had a lot of experience with the procedure will become the pro. Those who do it sporadically or have minimal experience will not have the same consistency and that can have negative ramifications on the final result. You should not be afraid to inquire about the experience level of the clinician from whom you are seeking treatment and it never hurts to get a second opinion.