This article is designed to assist patients to help understand if the surgeon they have selected to perform their dental implant procedure is truly qualified to perform the surgery. Often times patients go to their dentist for a missing or failing tooth and inquire about their options for replacing the tooth or teeth. The modern procedure is the placement of a dental implant. How does a patient know if their dentist is qualified?
Many times patients are referred to a specialist that is either an oral and maxillofacial surgeon or a periodontist. However, many times the general dentist offers to perform the surgery and the patient accepts the treatment. Patients often have a misconception that if a procedure is offered, that the doctor who offered the procedure is knowledgeable, competent and has experience with the procedure offered. Unfortunately, many times the surgeon who offers the procedure has little to no training and little to no experience. Many times general dentists and specialists who never received formal training in a particular procedure, will attend weekend courses designed to train the beginner to perform a particular procedure. By comparison, the specialist who was trained in the same procedure often had years of practical didactic training along with guided clinical and surgical training that took years to complete.
Not until very recently have most dental schools provided training for the general dentist in implant surgery. As such, many of the general dentist placing implants have had very little training. Most have accumulated their training from weekend courses or home study modules. The patient must ask their provider what training they had in school as well as what their dentist has had for post-graduate training.
Patients should be asking their dentist and their specialists they were referred to if they have received board certification. Board certification requires an extensive examination of the case experience of the doctor, followed by an extensive written examination followed by an intensive oral examination. With respect to dental implants, the American Board of Periodontology and the American Board of Oral and Maxillofacial Surgery are the only bodies who extensively test their candidates in the surgical field of dental implants. Both of these boards require the doctor to be re-examined every 10 years to make sure they are staying current. Patients should ask if their specialist is board certified.
Patients should be asking their dentist or specialist how many cases they have been involved with and their successes and their failures. Patient should also inquire if they are patient testimonials available and if they could speak to one or more previous patients that underwent the a similar procedure. Patients should also inquire if their dentist is familiar with implant planning using conebeam computed tomography and uses implant simulation software. Moderate to difficult cases normally have superior outcomes and have far less “surprises” when these methods of imaging and planning are used. Patients are often told the dentist is a member of several societies. A patient must ask what is the requirements for entry into a particular professional society ? For the most health care societies, you only have to be licensed and pay an annual fee to belong. As such, societal membership can often mislead the patient into a false sense of security.
One of the major concerns with implant surgery, is the doctor who performs the surgery qualified enough to handle the minor and major complications associated with the procedure? One of the things patients should be asking when reviewing the possible complications with their prospective surgeon, is who will be handling the complications should they arise ? If the dentist who is placing the implants is going to refer you out if one or more of the complications should arise, you should think about seeing another implant surgeon. Additionally, one of the best ways to evaluate if your surgeon is qualified, is to inquire about their hospital privileges. Should you have a serious complication or you are medically compromised, does your surgeon have the ability to perform that procedure in a hospital setting ? Most surgeons who have privileges at a hospital had to undergo scrutiny to get those rights to perform a particular procedure. They had to provide documentation of experience and training, meet the criteria their department put in place, and typically be observed in at least one case to ensure competency. Therefore, inquiring about their hospital affiliations and privileges can be a good tool for a patient to evaluate their surgeon’s abilities.
Many general dentists have gone through extensive post-graduate mini-residencies and hours of post-graduate training. It takes many hours of experience to become competent in implant surgery. It takes a tremendous amount of experience to begin to properly work-up a case for implant placement. Often times, the placement of the implant is the easy part. Preparing the bone and soft tissue to support the implant is often the difficult part along with planning the restorative portion of the treatment plan. It would be very difficult to become proficient at implant planning, surgery, and complication management from a couple of weekend courses. Most of the time, there is a symbiotic relationship between the the restorative doctor and the doctor placing the implant(s). There has to be an open line of communication between the surgeon and the restorative doctor to ensure an acceptable outcome and communicate reasonable expectations to the patient. Ultimately, it is unfortunately left up to the patient to inquire about the experience and training of their prospective implant surgeon. After inquiring about their prospective surgeon’s training and experience, it is up to the patient to either seek another opinion, ask for a referral to a specialist, or stay with that particular surgeon. Chances are, if you feel comfortable with that person, you are probably fine. However, if you are feeling apprehensive after your discussion with your doctor, it can’t hurt to get a second opinion. Since you are likely going to have this implant and the service it gives you for a long time, it is prudent to take your time in choosing your options and your surgeon.