Sauer relies on specialists not so much to take his complex cases as to resolve issues such as periodontal disease, inadequate bone, and gingival architecture. Sauer’s proactive approach, he says, is his key to implant success. “We try to take the time to get things set up to have an optimal situation.”
In keeping with his “keep it simple” approach to implants, Sauer says he often lets his CBCT be his guide. “That has probably been one of the most significant tools that I have added to my arsenal over the last 10 years. It can tell me beyond a shadow of a doubt if I may be getting into something that’s over my head or not.”
The ability to deal with complications is a prerequisite to having an implant practice, but clinicians should also be realistic and know their own limits. Sauer says two situations he tends to steer clear of are all-on-4 surgeries, “unless they are slam dunks,” and cases where a failing natural tooth causes the adjacent implant to fail.
Oliva, too, notes the importance of understanding your clinical expertise, and says he has criteria he calls “valves” created for his own practice. “If this patient is X, Y, Z, I will treat, but if they are A, B, C, I won’t. This is better for me and my practice.” He says he routinely performs sinus lifts—eg, crestal sinus technique, lateral window—using new techniques that make the procedure easier and more predictable, with less likelihood of perforating the sinus. “However, if a patient is medically compromised, suffers from certain systemic situations, or needs serious harvesting like block grafting, nerve-repositioning procedure, I refer them to specialists,” he explains. “You can’t spread yourself too thin, especially in this field—it’s better to do one thing really well than everything less well.”
Patel says everyone wins when GPs and specialists team up on implantology cases. Specialists benefit from referrals from GPs, who see more potential implant patients—many of whom would be better served by the specialist. In return, the GP has a go-to source of collaboration and, sometimes, advice.
Moldovan points out a fact of life among those who specialize in placing implants: Complications are inevitable. “Someone who hasn’t had a complication hasn’t done enough implants,” she says. However, “If you don’t know how to treat the complications, don’t do the procedure.”
Patel agrees. “What defines us as clinicians who are actually ready to be placing implants is not our ability to put them in, but our ability to deal with the complications that arise during or after placement,” he advises. Of course, avoiding complications altogether is best, says Oliva. “Like my dad said, measure three times and cut once.”
To avoid or minimize complications, Moldovan says patients should be followed closely—especially during the first year—with x-rays and probing when needed—and prompt treatment should be initiated at the first sign of trouble.
Quality Education Counts
Minichetti is quick to remind that learning to place implants is not as easy as some manufacturers might make it seem. “It’s far more than a scan and guide and having it milled by a lab; it involves smile line, lip line, incisal edge, vertical dimension. There are so many factors that need to be in place for the prosthetic result before you can even decide on the surgery.”
He therefore urges would-be implant doctors to seek training, especially in the comprehensive prosthetics that is the basis of implantology. “Proper training, which wasn’t available to me when I started, is so important,” Minichetti explains. Such training, he says, is available from numerous sources, including the 300-hour American Academy of Implant Dentistry (AAID) Maxicourse® in Implant Dentistry credentialing programs. Minichetti, the Director of the Las Vegas AAID Maxicourse, says, “These programs are designed to prepare doctors for comprehensive implant treatment planning and diagnosis and surgery and restorative, providing the understanding and clinical skills to do comprehensive prosthetics.” Further, Minichetti says, the AAID makes sure its training is nonbiased, noncorporate, and multidisciplinary.
Putting It All Together
As those interviewed made clear, placing implants is easier now than it was previously, thanks to advances in diagnosis and treatment planning and in implants themselves. But implant dentistry should not be attempted—even by specialists—without the specific training today’s implants require.
Doing implant dentistry right starts with a commitment to high-quality training and building relationships with a network of trusted colleagues for referral, collaboration, or advice. Even with the right training and tools, establishing a successful implant practice hinges on consistently achieving excellent results. This calls for careful case selection that considers patients’ general and oral health, as well as their motivation, hygiene habits, and mental state. Indeed, an implant practice benefits enormously when the clinician and dental team take the time to listen to patients’ concerns and educate them about implant benefits and risks.
When complications arise, a clear protocol, which may include referral, can make all the difference. In addition, a successful implant practice knows how to best collaborate with others to achieve the best esthetic and functional outcomes for their patients. This means having the wisdom to know what they can and cannot do, which cases they should or should not take, and when they should forge ahead or step aside.
Who Is Qualified to Place Implants?
John C. Minichetti, DMD, is a GP, not a specialist. However, credentials from both the American Board of Oral Implantology (ABOI), of which he is a diplomate, and the American Academy of Implant Dentistry (AAID), of which he was immediate past president, attest to his qualifications to concentrate in implant dentistry, which he does in his Englewood, New Jersey, private practice. He therefore describes himself as an “expert” or “keynote clinician” when it comes to implants.
Similarly, Brooklyn, New York, private practitioner Isaac Tawil, DDS, is a highly sought after implantologist who often trains others, including specialists. His qualifications include diplomate with International Academy of Implant Dentistry, fellowships with the International Congress of Oral Implantology and the Advanced Dental Implant Academy, and an advanced periodontal training certificate from Harvard School of Dental Medicine.
Minichetti says specialist interest groups in some states have attempted to prevent GPs—including those with training such as his—from placing implants. For that reason, he is involved in AAID efforts to have its credentials recognized as a dental specialty, and to defend against litigation initiated by such groups. “Already the AAID has won lawsuits in Florida and California, and is currently involved in one in Texas,” he says.
“Just because you’re a specialist doesn’t mean you know how to do implant dentistry,” he insists. “Both GPs and specialists need to refer appropriately, and it helps when those who have received the proper training can be tested to verify that they can perform implant procedures to a certain level. AAID is one group that provides bona fide testing.”
Tawil adds, “It is especially important for clinicians to acquire such credentials early on, because, without proper didactic training, you can have problems in today’s litigious society.”