Are Dentists Surgically Placing Implants?
As with any new frontier, the door of opportunity is open for those who want to get involved. And as implants in general have become more predictable and patient and clinician friendly, so too has the temptation for general dentists to expand their role to the surgical side, seeking education and training in order to keep all aspects of implant therapy in the practice. Although the percentages are quite small and the topic is controversial, American Dental Association surveys conducted in 1996 and again in 2006 report a less than 4% increase from 8.8% in 1996 to 12.3% in 2006.2 But that percentage could be on the rise in the present-day economy.
Kowalski has definitely seen more general dentists become involved in the implant treatment process and a rise in popularity among GPs for surgically placing implants. “With the price point dropping on CBCT scanners, some general dentists are beginning to realize that, if they choose to learn to place routine a single unit implant, a CBCT scan can be a way to bridge that gap to achieving predictable results.”
“An increase in the number of general practitioners involved in the surgical phase may also be spurred by the sagging economy and by implant companies encouraging general dentists to get involved in surgical placement ventures,” says Renzo Casellini, MDT, Certified Implant Prosthesist (ICOI Diplomat), owner of Swiss Quality Dental Ceramics and Dental Implant Studio in California. He believes implant manufacturers have a vested interest for broadening the base of those surgically placing implants. “Dentists are being pushed to take hands-on courses to master surgical placement procedures.” And although technology is making the surgical phase much more predictable, he is seeing a difference in the results of the final outcome among those who have specialty degrees and those who have invested in informal training.
In Kowalski’s experience, this may have stemmed from a few of his clients who are taking advantage of CBCT scanning technology and virtual treatment planning are actually ordering the surgical templates to use during surgery because of the added cost and time factor for the patient.
“This may be due to the volume of cases the practicioner handles,” says Dickerman. He finds that clients who handle large volumes of implant cases a year are less likely to use all the products available for treatment and surgical planning whereas those who do fewer surgeries do take advantage of them. “Guided surgery can give the less experienced dentist a lot more confidence in going forward with treatment.”
However, cautions Dr. Michael Sonick, DMD, owner of Fairfield County Implants & Periodontics in Fairfield, Connecticut, guided surgery should be used as an aid not a substitute for good surgical technique. “You are hearing a lot about how anybody can do implants using guided surgery. All you have to do is scan the patient, and order a patient-specific surgical guide, which will provide foolproof implant placement, plus the crown to fit that implant. All will be delivered the day of surgery,” he says. “Even though we use our in-house CBCT to scan nearly 35% to 40% of our patients, and those scans from my research are within 0.5-mm accuracy, I still lay open a flap 95% of the time to actually see the bone I am dealing with.”
Rose also advises caution when it comes to general dentists surgically placing implants. He knows several general dentists who have made the decision to perform the surgical aspect, partly because of the economy and partly because any time a new field opens up, everyone jockeys to see what role they can play. “Implant surgery is not simple,” he cautions. “Even if they know the anatomy and where best to position the implant, if there is a bleed during surgery or a bone fractures, dentists have to know what they are doing.”