IMPLANTS AND GENERAL PRACTITIONERS
GORDON J. CHRISTENSEN, D.D.S., M.S.D., PH.D.
Dental implants have made a significant impact on the profession in the United States, but they were initially regarded as highly questionable and unpredictable therapy. With the major introduction of root-form implants into the United States about 15 years ago, practitioner and patient interest in implants increased, continuing education courses about implants became readily available and clinical results were impressive.
For a few years, nearly everybody, including the public and press and prospective patients, had interest in dental implants. Oral surgeons and periodontists attempted to claim the surgical aspects of the implant procedure, but some prosthodontists and a few general practitioners also started to accomplish the surgical portion of the procedure. The prosthodontic portion of implant dentistry, and numerous significant innovations in the surgical area, were stimulated by prosthodontists who assumed leadership roles. General dentists became active in the prosthodontic portion of the concept.
As implant dentistry started to mature, general practitioners made decisions to accomplish either the surgical or prosthodontic portion of the procedure, both portions or neither portion. At this time, most estimations1 show that a high percentage of oral surgeons and periodontists place implants, along with some prosthodontists and a small percentage of general practitioners. Almost all prosthodontists and a majority of general practitioners restore implants. Although sought by many dentists, official recognition of specialty status for implant dentistry has not yet been obtained in the United States.
The people ultimately responsible for long-term restorative follow-up of patients receiving implants are general practitioners and prosthodontists.
What should be the role for general dental practitioners in implant dentistry? This article makes suggestions about this controversial subject and describes various methods for general practitioners to use to increase their expertise in implant dentistry.
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DIAGNOSIS AND TREATMENT PLANNING FOR IMPLANTS
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In my opinion, general practitioners are the only logical major group that should provide treatment planning for implants. Prosthodontists are a smaller group, and they should also provide treatment planning for patients, especially when complex plans are involved. In my opinion, oral surgeons and periodontists are support specialists for general practitioners and prosthodontists, and they should have significant input into the diagnostic and treatment planning phases in conjunction with general practitioners and prosthodontists. The people ultimately responsible for long-term restorative follow-up of patients receiving implants are general practitioners and prosthodontists. Unfortunately, some patients receive implants from surgeons before proper restorative treatment planning has been done, and some general dentists may not have sufficient knowledge to assist surgeons with diagnosis and treatment planning. How can these challenges be overcome?
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METHODS FOR GENERAL DENTISTS TO BECOME EDUCATED ABOUT IMPLANT DENTISTRY
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After 15 years of active teaching, research and practice in both the surgical and prosthodontic portions of implant dentistry, I have the following suggestions for practitioners.
Importance of implant dentistry.
Recognize the importance of implant dentistry in the profession. It represents the largest and most significant positive change in the profession during my years as a dentist. It cannot be ignored because of the great service it provides to patients.
Obtaining education about implant dentistry.
Find and attend an overall course on implant dentistry. This course should be an overview of the entire subject and should provide information about popular implant companies, as well as an introduction to each of the many categories of available implant prostheses. Materials and necessary equipment used in implant dentistry also should be included.
Special courses about implants.
Decide which implant company you prefer and attend a specific course presented by that company. Manufacturers are eager to include you in one of their courses or recommend a clinician who will teach you the details about their specific implants.
Implant organization.
Learning from experienced practicing colleagues and attending seminars are highly important when obtaining expertise in implant dentistry. The field is extremely broad in scope, and it changes rapidly. The following organizations (Box
, "Implantology Organizations") have excellent programs and information available for you. Each organization also has various levels of membership as you continue to advance in your knowledge about implant dentistry.
Prosthodontic clinical involvement.
Begin clinical therapy with a simple prosthodontic case, such as a single posterior tooth replacement or an over-denture placed over two spherical retentive abutments. Plan the case carefully after discussing it with an experienced colleague.
Gain experience.
Continue with simple prosthodontic cases until you feel proficient at that level. Advance to more difficult prosthodontic cases, such as anterior tooth replacement, multiple-unit fixed prostheses or "bar and clip" overdentures.
Implant surgery.
Decide whether you are interested in implant surgery. Do you include impacted third-molar extraction in your practice? The majority of general practitioners do.2 Routine implant surgery is considered by many to be less complicated and threatening to both dentists and patients than is impacted third-molar extraction. If you do not have an interest in surgical implant placement, find a practitioner in your area who is competent in implant surgery and who is willing to work closely with you on your implant cases.
Implant surgery instruction.
If you plan to perform implant surgery, continuing education is plentiful. Find a course on the specific implant system in which you have the most interest and attend the educational program. Hands-on seminars are the most helpful, since you gain actual experience in the procedures while someone supervises.
Obtaining practical experience in implant surgery.
I suggest gaining experience in implant surgery by placing implants into fresh animal jaws that you have obtained from a local slaughterhouse. You may obtain inexpensive educational implant forms from implant companies. This experience was very valuable while I was learning about implant surgery.
Surgery on patients.
For the first few implant surgeries, select simple procedures on healthy, cooperative patients. Examples of locations are the anterior edentulous mandible, maxillary premolar areas and other areas where at least 10 to 12 millimeters of bone is present from the alveolar crest to nerves, blood vessels or other critical structures, and bone is at least 7- or 8-mm wide from facial to lingual surfaces. As you gain confidence, advance to more difficult clinical situations.
Complex implant prosthodontics.
After accomplishing several simple prosthodontic cases, progress to more difficult cases. Obtain help with diagnosis and treatment planning from someone in your community who is experienced in implants.
Each area of dentistry, including specialties, has some involvement by general practitioners and some by specialists. I estimate that in at least five of the nine recognized specialties of dentistry (endodontics, oral and maxillofacial radiology, pediatric dentistry, periodontics and prosthodontics), most of the treatment is accomplished by general practitioners. Implant dentistry is still an evolving area of the profession. As time passes, I anticipate that a higher percentage of general practitioners will become proficient in both the surgical and prosthodontic aspects of implant dentistry. In my opinion, general practitioners who perform surgery provide better prosthodontic services because of their greater understanding of the entire procedure. Just as in every specialty area, including my own—prosthodontics—general practitioners should refer to specialists those patients who have clinical needs with which they feel uncomfortable.
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CONCLUSIONS
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Implant dentistry, using root-form implants, has become a widely used and predictable procedure. Many general practitioners have incorporated implant prosthodontics into their practices, while only a few general practitioners perform implant surgery. Suggestions have been made for general practitioners who may desire to increase their expertise in both implant surgery and implant prosthodontics.
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FOOTNOTES
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The views expressed are those of the author and do not necessarily reflect the opinions or official policies of the American Dental Association.
Educational information on topics discussed by Dr. Christensen in this article is available through Practical Clinical Courses and can be obtained by calling 1-800-223-6569.
Dr. Christensen is co-founder and senior consultant of Clinical Research Associates, 3707 N. Canyon Road, Suite No. 7A, Provo, Utah 84604, and is a member of JADA’s editorial board. He has a master’s degree in restorative dentistry and a doctorate in education and psychology. He is board certified in prosthodontics. Address reprint requests to Dr. Christensen.
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REFERENCES
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- Specialists become key providers of implant dentistry while GP activity tapers off. Dent Implantol Update March 1999:21.
- Christensen GJ. Dental surgery and the general practitioner. JADA 1997;128(1):85–7.
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DIAGNOSIS AND TREATMENT PLANNING...
METHODS FOR GENERAL DENTISTS...
