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Wed 7 Nov 2007 09:59 AM

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Implementing implants

MED looks at how dentists can profit from cutting edge techniques.

Implementing implants
Implementing implants

From a modest start as a niche speciality, implantology has bolted into the mainstream in recent years. Rising numbers of regional patients are opting to procure dental implants - undeterred by the relatively high cost - rather than settling for the traditional solution of crown and bridge procedures. For general practices facing competition from specialists, the increasing popularity of dental implants among patients offers an opportunity for practice expansion, with the right training. With dentists able to select the extent of in-house services, and pair with a specialist with more complex aspects, it has never been easier for generalists to get in on the act. MED speaks to the experts to determine how to maximise profit from this potentially lucrative procedure.

Education essentials

Implantology has progressed dramatically with the rise in digital dentistry. 3D imaging modalities have made the procedure less risky, by removing an element of guesswork from surgery, and implant firms continue to produce innovative products for increased predictability and stability. Technology has not, however, made implant surgery simple enough to ensure success for dentists with limited training. The best outcomes, explains Mark Hill, vice president of corporate communications at implant manufacturer Straumann, still occur with dentists who have invested in comprehensive training.

There literally are companies who are offering a weekend training course and toolkit.

Generalists should expect to invest in committed curriculum time, he says, as fast-track weekend courses are a recipe for disaster.

"There literally are companies who are offering a weekend training course and giving a handbook and toolkit and sending the dentists on their way," he explains. "That's not good. As a dentist you really have to have the right qualifications."

Nobel Biocare claims to offer comprehensive training to dentists on its implantation equipment and procedures. According to Dr Robert Gottlander, executive vice president of marketing and products at the implant solutions provider, dentists have a responsibility to ensure they are trained to a satisfactory level.

"We are offering some programmes, but we also co-operate with different training institutions. [Dentists] could have programmes consisting of five two-day sessions on the weekends," he explains. "If you are a dentist, you have to make this judgement yourself regarding how much information you need. We provide the information about the different opportunities that are available and then you can choose."

Educated consumers look for dentists with strong credentials and, in Dubai, this is enforced by government legislation requiring any practitioner offering implantology to have completed a minimum level of training.

"It's not usual that the authorities have this kind of impact, but they have taken this stand in Dubai," Gottlander admits.

Mentoring matters

Training is widely considered the weak link in implantology. The discipline is unique in that both restorative and surgical skills are required to secure a good outcome, so selecting the right training course is the most essential aspect for generalists.

Hill points to Straumann's own course as a good example of the minimum standard a dentist should achieve before offering implantology to patients. Dentists can expect an initial visit from a Straumann representative for a basic grounding in the system, before being referred to a training programme.

"We get them on the course and then help them build a network with a specialist," he explains. "It takes a week or two weeks to train them for restoration and then we hook them up with a specialist."
Sourcing a mentor is vital for generalists new to the field, stresses Hill. All initial procedures should be supervised while the dentist completes formal training, and this should continue until the mentor is satisfied that the dentist is competent.

"We give them a mentor - which would be a specialist or a dentist who does implants on a regular basis but isn't so close that there's a danger of turf grabbing," Hill outlines. "As the dentist gets more proficient, they can go on to do more complicated cases and get into inserting the implants in straightforward cases themselves.

"The key to success with implantology is knowing where your limits are and ensuring that the patient is going to get the implant put in by someone who has got the routine and the training."

Knowing when to refer

Implantology training is a time and cost-heavy exercise. For dentists preferring to start slowly, Hill advises building a referral relationship with a trusted local specialist. By creating a model where implant placement itself is outsourced to a specialist, but the restoration element is completed in-house, can ensure generalists retain their patients while building their skills base.

"This model is such that it is really easy for someone to get involved," Hill says. "Certainly every single dentist should be able to get involved in some way or another, even if it is just a case of referring patients to someone else."

Even for dentists utilising the referral model, the chairside time needed to complete the surgical and restorative elements of the procedure is typically shorter than the time needed to complete a crown and bridge, Hill argues.

"In terms of time spent, the patient has a consultation, goes to a specialist, then there's an abutment taken and the patient goes away with a provisional and then comes back for the final crown to be fitted.

"If you compare, the amount of chair time that dentists take to do a crown and bridge is hugely longer than it takes to do an implant, let alone considering the fact that they are giving their patient the second best form of care.

"It's clear and proven that an implant is a better and longer lasting option for the patient."

Cap the competition

Experts argue that implantology offers such easily demonstrable benefits that the procedure effectively sells itself. With an estimated success rate of more than 95%, implants significantly exceed the long-term success rates of bridges placed on natural teeth or root canals, posts, and crowns and are arguably more aesthetic and functional. Single-tooth implants boast success rates of up to 99%, and don't require preparation of adjacent healthy teeth.

"Put it this way, if I was out biking today and lost a tooth, I would like to have an implant to replace that tooth instead of cutting down two fresh teeth and doing a bridge," claims Gottlander. "I don't want to destroy two good teeth and I want to preserve the bone. If I do a bridge, I will not preserve the bone. Over time, I will have a bone deficiency and I will not be able to have an implant later on," he explains.

Dental practices are businesses and an element of their success comes from responding to market demands ahead of the competition. If you aren't able to offer implant services to your patients, it is likely that rival practices will. Dentists eager to offer the best option to patients should consider incorporating implantology, Gottlander concludes.

"Implantology is a part of restorative dentistry. The doctor has to select the best choice for aesthetics and for functionality. Patients demand the best treatment and dentists must be able to provide it."

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