This is a tricky one to write… but it is time that people started to talk about it.
I have been teaching General Dental Practitioners to provide implant treatment since the early 2000’s and I have seen varying degrees of competency through that time in people starting out in their implant surgery careers. Recently though, things have gotten ridiculous. There is no question that dental implants are expanding through general practice like wildfire as GDP’s try to get their “slice of the cake” this seems to have been propagated even further through the recent financial turmoil since 2008 and there now seem to very few practices that don’t offer some aspect of implant dentistry, whether it be restorations or a visiting surgeon.
I genuinely have no problem with this concept as our penetration in the implant market in the United Kingdom is still similar to some 3rd world countries and so far behind countries like Germany and Switzerland it is unbelievable. The amount of implants placed by head of population in this country is tiny and therefore the growth must still exist in huge volumes – enough for everyone surely.
My problem now is…and it is time to really start a debate about this, is that there are many dentists placing implants who are completely incompetent.
There has been a growing anxiety and disquiet about this whole problem, both in my practice and amongst people I speak to as I travel around the country. I have had discussions in England, Ireland and Scotland about these issues and they seem to be present all over the place now. The issues are that there are people taking on implant dentistry in their practice purely for profit motives who are not well enough trained.
Many years ago (8 - 10) I tried, in conjunction with Straumann and the ITI, to set up a basic surgical skills course. The first one we ever ran was at Gatwick and was infact attended by my friend and colleague Colin Burns who has now become an excellent implant surgeon at a very high level but had previously had oral surgery experience. We could not fill these courses and they had to be abandoned as they weren't popular enough.
We have tried to resurrect them on several occasions and it staggers me that dentists who are placing implants do not see this as an important aspect of their skill, or infact feel that they are finished with their surgical training when they have done very little. This has been shown by the cases which are now regularly coming into the practice and being presented by other speakers around the country.
Implant dentistry in general practice has blossomed and burgeoned with a host of companies marketing this on how easy it is and how profitable it is and of course, many young dentists have become involved.
We are now seeing cases every month where patients have been seriously damaged as a result of complete incompetency from surgeons who have not planned cases appropriately or executed them with what appears to be any degree of skill or conscience. When the patients attend our practice and we contact the dentists asking for further information generally the doors are closed and they are not willing to assist or help with patients who are having serious complications, including: constant pain and numb lips from posterior mandibular implants or hugely extended treatment plans with heroic bone grafting procedures in upper cases as we have seen recently.
The ITI promotes implant dentistry for the benefit of the patient and effectively has a series of recipe books which allow you to classify cases as Straightforward, Advanced or Complex and it is essential that surgeons are able to place themselves into the bracket where they're able to provide a competent level of work. I had a conversation with Danny Buser about this very subject some weeks ago when he came to Nottingham and he told me that the Swiss implant community had gone through a similar process 10 years ago when the market was flooded with cheaper implants and promoted to GDP's to be placing implants on a daily basis. He said that had stopped to a large degree but that they spend alot of time at the University of Berne removing implants which have been put in the wrong place or have caused the patient extreme distress.
It is time for an open and honest discussion about who should be placing implants surgically and exactly how much surgical skill is required to do this.
Leave a comment