It’s 1996.

It’s a wet, winter Saturday morning in Uttoxeter and I am a Senior House Officer in Maxillofacial surgery in Derby, who has travelled out with my consultant to assist in dental implant procedures in a private practice.

It’s a whole new world and I am staggered of what we’re doing and what is possible.

Prior to that, for more than 2 years, I had been working in oral surgery and oral medicine, and I would work for another year in oral and Maxillofacial surgery assisting my consultant from time to time in the private practice he would travel to at the weekends.

It was my first real introduction to dental implants, after a very, very brief 2 or 3 lecture series at dental school in the early 1990’s.

Dental implants weren’t here in the UK yet, they were seen as a cult and an outlier – how things have changed.

After my qualification from the University of Glasgow in 1994 I worked as a House Officer in perio, oral medicine and oral surgery in Glasgow. In 1995, I travelled to Nottingham to work in Maxillofacial surgery, and a year later travelled to Derby to work in Maxillofacial surgery at a higher and more advanced level.

I left my SHO job in 1997, finishing by assisting in a bimaxillary osteotomy procedure, where my consultant said “you’ll miss this when you’re gone”. I entered vocational training in 1997 with a lot of surgical experience and no dental experience whatsoever, it was a baptism of fire. During that time though, I carved out 30 minutes from 12:30pm-1pm on a Monday to do oral surgery in the practice and go back to my roots. I had also negotiated to continue to do a day case list at Derby Royal Infirmary on a Tuesday morning, doing impacted canines and wisdom teeth etc. That morning in Uttoxeter though had shown me if I wanted to do something in practice where I could do the skills that I had learned, then dental implants was likely to be it. I wanted to do oral surgery in practice, but knew that the NHS fee scale was quite restrictive in that regard, and it was difficult to set up a business around oral surgery. I wanted to do dental implants and in 1998 I won a raffle at a Straumann open evening and found myself at a 2-day surgical and restorative dental implant training course in Cambridge. I placed my first implant in 1998 at a large NHS practice in Ilkeston in Derbyshire. By the time I had left in 2008 I had placed over 2,000. My dental implant training journey was unconventional, all journeys at that stage were unconventional, there was no dental implant training pathway and there was no appropriate dental implant training. Dental implants came from the hospital and Nobel Biocare (previously Branimare) had cornered the hospital market in the UK, but these procedures were seen as advanced surgical procedures usually carried out by consultants who protected their private practice. On the continent, it was different and the ITI dental implant system had gone into practices and not hospital. It was much more restoratively lead, it was by chance that I ended up picking that system to start with in 1998.

Since then there has been much battle and debate about who should be providing dental implants and the nature of the treatment; but there is no question it is a restoratively driven specialty and the onset of guided surgery and the introduction of digital planning has cemented that within the culture. Sadly though, the 2-day dental implant training course became the model for implant dentistry and many people entered into implant dentistry having done 10-12 hours of dental implant training but very little surgical experience. Surgical aspects of implant dentistry cannot be underestimated and the complications that can occur cannot be ignored. 

Implants started to proliferated in dental practice in the UK in the 1990’s but much more through the early 2000’s. In 2006, in Edinburgh castle at the ADI congress, it looked like they had come of age, as Danny Buser presented a brand new dental implant surface for the Straumann dental implant system. From then on, it has become a battle ground of education and product with noise and interruption everywhere; it seems difficult to make sense.

Planning to become involved in implant dentistry in your career is more than career decision, it is a life decision. It is not possible to be a weekend warrior anymore as it seems to be in many other disciplines. The dental implant training pathway and the plan for development is one which will take you through your career if you wish to be good. The staggering fact is, that in statistics carried out by the implant dental companies themselves, over 90% of people who attend a surgical implant course are not placing implants 2 years later. This shows how the battle for education, and the poor quality of prevision for training has impacted on the confidence of the profession.

Other statistic show, that many people who carry out implant treatments place 15 or fewer implants per year, this is simply not enough to make the procedure economically viable nor ethically viable and things needs to change.

At The Campbell Academy we have always had the philosophy that dentists should be trained to move towards placing 50 implants or more, or stop placing implants. We believe this is a 3 to 5 year process for most practitioners which requires time, finance and emotional investment, but the rewards for those who can are fantastic and the practicing life is brilliant.

Things are very different now than when is started in 1998, over 20 years ago. In my day, the GDC were unheard of and were someone you paid a small amount of money to each year and stayed on the register unless you had committed some horrible crime. The CQC did not exist, and the weight of compliance that we see today was none existent. My early case notes in implant dentistry were laughable.

The threat of litigation was small, although did exist, but was sorted out easily and straight forwardly by the defence unions in most cases. The commercial pressure in implant dentistry was tiny, as there were very few people providing the service, and very few companies involved. Those that were involved were micro companies and their personal relationships were fantastic. Nowadays there are more than 2,500 dental implant systems, at least on the market, and not a day goes by where I see a different system or a different ‘innovation’ that I should be picking up. Evidence based dentistry has been cast aside in the race for market share and Facebook and social media teaching has become the norm leading inexperienced and under qualified practitioners into procedures which are simply not appropriate leading to the huge explosion of GDC and litigation cases and the circle seems to continue to grow.

So, why would you enter into implant dentistry now? Into a world that seems dangerous, threatening and stressful, the answer to that question is easy. If you choose to be good and to make yourself the best practitioner you can be the rewards will follow. Nothing like this should be easy, and it certainly is not, but the satisfaction and fulfilment developing into a competent and capable implant practitioner must be one of the best routes to take in dentistry in my opinion.

In setting out in your career, you would want to ask -

What do I want to achieve, in what area and to what stage do I want to get to?

If you wish to train as quickly as possible and as cheaply as possible, then there are plenty of providers who will allow you the opportunity to do that, but ask yourself the question, does it seem too good to be true? Because if it does it usually is.

If you have already developed surgical skills you’re half way there. If you’re an excellent restorative dentist, you’re the half that is half way there, but unless you have both of these together you will struggle in implant dentistry and may require the assistance of other people.