A commitment to excellence in dental implant education

President’s Message:

By Todd R. Schoenbaum, DDS MS; Academy News Editorial Consultant, and Peter K. Moy, DMD Guest Contributor and AO past president

Implant Dentistry in the modern era continues to evolve in respons to ever-changing pressures and developments. At least one thing remains true and has existed since the earliest days of the discipline…the need for collaboration.

This commonly takes the form of a surgical teammate, a restorative or prosthodontic teammate, and a technician teammate. IN advanced and complicated cases, the ptient will undoubtedly be nest served by  team of experts from each discipline who are engaged in preoperative, intraoperative, and postoperative care with continuous team communication and collaboration.

As the landscape is evolving, and practitioners are increasingly pressured to perform a greater breadth of the operations, solo practitioners and large practice groups have increasingly moved toward a model where more and more of the surgical aspects are performed by clinicians without formal surgical training (i.e., oral & maxillofacial surgery, periodontics). Some may lament this shift, but societal demands make it unlikely to revert to the older model where each clinician solely operates within their discipline.

The risks of an increasing number of clinicians performing implant and augmentation procedures with less depth of training will likely include higher number of failures and complications. Implant surgery is not easy, but with proper case selection and adequate training, there are certainly many cases that can be performed by non-specialists with a high degree of success. It is imperative, and self-treatments into their repertoire will seek out higher levels of training. And advanced training should include a thorough understanding of what cases fall within the individual clinician’s abilities and comfort levels. We must exercise restraint in understanding what is best for the patient given our training and knowledge.

As academicians, we could easily teach our first-year dental students, over the course of a weekend, to perform mechanical maneuvers such as applying local anesthesia, making an incision in the gingiva, drilling a few holes through provided guide, and screwing in an implant. Implant dentistry is not always hard. But it is not always that easy either…these students would be in no way proficient in risk/benefit analysis, treatment planning, and (most importantly) prevention and management of complications and failures.

The real challenge in any clinician operation is not the performance when things go well, it is in the knowledge and operational skills to use when things go sideways. And the knowledge to know in advance when complications are likely to avoid complications from occurring. We fear that some of our profession’s available surgical implant training programs paint an all too rosy picture of the simplicity of implant surgery and give the unsuspecting clinician a false sense of confidence.

Even in the most experienced and forthright clinician’s hands, failures and complications will occur. We should consistently seek to improve and expand our training and knowledge, but we should also be consistently mindful of our own limitations. We should enter all procedures with a “Plan A,” where everything goes according to plan. But we should also have a Plan G, C, D, F… What happens if my graft fails? What happens if I perforate the sinus membrane? What happens if the implant fails to integrate? What happens if there is a serious infection after surgery? Am I equipped to handle these complications? And if not, who will help me? If we have removed all other teammates from our team, we may find ourselves along when we most need help.

No matter the individual, we all possess a limited amount of time and energy to commit to advancing our clinical knowledge and training. The more breadth that any individual adds to their scope of their practice, the lesser the depth. Although not the same for all clinicians, our individual well is finite.

Imagine for a minute that you require significant orthopedic surgery of your operating hand. There are orthopedic surgeons with a great breadth of procedures they perform (knees, hops, hands, elbows, etc.), yet I suspect that you would diligently seek out a surgeon, who specifically specializes in hands. That’s it; all they do is hand surgery. Your hand injury requires advanced, expert level care. An expert in any field is, in part, characterized by the narrowness of their scope. Their well is very narrow, but also very deep.

Those of us commonly on the side of restoring implants need to ensure that we are well trained in the planning and restoration of implants. If we find ourselves lacking, we need to seek additional training, or find colleagues that can help us, or hand off to another colleague that is better suited to the tasks (and potential complications) at hand.

Surgical implant procedures can undoubtedly be taught in non-formal settings. The AO Annual Meeting always has a podium packed with clinician-educators that do in fact provide this training. These experts bring a deep, realistic, and honest approach to providing surgical implant training to anyone seeking it.

We must hold to the trust our patients put in us and aggressively endeavor to do what is best for them and their condition; to do no harm as we promised when we took our Hippocratic oath.

Dr. Schoenbaum is professor and director of clinical research at the Dental College of Georgia. Dr. Moy is a professor, endowed Chair, surgical implant dentistry, UCLA School of Dentistry.