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The Changing Role of GP's in Implant Dentistry
Are we now experiencing a major paradigm shift in implant dentistry, with the expanding role of the general dentist in the dental implant treatment process? Read an article on this topic by clicking here. Feel free to post your thoughts on this important topic, by adding your comments below.
September 9, 2005 in Future Trends | Permalink
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Comments
His comments would imply that the general dentist has done appropriate treatment planning such as imaging or perhaps CT scans before "writing the prescription" The role of the surgeon is far more than being a technician. A solid working relationship between the surgeon and restorative dentist overcomes all of the concerns detailed in this inappropriate article
Posted by: | May 10, 2005 3:19:54 PM
The comments imply that GP's are willing to advance their education to parity with their specialist colleagues. Further, he implication is that GP's are ready to take responsibility for treatment planning options for their implant cases. I find these assumptions to be less than valid. While it is important to have a prosthetically driven team, I see no advantage to driving implant surgery from the surgical specialist to a general practitioner. My general practice colleague do not routinely read professional journals, attend advanced training courses in surgical technique, and have little or no advanced training with respect to managing post-operative surgical complications.
Until recently implant dentistry is not taught at our undergraduate dental schools. I do not feel that a week-end course qualifies a dentist to make surgical decisions necessary during placement of implants.
The paradigm should not be shifting toward mediocrity.
Posted by: | May 10, 2005 4:37:10 PM
While Dr. Kaplowitz's comments encourage a more active role for the GP's, implications are not valid as already pointed out by the first two posters. Also, documenting the reasons why a "prescription" was not followed by the surgeon is already too late. A constructive team approach means that the GP and the surgeon work together BEFORE the treatment is done. There needs to be a treatment plan agreed on by the GP, surgeon, and the patient.
Posted by: | May 10, 2005 6:47:06 PM
PROSTHODONTICS is the specialty of dentistry, sanctioned by the American Dental Association, that is devoted to proper treatment planning and execution of advanced dental procedures, including the planning and restoration of dental implants. Many PROSTHODONTIC programs also offer proper implant surgical training. It is up to the surgical specialist and the general dentist to seek proper guidance in complex cases from a PROSTHODONTIST, a person who has the proper training in the subject. Let's shift the paradigm towards the specialists who took the time, and incredible effort to accquire the proper Post-Graduate education on the subject. Contrary to the Academy of General Dentistry, accumulating weekend course credits does not substitute for a proper Post-Graduate education in PROSTHODONTICS!
Posted by: | May 10, 2005 7:03:57 PM
I am a GP who has surgically placed and restored hundreds of implants since the mid '80s. Only on a handful of cases have I had to use angled or custom abutments because I place the implants where they should be for an optimal prosthetic outcome. If there is not enough bone present to do this, I graft it. I cannot say that I am seeing the same care taken by the "surgical specialist" in my area.
I urge any GP interested in implant dentistry to educate themselves and provide both surgical and prosthetic phases to their patients. In my and my patients' opinions it is much easier for them when they are treated in one office. For instance, if the implant is stable enough at the time of placement for immediate provisionalization this can be done to create perfect tissue contour for proper emergence profile of the final restoration. About 98% of the implants I now place are temporized at the time of placement. However, most of the surgeons in my area are still practicing the "ancient art" of two stage surgery.
Posted by: | May 10, 2005 7:08:53 PM
with all due respect to the author of this article, his comments are very UNREALISTIC, and he clearly lives in LA-LA land. There is a proven fact that "numbers don't Lie", and Statistics always prevail. Just show us how many ethical General dentists are "really" caring enough and dedicated enough to educate themselves and their staff, take and pay for long term hands-on courses,(NOT the over-the-weekend IMPLANT MOTIVATION COURSE!!) and really come back and try to "communicate" those knowledge with their surgeons, and patients. Yes, you may find very few respectable people , like this last guy who wrote the last posting, but not too many!. The other important factor missing from the author's arguement in "quest for perfection, by absolute IMPERFECT GP'S", is the "patient" and their financial flexibility. Don't you think that all the surgeons would love to have all the soft and hard tissue grafts and get paid for them prior to implants in order to get perfect results??. I strongly encourage that next time if you want to put an article up there, or send it to us in email, atleast interview someone who has a real degree, real certification, and REALISTIC goal, not just a bunch of wishful dreams (that he would like to see !) being presented as "DYNAMICS or CHANGING TRENDS".
Posted by: | May 10, 2005 8:39:29 PM
It's very interesting to see the strong responses here from some specialists. It would seem that those that feel threatened are not actually looking to the future. Their reponses merely rehash current affairs in the dental community. The fact is that big, big money is being invested by the implant companies in new implant designs, technology, and education so that the GP will be able to place implants successfully.
It is in fact in the implant companies best financial interest that more implants are placed, more quickly, and more easily. As this new technology gets implemented (and marketed) in the next 5-10 years, there will be a significant change in the way the GP and Specialists interact during implant treatment.
Let me close by saying, that nobody is saying that specialists are not vital for implant treatment, but the fact is that their role is going to change and they will quite frankly have to become "More Specialized".
Posted by: | May 11, 2005 3:09:46 AM
i am somewhat surprised at the acerbic tone to which much of the commentary has gravitated.....that being said, the singular aspect which surprised me re the article under review is the encouragement to document abdication of liability in a patient's progress note should the implant surgeon fail to meet the exact expectation of the referring restorative dentist.....should the failure of a fixture to maintain integration frighten us to the point of finger pointing we should stay away from this modality et. al.......the fact remains that inorganic materials may at times disappoint our expectations in an organic environment no matter how many letters we choose to aquire behind our names, and no matter in which fashion we choose to further enhance our knowledge and skills...perhaps a usable guideline for all of us to consider when surgically placing implants as GP or MS is to evaluate how comfortable we are in handling the eventual surgical complication.....patients fail around our implants as well....
Posted by: | May 12, 2005 8:10:19 AM
Most implant continuing education courses are geared to general practitioners. The lab can wax up study models and prepare surgical stents to guide implant implacement. Most labs have a dental consultant on staff to supervise the work and help with treatment planning. And contrary to what some of these specialists claim, many of us GPs attend courses, read journals and belong to study clubs. Would you want somebody treatment planning an implant bridge for you who has not placed a bridge since dental school?
Posted by: | May 13, 2005 4:39:18 AM
Perhaps the real paradigm shift is towards CT-based planning. This increases understanding and collaboration between all members of the implant team – surgical, restorative, and laboratory. Even patient understanding is increased with 3D images and models, leading to better acceptance and compliance.
We all benefit from the growing availability of cone beam scanners such as i-CAT (www.imagingsciences.com) and NewTom (www.aperioservices.com), stereolithography BioDental models (www.biomodel.com), and simulation software packages such as I-Dent, Simplant, and Implant3D. These tools facilitate optimum implant placement taking into account BOTH surgical needs and prosthetic goals.
Posted by: | May 15, 2005 7:56:44 AM
While CT scans and models created from them are a good adjunct to the diagnostic aids we now have, they are by no means necessary. Good panoramic images, periapicals, bone sounding when necessary, a thorough knowledge of anatomy, and a good helping of common sense will get you through any case. These have worked for me for over 20 years.
Posted by: | May 15, 2005 5:34:45 PM
I agree that most implants can be placed with good panoramic and perioapical radiographs. The value of cat scans lies in collaborative treatment planning. The GP can see for themselves that a wide diameter fixture can't be placed and the surgeon is not arbitrarily placing a small diameter implant. The GP and specialist can decide if bone grafting should be suggested or if a compromise in implant diameter or position is acceptable. Everyone's on the same page.
Posted by: | May 15, 2005 6:56:30 PM
The simple fact is that the most critical aspect of implant treatment planning is having the dental laboratory involved in pre-surgical planning. Also, if any of you even consider using any form of standard fixed (stock) abutment for your fixed cases, then you're practicing compromised dentistry. I recommend the Atlantis Components, patient-specific custom abutment.
Posted by: | May 20, 2005 7:08:48 PM
If the implant is placed properly in all three dimensions all you will ever need is a stock abutment.
Posted by: | May 22, 2005 5:33:04 AM
Rubbish. Given the technology we have now and the fees that our patients pay for treatment, a stock abutment should NEVER (I shout for emphasis) be used and is paramount to compromised dentistry. There is nothing standard or fixed about any patient.
Posted by: | May 23, 2005 6:48:50 AM
I agree that there is nothing standard or fixed about any patient. But if you are familiar with Tarnow's work, the principles of emergengce profile, and place implants where the tooth roots once were, custom abutments are not needed, especially with the ITI system. I have hundreds of cases that verify this statement the earliest of which dates back to 1988, still functioning, still beautiful.
Posted by: | May 23, 2005 7:27:20 PM
For those of you out there who think GP's should not place implants,let us not forget that implant dentistry is not a specialty recognized by the ADA. Secondly, and possibly most importantly most of the major innovations that have occured in implant denistry in the past and currently have been made by general dentists or non dentists(Brannemark) Orthopedic surgeons. It is unfortnate that the specialist feel so threatened by GP,s placing and restoring implants. Should GP's feel threatened by specialists placing final abutments? I am a GP who has been placing and restoring implant since 1988. I do sinus lifts and bone grafts routinely. My results are and have been since 1988 equal to or better than most specialists in my area. Go figure. Implant dentistry is not rocket science but it does require some extensive training. By the way there are some great programs out ther that will give the GP all of the tools necessary to sucessfully place and restore implants. Just for the sake argument how many of you out there would disagree with the fact that if you have enough bone, placing a single implant is about as easy as taking out a tooth. By the way most specialty programs(perio,OS) didn't offer very much training in implant dentistry until recently. So how many specialists started placing implants with the equivalent of a weekend implant course?
We need to support each other not attempt to destroy each other. There are plenty of missing teeth out there for everyone to replace with an implant if you so choose.
P.S. In Italy 55% of the implants placed are placed by. You guessed it GP,s. The numbers in other countries in the civilizes world are pretty close to this Italian figure.
Why is it that less than 5% of the implants in the US are placed by GP's.
Fear?
Intimidation?
???????
Posted by: | May 29, 2005 9:33:43 PM
The US is one of the very few countries that maintains a rigid and formal infrastructure of dental specialists. This is more of an anomaly than mainstream.When endo first became organized as a dental specialty in the US few GPs did endo.Now 80% or more of the endo is done by GPs. I think we are going to see the same trend in implants. Placing implants has revitalized perio and oral surgery. Protecting this turf is understandable but not justifiable.
Posted by: | May 30, 2005 3:56:05 AM
As our knowledge increases, so do our patient's demands. I have spent years training in Prosthodontics and Implant surgery at the post graduate level, to graduate and find out that there are plenty of general dentist out there who call themselves specialists in cosmetic dentistry and implants after taking a bunch of courses. Would you rather go to a cardiac surgeon for a bypass or to a general surgeon who took "courses"? There are, of course, excellent GP's who place and restore implants very successfully, sometimes due to proper training, and sometimes just plain luck, however, mostly, I get many referrals of patients who's dentist, unknowingly, got in "over his/her head". I find this true expecially in Prosthodontic planning and execution of full mouth reconstructions. At the same time, I have seen several patients with executed sinus grafts by well meaning periodontists and OMS's to later never use the grafts since "there are no teeth that far back"--obviousely a failure of the surgeon to get a proper prosthodontic treatmet prior to surgery. Mistakes are made on both ends. Ultimately, it is up to us as a profession to educate ourselves in proper execution, as well as how not to overstep our training. I never did understand how medical doctors are trained to consult and work with each other, and we dentists are trained to antagonize and compete.
Posted by: | Jun 1, 2005 7:55:00 PM
To all supporters of European dentistry... please take a plane to Italy or any other European country and check out their teeth! Is it a wonder that their specialists come to the USA to train? May I remind you that they also do not have the same accountability as we do here. I'll take our dentistry anyday.
Posted by: | Jun 1, 2005 8:00:23 PM
ENOUGH DEGRADTION OF GENERAL DENTISTS BY SO CALLED "IMPLANT" SPECIALISTS.
IF GENERAL DENTIST IS SINECERE AND HARD WORKING AND GET PROPER TRAINING FROM MANY nonweekend courses,HE/SHE CAN PERFORM AS GOOD AS ANY SPECIALISTS IN SURGICAL PLACEMENTS OF IMPLANTS.
I KNOW MANY FROM MY AAID ASSOCIATION WHO ARE FELLOWS AND DIPLOMATES OF AAID.
MAY BE IT IS ECONOMICAL THREAT OR NOT. I DO NOT KNOW. BUT IN MANY INSTANCES SOME MISGUIDED PERIODONTISTS BELIEVE THAT GENERAL DENTISTS SHOULD NOT PLAY ANY ROLE IN SURGICAL IMPLANTS PLACEMENTS.
MANY PERIODONTISTS ARE AWARE OF GENERAL DENTISTS INVOLVEMENT AND RESPECT IT.
LET ME GIVE YOU ONE RECENT INCIDENT HAPPENED TO ME.
ONE PATIENT APPROACHED ME FOR RECENTLY( 8WEEKS) EXTRACTED TOOTH NO.31.
I PLACED ONE STAGE IMPLANT AND PATIENT DID NOT RETURN AFTER. NOT EVEN FOR REMOVAL OF SUTURES INSPITE OF REPEATED NOTICES.
PATIENT DISAPPEARED FOR ONE YEAR.
ONE DAY SHE VISITED PERIODONTIST FOR THE COMPLAIN OF MINOR IRRITATION NEXT TO IMPLANT.
PATIENT WAS ASKED WHO PLACED THE IMPLANT WHETHER AN ORAL SURGEON OR A PERIODONTIST?
SO PATIENT CALLED MY OFFICE TO FIND OUT AND WAS TOLD THAT I AM A GENERAL DENTIST.
AND THEN YOU WOULD NOT BELIEVE BUT THAT OONOXIOUS PERIODONTIST CALLED MY OFFICE AND TOLD MY STAFF THAT BEING A GENERAL DENTIST I SHOULD NOT BE PLACING AN IMPLANT. i HAVE MADE A BIG MISTAKE IMPLANT IS TOO SUPERFICIAL AND HE HAS TO EXPLANT IT TO PLACE ANOTHER IMPLANT AT DEEPER LEVEL.
SO I CALLED PATIENT TO MY OFFICE AND TO MY SUPRISE I FOUND OUT THAT THERE WAS NO PROBLEM WITH IMPLANT. IT WAS TOOTH NO.2 WHICH WAS OVEREXTRUDED DURING LAST YEAR AND HITTING RETROMOLAR AREA.
I EXPLAINED TO PATEINT AND ADVISED FOR FULL COVERAGE RESTORATION FOR OR INTRUSION OF NO.2,TO MAKE A ROOM FOR RESTORATION OF IMPLANT.
I CALLED THAT PERIODONTIST AND EXPLAINED THE SITUATION AND HE FELT VERY OFFENDED THAT NOT ONLY HE MISSED PROPER DIAGNOSIS BUT ALSO ADVISED FOR UNNECESSARY EXPLANT OF FULLY INTEGRATED IMPLANT.
IT IS SUFFICE TO SAY THAT THER ARE MANY SPECIALISTS WHO RESPECT PROPER ROLL OF GENERAL DENTISTS IN IMPLANT DENTISTRY BUT THERE ARE FEW SPECIALISTS WHO DO NOT LIKE GENERAL DENTISTS DOING SURGICAL IMPLANTS PLACEMENT. REASON? I DO NOT KNOW??????????????????
Posted by: | Jun 4, 2005 12:35:12 PM
Why Should General Dentists Place Dental Implants?
By Dr. Jack Hahn
This author is a general dentist that has successfully placed over 25,000 dental implants over the past thirty-one years. After graduating Ohio State University College of Dentistry, I realized that I needed further training in periodontics and restorative dentistry. I enrolled in as many continuing education courses on those modalities as I could.
In 1969, a patient presented herself to my office with fifteen sets of dentures in a shoebox. I call this the "Shoe Box Syndrome". She had every configuration or type of denture that one could imagine: dentures with magnets, dentures with small rubber suction cups and metal base dentures are just some examples. Her husband was an orthopedic surgeon and asked me about dental implants that he read about in his orthopedic literature.
I gave him the standard answer that we were told in school, which was that implants don't last, there is rejection and infection. They left my office disappointed as she was basically a "dental cripple" not being able to chew or be seen in public.
I saw them six months later at a social function and they told me that they went to New York and had implants placed by a general dentist. She can eat comfortably and has renewed self-confidence and their social life has been changed dramatically for the better. The orthopedic surgeon said that implant dentistry at that time was in its infancy, but I should begin to study now as it is the future of dentistry. His statement was a wake-up call. He was correct in that implant dentistry was my future and still is. Every year there are new techniques and materials. Implant dentistry has had more advances and innovations than any other field of medicine.
Before 1984, over seventy percent of the implants placed were placed by general dentists. After 1984, implant training was given in the dental schools but only in the specialty programs and the team approach started to become popular. By team approach, I mean surgical placement was performed by one doctor and the restorative by another. The general dentist who can place implants has an advantage in that they know where the implants should be placed according to the desired prosthesis, thus having complete control of the final result.
In my opinion, what is happening in implant dentistry has happened in other dental specialties. For instance, many general dentists extract teeth in their offices. If it were a complicated extraction such as a mesio-angular bony impacted mandibular third molar where the roots are infringing on the mandibular nerve canal, they would probably refer the patient to an oral surgeon. Another example is that many general dentists perform endodontic treatment in their offices on teeth with relatively straight roots with obvious pulp chambers and canals. The twisted, convoluted roots they most likely would refer the patient to an endodonist.
The examples given are also happening in implant dentistry. The single tooth replacements with adequate height and width of bone are performed by general dentists. The cases involving totally edentulous mandibular ridges with adequate height and width of bone can be treated using various over dentures or fixed denture techniques by general dentists.
Partially edentulous patients with, again, adequate height and width of bone may be treated by general dentists giving the patient a fixed prosthesis eliminating the free end partial denture. Patients with a fractured or unrestorable tooth should be able to have the tooth extracted and an implant placed immediately by a general dentist.
Patients requiring bone grafts, sinus cavity manipulation and nerve repositioning would generally be referred to specialists such as oral surgeons, periodontists or general dentists who have been trained and have extensive experience in those modalities. These practitioners may be called oral implantologists.
For the past twenty-five years I have trained general dentists all over the world how to place and restore dental implants safely and predictably. Dr. Gordon Christensen states that if you are not placing and restoring dental implants in your practice, you will be behind the times. Dr. Christensen goes on to say that he will no longer make a patient a new lower denture without placing at least two implants. Two implants for a lower denture in his office is a standard of care.
There are thirty-five million edentulous patients in the United States. In fact, every minute some person in this country is losing a tooth. As you can see, there is a great need and demand for implant dentistry. In July 1989, the National Institute of Health issued a statement regarding patients who are missing teeth. The statement is as follows: Patients missing one or more teeth should be offered the option of a dental implant or implants. The general dentist can perform or refer the service.
Dr. Roger Blackwell, Professor of Marketing and Dean of the Business College at Ohio State University, had his graduate students research the future of the business of dentistry. The conclusion of that study was that for dentists to grow their practices in the millennium, they must be involved in cosmetic dentistry and the placement and restoration of dental implants.
How many of your patients get excited over a three-unit fixed bridge? But patients do get excited over a single implant and not having to have adjacent teeth prepared. Satisfied patients refer new patients. In my office, single implant tooth replacements require only three visits and we have a satisfied patient. We have found over the years our practice has experienced growth.
In conclusion, dentists can be trained to perform implant dentistry. Patient selection, surgical and restorative techniques are skills that can be attained by general dentists. Dentists should be able to treat patient's edentulous areas that have sufficient height and width of bone in low risk areas.
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P.O. Box 449 Union, WA 98592-0449
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Posted by: | Jun 4, 2005 2:05:07 PM
Why are some of you specialists acting like placing an implant is like doing open heart sugery. It is not that difficult. Granted, there are risks involved however very few that are life threatening. Prior to 1984 few periodontists or oral surgeons were placing implants. It was the general dentists who took all the heat and now some of you are trying to act like GOD. Get real: pinch yourselves. The exclusive reign you had over implant placement for the last two decades is rapidly coming to and end. Suck it up and get over it.
Posted by: | Jun 4, 2005 2:26:10 PM
I still do not understand why are these specialists hate general dentists so much?
Is it really a true concern for the welfare of patients?
or
Just "M" word.
All those specialists should be thankful to thier referring GPs not only for their RICHES but SURVIVAL.
A person with sound mind will never compare implant placement with a heart surgery.
In otherwords all endo patients should be treated by endodontists.
Apart from varios grafting procedures implants placement is not so difficult.
GP knows how to reflect flap,make a hole in bone and insert a screw.Most of the cases handle by GPS are simple cases or over dentures.
sometimes I find ATRAUMATIC extraction of endodontically treated tooth is more difficult than placing an implant.
With the help of to day's advanced technology and gadgets implant dentistry is becoming far easier.
Ofcourse when need arise for complicated cases GP should seek help of proper experts.
In short,
placing an implant should not be made big deal.
Bigest deal should be proper diagnosis and treatment planing.
Howmany oral surgeon can claim to place more dentures (removable or fixed) than GP ?
How many periodontists know difference between polyether and poly vinyl siloxane?
Only specialist who may claim to be better than GP in that matter should be prosthodontist.
But can he/she claim to be more experienced in surgical procedures than GP?
I do not think so.
Most prostodontists refer out their patients for surgery.
I am glad Dr. Jack Hahn responded propery.
Posted by: Dr. Satish Joshi | Jun 6, 2005 9:15:12 AM
Many periodontists and oral surgeons are running Mentor Programs where they teach general practitioners to place implants. The feedback that I get is that the GP's place implants in the simple cases and refer the more complex ones. The sum total is more implants being placed and more GP's diagnosing implants and referring more and more cases to the Mentors. Clearly a win-win situation for all parties.
Posted by: | Jul 1, 2005 2:28:18 AM
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