CPD Article – Getting started in implant dentistry with Paul Swanson

The UK, France and Germany are among those leading the way in Europe in terms of dental implant placement, and when you consider that Europe sees the greatest number of implants being placed worldwide , this is an astonishing and energising fact.

For dentists and their teams, it means there are exciting opportunities in terms of career and practice progression. As the baby boomers – the first generation to keep most of their natural teeth as they advance in years – continue to live well and for longer, the implant market will carry on growing.

When a patient presents with a view to receiving dental implants there is, of course, a need for an initial assessment of their situation. The first thing is to establish if the patient is generally fit and well, medically speaking; for example, they don’t have any pre-existing conditions or medication that might impact on their suitability for treatment.

The next step is to establish their dental health, to ascertain the condition of the rest of the dentition and gingivae. Alongside this, as a matter of priority, the dentist needs to ‘stabilise’ the patient – put simply, get them out of pain and consider any urgent periodontal problems.

It is also important to assess whether they brux (if they do, any restoration might stand proud of worn away natural teeth over time) and if they are willing to take responsibility for their own oral healthcare between check-ups and hygiene appointments. How often do they go for check-ups? How often do they need hygiene appointments? If their current level of oral care is insufficient, are they willing to change?

If these considerations lead the dentist to believe implants may be a viable option, it is important to look at the bone volume and quality, both generally in the jaw and where an implant would be placed. If not, how that bone can be rebuilt needs to be thought about, as does the type of implant in terms of workable dimensions.

Communicating this to the patient is key, as is discussing other possible treatment options before anything else happens.

Perhaps the biggest variable in implant dentistry is the patient. To manage (and, ultimately, exceed) expectations, the dentist needs to ask something along the lines of “what can I do for you? What brings you to see us?”.

Dentistry is not always as straightforward as we would like it to be, and implant treatment is certainly no exception. As mentioned earlier, clinicians need to be looking for adequate bone around the implant and healthy gums, as well as an absence of abscesses or the patient presenting with any pain or discomfort. Any such undesirable findings should set off alarms in the clinician’s head that something needs to be done to address these potential complications.

In terms of placing the implants themselves, they must be positioned in such a way that the restoration will look like it is in a natural position and has a good emergence profile, otherwise an aesthetic outcome is impossible to achieve.

Part of realising this goal is partnering with the best possible implant surgeon. Thus, it is important to understand what credentials the surgeon needs to have and what the restoring dentist should be getting back from the referral practice. For example, standard practice suggests the patient should be returned with some sort of covering letter, which should include, for example, all patient records, X-rays and photographs, copies of any letters, as well as any pricing information and after care advice.

As the demand for implant dentistry continues to increase, dentists who are not prepared to manage their delivery and maintenance may well miss out in terms of career progression and satisfaction, as well as the financial benefits.