Position Statement of the American College of Prosthodontists
Placement of dental implants is a procedure, not a National Certifying Boards for Dental Specialists (NCRDSCB) recognized Dental Specialty. Dental implants like all dental procedures require dental education and clinical training.
Implant therapy is a prosthodontic procedure with radiographic and surgical components. Using dental implants to replace missing teeth is dictated by individual patient needs as determined by their dentist. An implant is a medical device approved and regulated by the US Food and Drug Administration, which can provide support for a single missing tooth, multiple missing teeth, or all teeth in the mouth. The prosthodontic and the surgical part of implant care can each range from straightforward to complex.
Restorative dentists are experienced in restorative procedures, and many have been trained and know requirements for providing dental implant restorations. A restorative dentist trained to place and restore implants may be the appropriate practitioner to provide care using dental implant procedures. This will vary depending on an individual clinician’s amount of training and experience. However, the dentist should know when care should be referred to a specialist (a prosthodontist, a periodontist or an oral and maxillofacial surgeon.
Orthodontists may place and use implants to enable enhanced tooth movement. Some endodontists may place an implant when a tooth can’t be successfully treated using endodontic therapy. Maxillofacial prosthodontists may place special implants or refer for placement when facial tissues are missing and implants are needed to retain a prosthesis.
If a patient’s implant surgical procedure is beyond the usual practice of a dentist, this part of the care should be referred to another dentist that is competent in placement of implants. The referring dentist should effectively communicate and provide specific instructions and any necessary surgical template(s) for appropriate care.
The patient should be referred to a prosthodontic specialist (a prosthodontist) if the procedure is complex and beyond the usual practice of the restorative dentist. Prosthodontists may place implants as part of their patients’ reconstructions, but they also may refer with instructions and surgical templates when the implant placement is beyond their level of competence. An example would be referral to an oral and maxillofacial surgeon complicated surgical procedures or for patients with serious medical conditions. Referral to a periodontist might be indicated when a patient exhibits significant periodontal disease that needs to be treated in combination with the implant placement.
Placement of implants without careful diagnosis and treatment planning should be avoided. The more complex and/or extensive the care, the more critical the provider knowledge and experience is to obtaining a satisfactory outcome for the patient. Implants placed with improper position, orientation, or without adequate space for the restoration can result in compromise of function, durability, esthetics or any combination of these problems. Implants may even need to be removed to get appropriate results for the patient. In addition to producing a compromised outcome, restoration of improperly placed implants can be expensive and burdensome.
It is the position of the American College of Prosthodontists that the procedures dentists perform should meet the standard of care for that procedure. A dentist should refer to a specialist those implant procedures they are not experienced and trained to do. Dental specialists also vary in their level of experience and training relative to the use of dental implants and should not perform procedures they are not experienced and trained to do.
In summary, not all restorative dentists and dental specialists routinely perform dental implant therapy in their practice. When considering a dental implant, patients should ask what training and credentials a particular dentist has that makes them appropriately qualified to perform the implant procedure. Just as in medicine, consumers should research their dentist’s credentials and training.
Some questions that a patient could ask a dentist include:
1. How often do you do this procedure?
2. What has been your training in this procedure? How long was it? (A weekend type course, 14- 20weeks of continuing education, specialty training at an accredited dental school etc.?)
3. Do you take implant continuing education courses?
4. What is the success rate for this procedure for me and how long can it last?
5. How long will the procedure take from beginning until I have my permanent teeth?
6. Will I have to be without teeth for any period of time?
7. How much will it cost for the entire treatment from start to completion?
8. How much will it cost for follow-up maintenance of my restoration?
9. What are alternative treatment options for this procedure?
John R. Agar, DDS, MA, FACP
Approved ACP Executive Committee: October 1, 2014
Affirmed ACP Board of Directors: November 4, 2014
Revisions affirmed ACP Board of Directors: June 13, 2015
Revisions approved ACP Executive Committee: June 9, 2019
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