Position Statement of the American College of Prosthodontists
Placement of dental implants is a procedure, not an American Dental Association (ADA) recognized Dental Specialty. Dental implants like all dental procedures require dental education and training.
Implant therapy is a prosthodontic procedure with radiographic and surgical components. Using a dental implant to replace missing teeth is dictated by individual patient needs as determined by their dentist. An implant is a device approved and regulated by the FDA, 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.
A General Dentist who is trained to place and restore implants may be the appropriate practitioner to provide care for dental implant procedures. This will vary depending on an individual clinician’s amount of training and experience. However, the General Dentist should know when care should be referred to a specialist (a Prosthodontist, a Periodontist or an Oral and Maxillofacial Surgeon). Practitioners should not try to provide care beyond their level of competence.
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. General Dentists are experienced in restorative procedures, and many have been trained and know requirements for the dental implant restorations they provide.
However, 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 guide(s) for appropriate care.
Likewise, the patient should be referred to a Prosthodontic specialist (a Prosthodontist) if the restorative procedure is complex and beyond the usual practice of the General Dentist. Prosthodontists may place implants as part of their patients’ reconstruction, but they also may refer with instructions and surgical guides when the implant placement is beyond their level of competence. An example would be referral to an Oral and Maxillofacial Surgeon for more complicated surgical procedures or for patients with serious medical conditions. Referral to a Periodontist would be indicated when a patient exhibits significant periodontal disease that needs to be treated in combination with the implant restorations.
Dentists vary greatly in the procedures they perform and the ones they refer. Procedures that dentists perform should meet the standard of care for that procedure. A dentist should refer to a specialist those 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. Therefore, any practitioner’s implant knowledge and experience needs to be known by the referring dentist and to the patient regardless of the specialty.
Placement of implants without careful diagnosis and treatment planning should be avoided. The more complex and extensive the care, the more important it is to obtaining a satisfactory outcome for the patient. Implants placed without proper planning can result in an implant being placed with improper position, orientation, or without adequate space for the restoration. This can result in compromise of function, durability, esthetics or any combination of these problems. Implants may even need to be removed to get anticipated results for the patient. In addition to producing a compromised outcome, restoration of improperly placed implants can be expensive and burdensome.
In summary, not all General Dentists and Dental Specialists 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 appropriate to be doing the implant procedure. Just as in medicine, consumers should research their dentist’s credentials and training. They should ask the same questions about any dentist(s) they may be referred to for all or part of the implant care. A list of some good questions to ask is below. Patients should check a dentist’s web site for information and also check for comments by patients on the web.
1. How often do you do this procedure?
2. How many times have you done this procedure?
3. What has been your training in this procedure? How long was it? (weekend course, lecture, 14- 20 weeks CE at a dental school, or years of specialty training at an accredited dental school?)
4. Where were you taught?
5. Do you take lifelong learning / Continuing Education credit and if so, when, where, how often and in what area?
6. What’s the success rate for this procedure for me and how long will it last?
7. How long will the procedure take from beginning until I have my permanent teeth?
8. Will I have to be without teeth for any period of time?
9. How much will it cost for the entire treatment from start to completion?
10. How much will it cost for follow-up maintenance of my restoration?
11. What are alternative treatment options for this procedure?
12. What training do you have in these alternative options?
13. May I get my treatment plan in writing?
14. How do you feel about me getting a second opinion?
John R. Agar, DDS, MA, FACP
Approved ACP Executive Committee: October 1, 2014
Affirmed ACP Board of Directors: November 4, 2014
Revisions approved ACP Executive Committee: April 18, 2015
Revisions affirmed ACP Board of Directors: June 13, 2015
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