Beginning the Journey Into Dental Implant Treatment

The provision of implants is similar to the provision of endodontic therapy in that it is critical to assess the challenges and risks associated with the treatment. Oftentimes, dentists who are early in their careers try to treat more challenging endodontic cases because they lack the training and experience to properly assess the difficulty. For example, cases involving "S-shaped" canals can be some of the most challenging ones undertaken by highly trained endodontists. However, they can usually perform these procedures without much difficulty due to the advanced skills that they have acquired through their training. Similarly, training helps general dentists who are beginning their journeys into performing dental implant surgery to understand which cases are the riskiest. It is critical to understand the level of difficulty of each case in order to determine which ones should be referred to a specialist. That being said, there are many surgical  implant cases that the general dentist can perform very successfully at a high level of competence.

Most dental schools do not offer a surgical program for graduating dentists to complete during their dental training. This is unfortunate because there are many cases that can be skillfully completed using digital planning with cone-beam computed tomography (CBCT) and guided surgical protocols. Understanding the planning of dental implants is a key component of selecting a surgical program. Surgical education must be well-founded in the roots of evidence-based dentistry, treatment planning, and the science of implant dentistry.

In my opinion, it is absolutely critical to have a strong restorative background prior to performing the surgical placement of dental implants. As an instructor educating new dentists about surgical implant placement, the most challenging aspect can often be assessing students' readiness to perform dental implant therapy, and it is often the dentists who are very experienced in the restorative aspects of implant dentistry who become the best implant surgeons.

It is imperative that dentists utilize their "tacit knowledge" when performing the new implant therapies that they will learn during their professional careers. Tacit knowledge, or implicit knowledge, involves information that is difficult to transfer to another person by means of writing it down or verbalizing it. Dentists utilize this type of knowledge every day in their clinical work. The successful placement of dental implants is very grounded in the touch and feel of doing the procedure rather than merely replicating the steps that were described during training. Procedures can be easily visualized by watching them on the internet; however, really getting the feel of the angles and complexity of a procedure will require the application of tacit knowledge as experience is gained. Early in your implant journey, performing procedures can be stressful and scary. But through education and ongoing experience, you will acquire additional tacit knowledge that will increase your confidence and decrease the stress involved.

This is where the role of hands-on training is essential to the learning process. Watching someone else perform the procedure doesn't help you develop the ability to feel the difference in the sensation of light bone versus dense bone. Dentists need to learn procedures with both their minds and their hands.

Overall, it is important to understand that implant dentistry is a surgical-prosthetic field. General dentists should treat at least 50 cases in which they restore dental implants prior to attempting to perform the surgical aspect of implant therapy. Furthermore, the surgical journey of a general dentist should be paced in a way that minimizes the amount of risk early on, then progressively adds more challenging cases as the dentist continues to gain more experience and receive more education. It is very possible for a general dentist to acquire the skills to perform many surgical procedures in implant dentistry; however, it is important to understand that the primary benefit of being a general dentist with these skills is that you are able to select the cases that you want to handle yourself in your office and refer the rest to a specialist team. Having a good relationship with a local implant specialist will be an important aspect of your continued growth.

For many dentists, the implant educational path involves training that is both formal and informal. It is recommended to base your training on education from a learning organization/mentor and to place an emphasis on guided surgical approaches that are taught using both template and navigational methods. Proper treatment planning in both analog and digital formats is imperative to success. You need to be able to see the forest for the trees, not just fill empty holes with dental implants.

Lastly, it is paramount that general dentists acknowledge that patients are expecting them to provide optimal care that is both predictable and knowledge based. A proper assessment of the risks of implant therapy must be completed for every patient and effectively communicated. Beginning by performing treatments to restore implants in your office will allow you to gain experience so that you can properly assess and ultimately learn to provide implants for the patients who walk in your door. Like endodontic cases involving s-shaped root canals, some very complex implant cases exist and need to be recognized. To optimize your success, ensure that your pursuit of implant training is a lifelong effort involving mentors that possess the maximum amount of experience that you can find. Never stop learning!

Scott MacLean, DDS, is a cosmetic and implant dentist who practices in Halifax, Nova Scotia, Canada.