Implants and General Dentistry

At a recent lecture that I gave at a major dental meeting, I asked the few hundred dental professionals in attendance, “How many of you restore dental implants?” It was no surprise that approximately 90% of the audience raised their hands. My next question to them was, “How many of you surgically place dental implants?” I would estimate that not even 10% of the hands went up. This group, mostly general dentists (GPs), is reflective of just about every lecture that I have given in North America in the last 10 years. For some very strange reason, only about 8% to 10% of general dental clinicians in North America actually place dental implants.

RECENT SURVEY RESULTS
In surveying the nearly 7, 000 members of the American Academy of Facial Esthetics (AAFE), this survey resulted in about 20% of the membership surgically placing and restoring dental implants. Not surprising, as this group represents dentists and healthcare professionals who are often early adopters in techniques to treat facial aesthetics and facial pain—implants are a very important element in both facial pain and facial aesthetic treatment. This is still a relatively small number, when you look at the global dental implant market. In most other countries around the world, 80% to 90% of GPs surgically place and restore implants. Why would this be the case? Why is general dentistry in North America so far behind the rest of the world in surgical placement of dental implants, and yet we are so advanced in so many other aspects?
General dentists around the world certainly have proven that it is well within the capability of every GP to be able to surgically place dental implants. So, what is stopping you, the North American GP, from surgically placing implants? From speaking to thousands of dental professionals each year in all of my various programs and surveying the AAFE membership on a regular basis, the following are the reasons I hear from GPs as to why they do not surgically place dental implants. I will follow this with my own viewpoint, with the goal of hopefully stimulating you to learn more about this fast-growing area of dentistry that you need to incorporate into your practice.

REASONS GENERAL DENTISTS DON'T PLACE IMPLANTS
1. The surgical procedure is difficult—I hear this quite often, so let me tell you this: just yesterday in my office I prepared an upper second molar for a crown on a young patient with limited opening. Now, that is really difficult! Yet, I performed the procedure despite the difficulties that needed to be overcome. The surgical procedure for placing an implant is much easier than that of second molar crown prep. Dental implant placement is very similar to screwing a screw into a very hard wooden board. Some people are going to scream at me for the simplicity of that analogy but, truth be told, if you are placing an implant into cortical bone, it is not all that different. Of course, you need to know the anatomy involved, as well as the proper choice of equipment to make it seem easy, but the actual physical and clinical procedure is not very difficult to accomplish for the present skill set of most general dentists.

2. I need to buy a lot of expensive equipment—No, you don’t, not if you are going to start off with mostly single-unit implant cases, which is the starting point for nearly every dental practitioner beginning to place dental implants. Did you know that most dental implants placed are single units? In speaking to many implantologists as well as the large laboratories in North America, their experience and statistics come out pretty much like this—approximately 80% of implants placed are single-unit restorations, with 70% being posterior teeth, with anywhere of 30% to 35% of those being the lower first molar. Do those statistics sound familiar? Because they are relatively close to the exact same statistics that we have had for the last 50 years in crown and bridge dentistry. In terms of the equipment, you can easily start with a basic surgical kit that is provided with just about any implant system, costing between $2, 000 to $5, 000. That is just about all you would need to surgically place a single-unit dental implant. Considering that patient implant fees can be between $3, 000 to $4, 000 per implant, you will easily and quickly recoup your initial investment.

3. I need to have a computed tomography (CT) scan or a cone beam (CB) unit to surgically place dental implants—Hear me and hear me well: Despite what you see in many dental journals that describe implant cases, a CT scan or a CB is a necessity in some implant cases, but certainly not in all or even most implant cases, especially when you are doing a single-unit dental implant in an area that has sufficient bone and very few worrisome anatomical structures around the area where you are going to place the implant. I am a big proponent of CB units in dentistry, but they have to be used judiciously, and one has to weigh the risks/benefits of their use. While CB may be nice to have in every case, don’t let anyone tell you that it is absolutely essential for simple implant cases (which will be the bulk of the cases you will first be doing).