OPTIONS, options, options – that is all we dentists seem to hear about. Not only must we ensure our patients are aware of all the options, but also the advantages and disadvantages of all the relevant treatment modalities. And then there is the process of informed consent to contend with. As dentistry becomes more and more litigious, and treatments more complicated, it can leave the patient as confused as a cow on Astroturf.
And that is just the patient. What about you, the young enthusiastic dentist? Not only do you need to worry about your patients, you also have a career to plan which brings with it a further array of confusing options. All of a sudden the cow looks all-knowing, and you start to look out of the window at the rolling fields surrounding your student bedsit, day-dreaming of driving the latest Massey Ferguson tractor, thinking: “stuff it, I’ll become a farmer!”
However, before you rush out to buy the latest pair of designer Wellingtons, rest assured that things are not that bad. The Dental Foundation Training programme is an excellent, well organised, structured year that allows you to experience many career opportunities. By the end of it you are more equipped to make informed decisions about the rest of your life and the thought of making an abrupt career change into farming should be a distant memory.
Implant dentistry is certainly one career option that offers both challenge and reward to a young dentist. It can produce great results for the patient and dentist and can also be financially beneficial. But how do you know if it is for you? The skills and qualities needed for implantology include:
- Basic surgical experience
- In-depth understanding of the periodontal tissues
- In-depth understanding of medical histories
- Commitment to postgraduate and on-going education
- Thorough knowledge of all treatment options and the ability to explain these in an impartial, objective manner
- Effective team participation/management
- Forward planning and organisation
- Confidence in own ability
- Ability to manage patient expectation.
Even if your skill set does not naturally lead you towards dental implants, it is important that you know the essential principles. That way you can properly advise your patient and guide them through the consent process. For dentists there are three broad options to consider when it comes to implant dentistry: recognise and refer all implant cases; recognise and refer the surgical phase but restore implants that have been placed by a trained surgeon; or undertake both the surgical and restorative components.
Placing dental implants is a surgical procedure which should only be carried out by a suitably trained dentist. Not all dentists who want to offer implants have to place them and those who are not comfortable with the idea of doing the surgery can consider teaming up with a suitably trained partner who is.
The ADI (Association of Dental Implantology) can simplify the options and guide you through the postgraduate requirements that are needed for you to undertake implant work. Since its formation in 1987, the ADI has been dedicated to providing ongoing postgraduate education to the dental profession in order to extend awareness of dental implant treatment as an option for improving patient oral health. Its range of educational opportunities is varied, from specialised implant journals to masterclasses, evening study clubs to international congresses. Problems can be discussed on a secure clinical forum and increasingly important implant audit facilities (Implant Logbook) freely accessed. Members can also access a membership directory, a monthly ADI e-update and will receive a certificate of membership.
The guidance Training Standards in Implant Dentistry 2008 from the Faculty of General Dental Practice (UK) and the Royal College of Surgeons of England sets out the requirements that are needed to undertake implant work. It states that the clinician must have a detailed knowledge and understanding of dental implants, be mentored, have the appropriate indemnity and keep a log of cases and outcomes. It further states that you, the clinician, should develop systematically, ensuring competency in the more straightforward cases, before going on to treat the more complex patients. The General Dental Council has confirmed that it will refer to these guidelines when assessing complaints against dentists who are accused of practising implant dentistry beyond their competence.
It is clear that formal training is needed to fulfil these requirements. There are many different and excellent courses available to you. These include privately and commercially run courses, online courses such as Ark, diplomas at university and the Royal College of Surgeons, and at MSc level.
A good approach to implant dentistry is to firstly ensure that you fulfil the desirable qualities, then try to get as much exposure and experience as you can. Implantologists adore being observed and welcome young dentists who want to get involved with treatment planning, observing the surgery and restorative stages, and being actively involved in the very important maintenance phase.
Once you have started gaining experience and understanding, enrol on a private course (the commercial implant companies or the ADI can help you decide which is best for you), then as you progress undertake formal qualifications from a university or Royal College. This of course can be done alongside your generalist responsibilities and other postgraduate qualifications.
If implant dentistry is suited to you and you are willing to commit to the ongoing education and approach it in a structured well-organised manner, slowly building up your competence, experience, formal knowledge and skill base, all under the supervision of a qualified mentor, then the opportunities are vast. These include professional respect, patient satisfaction, remuneration, and personal fulfilment.
Soon you will no longer look out of the window of your fantastic implant surgery and contemplate becoming a farmer. You will look at cows in the field not for their milk, but for their femur bone graft material that is used to support your implants.
Dr Simon Wright BDS MSc PGCTLCP PGDip Dental Implantology FHEA is principal partner with Glencairn Practice Group, senior lecturer University Salford Dental Implantology, Director of Education at the ADI and chairman of the Local Engagement Network for Wirral PCT
Q&A - Zoe Wray, studying for a Masters degree in implant dentistry
What inspired you to take up implant dentistry?
I have always had an interest in oral surgery having worked as a maxillofacial SHO for two years after my vocational training. Implantology seemed a natural progression. I also realised that other methods of replacing missing teeth were outdated by implants, and that in most cases the disadvantages of these methods far outweigh the advantages.
Did you find the training a challenge?
Yes. Finding training courses that are worthwhile undertaking is difficult. There was not a network of mentors available when I trained, which there is now. The MSc in implantology has been very useful, providing me with the skills to assess current advances in the field. My training will be on-going. There will always be advances in implant dentistry and it will always be necessary to be aware of these and put them into practice.
What did you enjoy most about it?
I enjoy meeting colleagues, being able to discuss cases with them and how they implement processes, policies and procedures in their practices and also finding out and evaluating the evidence behind my everyday implantology work. I hadn’t realised that there are very limited studies in the field and there is a lack of good quality studies to underpin our work.
What did you find most surprising?
I was surprised at the lack of formal training available, especially recognised hands-on courses.
Do you see any downsides to the practice of implant dentistry?
Yes, as I’ve mentioned before there are issues surrounding training. Dentists can undertake implant dentistry with very little extra training and there is limited support available. I think that implantology is all about treatment planning. Anyone can place an implant, that’s the easy part, but if the case is not treatment planned correctly then big mistakes can be made.
What attributes do you feel are important in implant dentistry?
I think it is important to have good communication skills. It is also beneficial to have a good foundation in restorative dentistry as well as surgical. Being able to treatment plan and build-in contingency measures is also a useful attribute.
Is there one piece of advice you could give to a dentist considering further training in implant dentistry?
I would advise anyone who is interested in following this particular path to research the courses available and make sure you select the right course for you. This might involve having to go on several different courses before you find the one that suits you. The MSc I’m undertaking is not a hands on-course and you benefit from it most if you have already had hands-on experience.