What to Look For When Selecting the Right Dentist For Your Implants
In the early days of implants only specialists—periodontists, prosthodontists and oral surgeons—placed and restored implants. Oral surgeons or periodontists often placed the implants and prosthodontists (dentists who specialize in restoring teeth) crafted the teeth that fitted onto the implants. Today most general dentists do both procedures, often without adequate training, which complicates the selection process for patients enormously.
Most specialists go through 2 to 3 years post doctoral training in implants. My residency included both periodontal work and implants. We not only learned how to properly place them but also how to do bone grafts and sinus lifts which are often necessary as part of the process. However, there are implant gurus out there who claim to teach dentists to do implants in a weekend. There is so much incompetence in the field that some law firms are dedicated just to suing dentists over implants.
This does not mean a dentist has to be a specialist to do implants. There are legitimate training programs that train general dentists in implantology. However they last for 2 to 3 years, not 2 to 3 days or weeks.
Placing an implant is not a simple matter of putting a screw into the bone. Implants are complicated, involving a two stage process—the first is surgical, where the implant is placed in the jaw. Surgery requires anesthesia and often, antibiotics, which requires extensive training, especially when it comes to working on patients who have pre-existing conditions like diabetes or heart disease. The second stage is restorative, where the tooth or teeth are fitted onto the implant/s. This stage takes skill in prosthetic dentistry.
The dentist needs to understand the anatomy of the jaw, where the nerves and blood vessels are located, how to determine if there is enough bone, where the sinus is. If, for example, an implant is placed in the wrong direction the restoring dentist can’t make a properly formed tooth. There may not be enough bone, or periodontal disease can develop around the implant. Three to four years later the restoration can look terrible. There are dentists who place implants into nerves, or lose them because there isn’t enough bone, or even put them into the tooth next to where the implant should go. As a periodontist and implant specialist I see a lot of these disasters because patients come to me to fix the mistakes other dentists have made.
I strongly recommend that when it comes to implants, you should ask for the dentist’s credentials, specifically where they’ve been trained and how long the program lasted. Ask to see photos of patients with implants. Ask if the dentist is certified in implantology. There are organizations that certify implant dentists: The American Academy of Periodontology, the International Congress of Implantologists, and the American Board of Implant Dentistry. Ask your dentist how many implants he has placed. One rule of thumb is sheer experience. There’s a study in the Journal of Oral and Maxillofacial Surgery that says you’re not considered competent until you’ve placed at least 50 to 150 implants. Implant societies require placement of over 200 implants for membership.
The wise dentist knows his limitations. When I was a general dentist I referred out root canals even though they’re very lucrative because I wasn’t good at them. The same should apply to implants.
by Dr. Nicholas Toscano
About Dr. Nicholas Toscano
Dr. Nicholas Toscano, a board certified periodontist, received his D.D.S from Columbia University School of Dental Medicine in New York, NY. in 199X. He has been practicing for X years. He completed a General Practice Residency at the prestigious National Naval Medical Center ("The President's Hospital") in Bethesda, MD. During his 13 years in the United States Navy he received 2 Navy and Marine Corp Commendation Medals. He is currently Co-Editor in Chief of the Journal of Implant and Advanced Clinical Dentistry. His practice is at www.manhattanperiodontist.com
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