Why Don’t General Dentists Place More Implants?

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).

4. I need to be all digital in order to successfully place and restore implants—If you do have the right kind of practice, investing in integrative digital technology can be a tremendous benefit to your practice, not only in the area of implants, but in many other phases of dentistry. Do a lot of due diligence in this area, as making the right kind of decisions can really take your practice to the next level, while making the wrong decisions can bankrupt you. Can you surgically place dental implants without a digital workflow? The answer is absolutely. As you grow in dental implantology, then there are many opportunities for various uses of digital technology when it makes sense for you and your practice.

5. I’m confused by all of the implant systems out there—So were we all when we first got started! Learn the differences and make the right choices for you and your patients. Most dental professionals are equally confused by all the composite resins out there; bonding agents, glass ionomers, crown and bridge material choices; and a myriad of other choices; choices that dentists have to make each and every day that they practice. You work your way through it, you choose what is right for your patients, and you and your team can do the same with implants. It is a lot of pieces and parts, but let me boil it down for you—you have to choose a drill, you have to pick a screw, and then you have to choose the attachment that fits inside the screw. After that, it’s just like putting a crown on any other tooth in the mouth. By the way, now many dental laboratories are starting to make the process much easier for dentists worldwide. Many dental laboratories (such as Glidewell, Burbank, and Aurum Ceramic) have all-inclusive packages that take you from placing the implant all the way through the delivery of the final restoration. I applaud these laboratories, as this has made the pricing much simpler for dental professionals to understand, also helping the doctor figure out appropriate patient fees. Some of these programs have even started to offer some warranty programs on the implants, which is a tremendous leap forward for implant dentistry.

6. The training is long and expensive—Well, let’s put that into perspective. Do you remember dental school? How long did that take? How much did it cost? The training to become a dentist was long and expensive. Now that you know your way around the mouth, dental implant training is not long, nor is it comparatively expensive. I recommend to all dentists, no matter what kind of training they are getting—whether it is sleep apnea, no-preparation veneers, Botox and dermal filler training, or dental implants—start on the easiest cases, get training and learn how to master them, and then start to build your way up. If you now know that 80% of implants are single-unit cases, start with training that will teach you those cases. This is going to be the bulk of any implant practice anyway, and those are usually the easiest to accomplish. Here is what you need to learn in training, no matter what phase of dentistry: anatomy, physiology, technique, products available, how to fix complications, and mostly, how to avoid complications.
Here is an important idea—if you are a GP, look for dental implant training that is geared toward the GP. That is the real key. If you do not have surgical experience, then you need a course specifically designed for your skill level as you begin your journey into implant dentistry. You also ideally would like a course that speaks directly to you and your dental practice from faculty that have practices like yours so you can see how to properly integrate your new skills into your office.

CLOSING COMMENTS
The bottom line is that surgically placing dental implants today is a straightforward procedure for the most common cases. Anesthesia is easy to accomplish, which makes this a painless procedure to the patient, and with proper instrumentation, it is a fairly quick procedure with proper planning. You can surgically place a dental implant much faster than you can do a crown preparation, an endo procedure, or MOD composite resin restoration. Stop with the excuses and get started today!


Dr. Malcmacher is a practicing general dentist and an internationally known lecturer and author. He is president of the American Academy of Facial Esthetics. His Web site, commonsensedentistry.com, contains information about his hottest topics seminar schedule and live patient hands-on Botox and dermal filler training courses, frontline TMJ/headaches/facial pain training course, his resource list, and a free monthly e-newsletter. He can be reached at (800) 952-0521 or via e-mail at drlouis@facialesthetics.com.

Disclosure: Dr. Malcmacher reports no disclosures.



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