The Implant Practice

Michael Tischler, DDS


GPs are in an ideal position to provide dental implant services, since a majority of us have a pool of patients in our own practice who need these services. In fact, the more comfortable and educated general dentists are, the more implant services that they will find when examining their own patients.

This month’s Implants Today topic is “The Implant Practice.” General practitioners (GPs) who choose to bring dental implant surgical and/or prosthetic treatment to their practice will face many practice management and implementation challenges that must be addressed for practice and clinical success. Some tasks and topics that a GP needs to address when providing implant services to their patients are the following: facility design considerations, appropriate training and credentials for all team members, communication issues, appropriate marketing services, coordination with the general dental practice, ordering and organization of equipment and materials, and much more. While the responsibility of providing implant services is certainly formidable, so are the rewards for the dentist, practice, and the permanency of services that dental implants offer our patients. GPs are in an ideal position to provide dental implant services, since a majority of us have a pool of patients in our own practice who need these services. In fact, the more comfortable and educated general dentists are, the more implant services that they will find when examining their own patients.

For GPs wishing to successfully add implant services to their practice, they should start with a vision and a plan for the desired goals. Personally, I recommend that the goals be written down with a defined time frame for implementation. By writing down goals, one solidifies a commitment and facilitates the process. A realistic time frame for implementation, training, and credentialing is 3 to 5 years from just starting out. When both the surgical and prosthetic aspects are going to be taken on by a general dentist, 5 years is a realistic time frame. When there is a true passion for the field of implant dentistry and a high level of respect for the amazing results that dental implants can offer our patients, this 3- to 5-year path for practice implementation is a pleasure, not a struggle. After almost 20 years of providing implant surgical and prosthetic services in my own practice, I can happily say that I still enjoy learning and improving my implant skills and knowledge.

A great starting point for clinicians who want to learn more—and to fully implement these services into their practices—is to join one or more of the excellent implant organizations. The American Academy of Implant Dentistry (AAID), International Congress of Oral Implantologists (ICOI), and Academy of Osteointegration (AO) offer credentialing and training for implant dentists and their teams. Credentialing is an important part of success as it challenges a dentist to learn more and also allows for increased medical legal protection. Communication with experienced local clinicians who provide implant services is also recommended. This is especially true early on, when starting out in implant surgery. Mentorship has tremendous value, and it is important to realize that especially when beginning the learning process, one will not be treating every implant case. Most experienced and dedicated implant dentists understand this and will be glad to help a fellow clinician grow their knowledge and experience.

The dental facility that supports implant dentistry should support the goals spelled out by the practitioner. The facility needs to adequately represent this discipline of dentistry that requires an often self-pay procedure, higher costs, and a more clinically demanding discipline than other nonsurgical-based services. The dental office should be meticulously maintained, offer an updated design to set it apart, and offer adequate space for the clinical implant procedures. This ergonomic and aesthetic design of the dental office ties into the marketing that attracts and maintains implant patients.

Marketing dental implants is an important part of financial success as a GP promoting implant services. It also sets the practitioner apart from others in his or her local market. Marketing should not only represent the implant services and facility of the implant dentist, but should also represent the credentials, clinical work performed, and overall philosophy of the practitioner. This is the message that represents the brand of the practice. This branding process requires an informative and attractive web­site, combined with options of print, TV, radio, and/or other advertisement that is in line with the vision of the practice. I recommend continuity in all advertising and branding with respect to colors, fonts, and themes.

Staffing an implant-focused practice is somewhat more demanding than that of a general dental practice. The surgically based intensity of implants, as a discipline, requires a parallel intensity in the support staff with regards to training, material and supply organization, case presentation skills, dealing with problems and complications, and coordinating all of this with the concurrent dental practice. A large part of successfully implementing implant dentistry into a practice, especially with large treatment plans, is acquiring the ability to effectively present these treatment plans to patients. This requires a treatment plan coordinator who is confident, a good communicator, and very knowledgeable about implant dentistry. There are other chairside and appointing positions in an implant-based practice that also require the same skills. To have employees who can fill these needs requires both focused hiring criteria and then appropriate training once hired. Involvement with the previously mentioned implant organizations and their auxiliary training programs are excellent resources for training the chairside and office teams.

Staff roles go beyond just presenting, communicating with patients, and chairside assisting. An implant-focused practice requires organizational skills and knowledge of implant parts/pieces and adjunctive materials and techniques, such as bone grafting products and membranes. An in-depth knowledge about implant prosthetics is required in order to be able to facilitate this. It is also imperative to stay abreast of the latest advances. Dental journals and continuing education venues can help with this goal. With the abundance of different parts/pieces often needed to support dental implants and the inventory of dental implants, an organized inventory system is needed. It is also recommended that in-depth labeling be done on all equipment and trays so that everything can be found efficiently when needed. With often challenging surgical and prosthetic situations being pre­sented with implant dental treatment, this organization and knowledge of parts/pieces is needed to create treatment excellence.

As a general dentist, bringing implant services into a practice can be energizing for both the practice environment and the team. The tie-in with a general dental practice needs to be done with awareness to the delicate nature of this relationship. Each team member must have his or her role clearly defined, so that any coordination is in harmony with the whole team. The hygienist(s) must be especially aware and knowledgeable of the GP’s implant vision for the practice, as hygienists have daily contact with patients and can facilitate communication with the rest of the team. It is also important for the hygienist(s) in a practice to know the latest hygiene techniques related to implants. Another important link of implant services to a general dental practice relates to scheduling. Implant services often require longer appointments, and with surgical procedures, uninterrupted appointments. This often requires block scheduling, and the inability to perform hygiene exams. These scheduling dynamics have to be taken into account. Lastly, there needs to be coordination and communication of the practice with the dental lab, and this also requires a different skill set than nonimplant-supported dentistry.

In this issue, we have 2 excellent articles that exemplify the points related to running an implant related practice that I have made above. First, Drs. Wendy AuClair Clark, Ronald Goldstein, Maurice Salama, and Implants Today Advisory Board member David Garber have a benchmark article for this section, appropriately entitled “The Implant Practice.” This article addresses the importance of the team in implementing implant excellence and the roles of the team members with regards to education, hiring, and flow to make this happen. The importance of the right equipment is shown, especially the proper use of CBCT technology, as an example. Their article is brought to reality by showing the treatment steps for full-arch immediate loading of a patient’s maxillary arch with a zirconia screw-retained bridge. Through understanding the case presented, one can truly see the immense coordination that is required, the many products needed, and the work it takes for clinical success with an implant cases.

Dr. Tim Kosinski, an Implants Today Advisory Board member, contributed another compelling article, entitled “A Simple and Cost-Effective Socket Grafting Technique.” This case report article also eloquently shows how coordinated team efforts are needed for clinical success. The knowl­edge of treatment planning—of every supply needed and the team coordination with regards to ordering and organizing the materials and treatment—is essential for a great patient outcome.

The rewards of bringing dental implant services are numerous, as is the responsibility to make it happen. Through passion for dental implants, a vision, and taking the time for education of the doctor and team, a general dental practice can predictably and successfully deliver implant-related services.