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Implant Dentistry: Growing Our Opportunities
EDITORIAL J Oral Maxillofac Surg 75:1-2, 2017
Implant Dentistry: Growing Our Opportunities The thought that our national association hasn’t done enough to promote the OMS’s major role in providing various types of surgical services for patients undergoing implant dentistry is a stretch. The association sponsors and conducts a very wellattended, cutting-edge, multidisciplinary implant conference each December. In addition, our annual meeting and scientific sessions have a large number of implant-related courses, seminars, and symposiums. The currently running major multimedia informational campaign has a generous segment devoted to educating the general public of the capabilities of our specialty in the provision of implant dentistry. As with other clinical arenas, the means of building a strong reputation in the area of implant surgery goes beyond national campaigns or making any attempt to limit competition. In my mind, there are 2 principal methods of attaining success in an area of practice. The first relates to local business strategies, and the second relates to helping ensure dentists entering practice are aware of and appreciate what we have to offer. There is no mystery in what an individual or groups of OMSs should do to help grow and maintain a robust implant practice. They are, in this order: 1) have a well-located, well-managed office, 2) provide highquality implant surgical care, 3) create satisfied and even delighted patients (in all aspects of one’s practice), and 4) develop personal and collaborative relationships with and satisfy referring clinicians. Obviously, this is all easier said than done, but should be a major part of an OMS practice’s strategic plan. Implant dentistry for many years was in the curriculum backwaters of many dental schools and colleges. For most educational institutions this is no longer the case. Implant care for patients has become a core part of the dental curriculum in a large percentage of schools and is required by accreditation guidelines in general dental and most dental specialty residency programs. In all dental schools and colleges didactic learning about implant dentistry occurs, and in many institutions students can or even must learn how to do some implant retained or supported restorative dentistry. Some schools also teach students how to place implants on jaw replicas and/or on actual patients.
Implant dentistry has become a major aspect of dental care provided in North America and in other parts of the world. Millions of patients have had dental implants placed and restored over the past 30 some years ever since predictably successful dental implants were introduced to the United States and Canada by Ingvar Br anemark and his Swedish team. There continues to be a large backlog of patients who could benefit from dental implants, particularly for dentists striving to improve the affordability of implant dentistry. However, I regularly hear members of our specialty express concern about the volume of implant surgery they provide. In some cases the implant surgery part of their practice is not growing, while many others see the proportion of implant cases falling in relation to other surgical services. There are various explanations oral-maxillofacial surgery practitioners give for the stagnation or decline in the demand for implant care in their offices. Some believe it is due to growing competition by other dentists. Oral-maxillofacial surgeons (OMSs) wonder why so many implants are being placed by periodontists, prosthodontists, general dentists, and even endodontists. I’ve also heard complaints that our national association’s informational campaign is not doing enough to publicize the education and training in implant care our members possess and the extensive experience many OMSs have in advanced forms of implant surgery. With respect to competition from other dentists in the placement of dental implants, it is unfortunately a fact of life that procedures that can be learned with classroom and then clinical learning are virtually impossible to keep within one’s own domain, whether or not the training was adequate. Where would our own specialty be if those who preceded us in oral surgery did not push the scope of our practice beyond the removal of teeth and intraoral draining of infections under local anesthesia? Dental licensure regulations permit all licensed dentists to do implant surgery, leaving it to the marketplace to exert controls over who does what kinds of dental procedures. Although there was a relatively short period when the first major implant manufacturer limited training and the availability of implants to only OMSs in North America, that ended long ago.
1
2 Members of our specialty should be front and center in implant dentistry teaching at the pre- and postdoctoral levels, including serving on institutional implant care teams and committees. Yet, this is often not the case. Variables such as non–implant-related clinical demands, inadequate faculty numbers, and even, in some cases, lack of OMS faculty interest or capabilities can make it difficult for the OMS department of a dental school or college to help upcoming generations of dentists understand and appreciate the education, training, skills, and userfriendliness of OMSs. This has allowed periodontology and, in some schools, prosthodontics to take the lead role in teaching implant dentistry to students and non-OMS residents. This is particularly true with respect to our colleagues in periodontology. In most schools, this discipline enjoys a disproportionally large percentage of curriculum time in comparison to oral-maxillofacial surgery. This makes it incumbent upon oral-maxillofacial leadership in dental schools and colleges to lobby for a greater role in helping students and residents gain implant dentistry education and skills. OMS faculty need to be able, available, and affable to help establish our rightful place and reputation as they relate to all forms of surgery; this includes surgery to do advanced forms of site preparation and place dental implants, as well as manage implant patients with medical problems or benefiting from advanced forms of anesthesia for their surgery. Faculty should also develop collaborative relationships with other non-OMS faculty involved in teaching and providing implant-related dental care. All of this is already true in many dental schools, but needs to become the norm anyplace dental trainees are receiving implant training. Finally, the leadership of the AAOMS, recognizing the critical importance of supporting OMS faculty and the learning of implant dentistry by dental students and general practice residents, has approved the creation and wide distribution of a teaching guide
EDITORIAL
for implant dentistry. The guide has been produced as a supplement to the JOMS and hardcopies are being sent to all third-year dental students.* It also will be made viewable on the dental student portion of the AAOMS website and on the JOMS website. The guide is designed to be used by OMS faculty to help teach students and general dental residents the basics of implant dentistry, particularly as they relate to surgical placement. Heavy emphasis is placed on careful diagnostic evaluation and treatment planning. The basic steps in implant placement also are described to help students understand the restorative dentist’s important role in helping guide the number, size, and positioning of implants. The guide goes on to describe and illustrate the strategies used by OMSs to surgically compensate for jaw anatomy that would compromise the success of implant osseointegration or esthetics. Several cases are presented showing how OMSs can do surgical procedures that will help the restorative dentist manage challenging patient circumstances. The Student Guide to Implant Dentistry supplement to the JOMS will hopefully go a long way in helping younger dentists entering practice be aware of how working with an OMS will help them become successful in the care of their patients who would benefit from dental implants. JAMES R. HUPP, DMD, MD, JD EDITOR-IN-CHIEF
Ó 2016 Published by Elsevier Inc on behalf of the American Association of Oral and Maxillofacial Surgeons http://dx.doi.org/10.1016/j.joms.2016.10.016
*As with the previously created and distributed August 2015 suturing guide supplement to the JOMS, the implant dentistry guide will not be sent to JOMS subscribers. However, as with the suturing guide, all subscribers and nonsubscribers will have access to the implant dentistry guide on the AAOMS website in the dental student section and on the JOMS website.
Implant Dentistry: Growing Our Opportunities The thought that our national association hasn’t done enough to promote the OMS’s major role in providing various types of surgical services for patients undergoing implant dentistry is a stretch. The association sponsors and conducts a very wellattended, cutting-edge, multidisciplinary implant conference each December. In addition, our annual meeting and scientific sessions have a large number of implant-related courses, seminars, and symposiums. The currently running major multimedia informational campaign has a generous segment devoted to educating the general public of the capabilities of our specialty in the provision of implant dentistry. As with other clinical arenas, the means of building a strong reputation in the area of implant surgery goes beyond national campaigns or making any attempt to limit competition. In my mind, there are 2 principal methods of attaining success in an area of practice. The first relates to local business strategies, and the second relates to helping ensure dentists entering practice are aware of and appreciate what we have to offer. There is no mystery in what an individual or groups of OMSs should do to help grow and maintain a robust implant practice. They are, in this order: 1) have a well-located, well-managed office, 2) provide highquality implant surgical care, 3) create satisfied and even delighted patients (in all aspects of one’s practice), and 4) develop personal and collaborative relationships with and satisfy referring clinicians. Obviously, this is all easier said than done, but should be a major part of an OMS practice’s strategic plan. Implant dentistry for many years was in the curriculum backwaters of many dental schools and colleges. For most educational institutions this is no longer the case. Implant care for patients has become a core part of the dental curriculum in a large percentage of schools and is required by accreditation guidelines in general dental and most dental specialty residency programs. In all dental schools and colleges didactic learning about implant dentistry occurs, and in many institutions students can or even must learn how to do some implant retained or supported restorative dentistry. Some schools also teach students how to place implants on jaw replicas and/or on actual patients.
Implant dentistry has become a major aspect of dental care provided in North America and in other parts of the world. Millions of patients have had dental implants placed and restored over the past 30 some years ever since predictably successful dental implants were introduced to the United States and Canada by Ingvar Br anemark and his Swedish team. There continues to be a large backlog of patients who could benefit from dental implants, particularly for dentists striving to improve the affordability of implant dentistry. However, I regularly hear members of our specialty express concern about the volume of implant surgery they provide. In some cases the implant surgery part of their practice is not growing, while many others see the proportion of implant cases falling in relation to other surgical services. There are various explanations oral-maxillofacial surgery practitioners give for the stagnation or decline in the demand for implant care in their offices. Some believe it is due to growing competition by other dentists. Oral-maxillofacial surgeons (OMSs) wonder why so many implants are being placed by periodontists, prosthodontists, general dentists, and even endodontists. I’ve also heard complaints that our national association’s informational campaign is not doing enough to publicize the education and training in implant care our members possess and the extensive experience many OMSs have in advanced forms of implant surgery. With respect to competition from other dentists in the placement of dental implants, it is unfortunately a fact of life that procedures that can be learned with classroom and then clinical learning are virtually impossible to keep within one’s own domain, whether or not the training was adequate. Where would our own specialty be if those who preceded us in oral surgery did not push the scope of our practice beyond the removal of teeth and intraoral draining of infections under local anesthesia? Dental licensure regulations permit all licensed dentists to do implant surgery, leaving it to the marketplace to exert controls over who does what kinds of dental procedures. Although there was a relatively short period when the first major implant manufacturer limited training and the availability of implants to only OMSs in North America, that ended long ago.
1
2 Members of our specialty should be front and center in implant dentistry teaching at the pre- and postdoctoral levels, including serving on institutional implant care teams and committees. Yet, this is often not the case. Variables such as non–implant-related clinical demands, inadequate faculty numbers, and even, in some cases, lack of OMS faculty interest or capabilities can make it difficult for the OMS department of a dental school or college to help upcoming generations of dentists understand and appreciate the education, training, skills, and userfriendliness of OMSs. This has allowed periodontology and, in some schools, prosthodontics to take the lead role in teaching implant dentistry to students and non-OMS residents. This is particularly true with respect to our colleagues in periodontology. In most schools, this discipline enjoys a disproportionally large percentage of curriculum time in comparison to oral-maxillofacial surgery. This makes it incumbent upon oral-maxillofacial leadership in dental schools and colleges to lobby for a greater role in helping students and residents gain implant dentistry education and skills. OMS faculty need to be able, available, and affable to help establish our rightful place and reputation as they relate to all forms of surgery; this includes surgery to do advanced forms of site preparation and place dental implants, as well as manage implant patients with medical problems or benefiting from advanced forms of anesthesia for their surgery. Faculty should also develop collaborative relationships with other non-OMS faculty involved in teaching and providing implant-related dental care. All of this is already true in many dental schools, but needs to become the norm anyplace dental trainees are receiving implant training. Finally, the leadership of the AAOMS, recognizing the critical importance of supporting OMS faculty and the learning of implant dentistry by dental students and general practice residents, has approved the creation and wide distribution of a teaching guide
EDITORIAL
for implant dentistry. The guide has been produced as a supplement to the JOMS and hardcopies are being sent to all third-year dental students.* It also will be made viewable on the dental student portion of the AAOMS website and on the JOMS website. The guide is designed to be used by OMS faculty to help teach students and general dental residents the basics of implant dentistry, particularly as they relate to surgical placement. Heavy emphasis is placed on careful diagnostic evaluation and treatment planning. The basic steps in implant placement also are described to help students understand the restorative dentist’s important role in helping guide the number, size, and positioning of implants. The guide goes on to describe and illustrate the strategies used by OMSs to surgically compensate for jaw anatomy that would compromise the success of implant osseointegration or esthetics. Several cases are presented showing how OMSs can do surgical procedures that will help the restorative dentist manage challenging patient circumstances. The Student Guide to Implant Dentistry supplement to the JOMS will hopefully go a long way in helping younger dentists entering practice be aware of how working with an OMS will help them become successful in the care of their patients who would benefit from dental implants. JAMES R. HUPP, DMD, MD, JD EDITOR-IN-CHIEF
Ó 2016 Published by Elsevier Inc on behalf of the American Association of Oral and Maxillofacial Surgeons http://dx.doi.org/10.1016/j.joms.2016.10.016
*As with the previously created and distributed August 2015 suturing guide supplement to the JOMS, the implant dentistry guide will not be sent to JOMS subscribers. However, as with the suturing guide, all subscribers and nonsubscribers will have access to the implant dentistry guide on the AAOMS website in the dental student section and on the JOMS website.