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Dentistry 23 April 2019Clinical

Beginner’s guide to implant dentistryPaul Swanson gives an introductory overview to getting started in implant dentistry, with thought-provoking insight and the pitfalls to avoid

The UK, France and Germany are among those leading the way in Europe in terms of dental implant placement*. When you consider that Europe sees the greatest number of implants being placed worldwide*, this is an astonishing and energising fact.

For dentists and their teams, it means there are exciting opportunities in terms of career and practice progression.

As the baby boomers – the first generation to keep most of their natural teeth as they advance in years – continue to live well and for longer, the implant market will carry on growing.

With all of that in mind, this article offers an introductory overview of getting started in implant dentistry, presenting thought-provoking insight into the realities of this treatment modality.

Assessing patientsWhen a patient presents with a view to receiving dental implants there is, of course, a need for an initial assessment of their situation. The first thing is to establish if the patient is generally fit and well, medically speaking; for example, they don’t have any pre-existing conditions or medication that might impact on their suitability for treatment.

The next step is to establish their dental health, to ascertain the condition of the rest of the dentition and gingivae. Alongside this, as a matter of priority, the dentist needs to ‘stabilise’ the patient – put simply, get them out of pain and consider any urgent periodontal problems.

It is also important to assess whether they brux (if they do, any restoration might stand proud of worn away natural teeth over time) and if they are willing to take responsibility for their own oral healthcare between check-ups and hygiene appointments. How often do they go for check-ups? How often do they need hygiene appointments? If their current level of oral care is insufficient, are they willing to change?

If these considerations lead the dentist to believe implants may be a viable option, it is important to look at the bone volume and quality, both generally in the jaw and where an implant would be placed. If not, how that bone can be rebuilt needs to be thought about, as does the type of implant in terms of workable dimensions.

Communicating this to the patient is key, as is discussing other possible treatment options before anything else happens.

Managing patient expectationsPerhaps the biggest variable in implant dentistry is the patient. To manage (and, ultimately, exceed) expectations, the dentist needs to ask something along the lines of ‘what can I do for you? What brings you to see us?’.

The answer allows the dentist to gauge expectations very quickly, based on issues such as how critical they are about their appearance and their recounting of previous treatments. Their hopes as to the longevity and success of their treatment are key to a successful appraisal of the situation.

Dentists can find saying no to patients extremely daunting, but the ability to recognise what is wanted cannot be delivered is every bit as important as offering great clinical outcomes. That means there are occasions when you must let the patient down gently. There is no ‘right’ way to do this and it gets easier with experience; however, it is worth bearing in mind you are basing your ‘no’ decision on the patient’s needs and best interests, which can help enormously in finding the right words in individual situations.

Avoiding pitfallsDentistry is not always as straightforward as we would like it to be, and implant treatment is certainly no exception. As

mentioned earlier, clinicians need to be looking for adequate bone around the implant and healthy gums, as well as an absence of abscesses or the patient presenting with any pain or discomfort. Any such undesirable findings should set off alarms in the clinician’s head that something needs to be done to address these potential complications.

In terms of placing the implants themselves, they must be positioned in such a way that the restoration will look like it is in a natural position and has a good emergence profile, otherwise an aesthetic outcome is impossible to achieve.

Part of realising this goal is partnering with the best possible implant surgeon. Thus, it is important to understand what credentials the surgeon needs to have and what the restoring dentist should be getting back from the referral practice. For example, standard practice suggests the patient should be returned with some sort of covering letter, which should include, for example, all patient records, X-rays and photographs, copies of any letters, as well as any pricing information and after care advice.

Meeting demandAs the demand for implant dentistry continues to increase, dentists who are not prepared to manage their delivery and maintenance may well miss out in terms of career progression and satisfaction, as well as the financial benefits.

In the right hands, implant dentistry is an incredible skill to possess, so dentists who are interested in learning more should seek further advice and explore training options. For example, the Implant Restorative Course with IDEAL, pitched at beginner level, has been designed to ensure delegates leave confident and able to restore a single implant, as well as offering a greater awareness of multiple-unit restorations. Delegates also take part in interactive hands-on workshops and live surgical demonstrations. *Dental Implants Market - PMR’s analysis of global key trends, drivers, and restraints from supply and demand perspectives to 2020.

FOR FURTHER DETAILS on the restorative course options for you visit, www.theimplanthub.com/events.

Dr Paul SwansonOwner of a referral practice in Liverpool,

Royal College of Surgeons tutor, Liverpool University Dental Hospital honorary

lecturer and co-director of IDEAL

Enhanced CPD, courtesy of Biohorizons Learning outcomes: A, B, C, DThis article is equivalent to one hour of enhanced CPD. To complete this CPD article and receive your certificate, email your answers, name and GDC number to cpd@biohorizons.com

Aims and objectives To offer an introductory overview of getting started in implant dentistry, presenting thought-provoking insight into the realities of this treatment modality. On completing this enhanced CPD article, the reader will:1. Understand the reasons behind the increasing demand for

implant treatment2. Understand how to begin assessing patients for dental

implants3. Understand how to evaluate patients’ expectations4. Understand some of the circumstances in which no

implant treatment is the best option5. Understand the potential pitfalls of implants and how to

recognise them in advance.

Enhanced CPD questions1. According PMR’s analysis of global key trends, which European countries are among those leading the way in terms of dental implant placement?a) The UK, France and Spainb) The UK, France and Germanyc) Germany, France and Portugald) Switzerland, Austria and the UK

2. What cohort represents the first generation to keep most of their natural teeth as they advance in years?a) Baby Boomersb) Millennialsc) Generation Xd) The Silent Generation

3. According to the author, what is arguably the biggest variable in implant dentistry?a) Costsb) Time-scalesc) Patientsd) Aesthetics

4. When declining to treat a patient, what can be kept in mind to help form the best possible dialogue?a) The decision is based upon financial aspectsb) The decision is based upon the patient’s needs and best

interestsc) The decision is based upon personality differencesd) All of the above

5. What sign(s) may indicate that implant treatment might not be straightforward?a) Inadequate bone around the implant siteb) Abscessesc) Unhealthy-looking gingivaed) All of the above

Figure 1: Before front view Figure 2: Before occlusal view Figure 3: Before side view

Figure 4: Denture Figure 5: After front view Figure 6: After side view

Figure 7: Postoperative, healed