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8 Questions To Ask Your Implant Surgeon

November 23, 2019

Dental implants are the most significant advancement in dentistry in recent history. Dental implants offer patients and dentists an excellent, long-lasting solution to replace missing teeth and maintain bone to provide improved function, comfort, aesthetics, and ultimately, health and quality of life.

Dental implant use in dentistry is so new that it was not taught in most dental schools as recently as a decade ago, and dental implant surgery training is still not part of many dental school curriculums. In other words, the majority of dentists currently practicing dentistry have had little to no formal training in dental implant surgery.

On Dental Specialties

Dental implant surgery is not a recognized dental specialty, there is no official advanced certifications or degree in dental implant surgery or implant restoration (making the teeth that go on the implants). Many of the dental specialties are attempting to claim dental implants as their area of practice. We now have oral surgeons (primarily teeth removal) , periodontists (gum disease) , prosthodontists (traditionally dentures and partials and crown and bridge), and even endodontists(root canals), all jumping into the field of dental implants, as well as some general dentists.

The dental profession requires that the licensed professional regulate himself. He is not to provide treatment which he believes is beyond his ability to provide to the standard of care. Let me just say that some dentists have a more realistic opinion of their ability than do others. They don’t know what they don’t know, meaning that it’s critical for you to be an informed consumer.

What Patients Need to Know about Dental Implants

So, how do you as the consumer know whom to select to place your implant? Or restore your implant?

Most patients simply depend upon the general dentist to make a recommendation. This usually happens when the general dentist has a relationship with a specialist who places implants, most commonly an oral surgeon or periodontist. The specialist places the implant and then returns the patient to the general dentist to place the restoration. There are a few potential problems with this system.

(As an aside, if you are using a specialist to place your dental implant, I recommend you select a board-certified periodontist. If you are using a specialist to restore your implant, I recommend a board-certified prosthodontist).

Dentists are humans. Humans tend to avoid things that are uncomfortable. The general dentist who lacks training and experience in dental implants may be less likely to encourage patients to pursue this solution for their missing teeth. (If all you have is a hammer, every problem looks like a nail.)

Plus, restoring dental implants is NOT the same as restoring teeth. There are significant differences between a crown on a natural tooth, and a crown on an implant. Many dentists and specialists getting involved with implants don’t know what they don’t know.
The same is true for many specialists. A specialist who does surgery may assume that means he can place implants. Placing implants requires an entirely different set of knowledge and skill than what was likely taught in their specialty. Remember, many of the more “mature” specialists received very little implant training in their specialty programs.

The good news is that implants have been mainstream for decades now. The techniques are proven and results are predictable and have a very high success rate – higher than just about any other body part replacement procedure in dentistry or medicine. And, there are now great training programs offered by highly skilled and experienced clinician-educators. It is easy for the motivated general dentist or specialist to acquire high-quality training if they are willing to make the effort and to invest the time and money.

Questions To Ask Your Dentist Before Agreeing To Dental Implants

Still, you as the consumer need to know a few things.

Is the person doing my surgery, or restoring my implant qualified? Do they know what they are doing? May I reasonably expect a positive outcome?

You should feel comfortable asking your care providers questions, and an experienced trained provider will not be offended or defensive in their answers. They will directly answer your questions and appreciate the fact that you are aware of their professional commitment. So, here are the questions, with a few comments where helpful. Questions are written from the perspective of the surgery, you may modify with respect to restoration of implants.

  1. How long have you been placing implants? We all had to start somewhere, but experience does count. Implant surgery is very technique sensitive and there are things the surgeon simply does not fully understand until he has been experiencing them for some time. It is great that patients are willing to help providers get started on a new skill, but I think they should be aware that this is what they are doing.
  2. How many implants have you placed? This is NOT the same as the above question. You may have a provider who places 3 or 4 implants per year, with a decade of experience. That is not the same level of experience as a provider who places implants every week.
  3. What type/brand of implant do you use? Where are they made? At one time, there were hundreds of companies making thousands of different implants. Over time through consolidation and attrition, the field has narrowed considerably. There are several high-quality well-established implant manufacturers. But, there are also several low price knockoffs – who use lower quality materials, have lower quality control, lower tolerances, and lower prices. I’d suggest you ask for the exact brand, or request an exact brand. We use BioHorizons, which is American made in the USA and is guaranteed for life against fracture. NobelBiocare and Astra are also top-quality brands.
  4. What kinds of problems/failures have you had? I love this question. ANYONE who has real implant experience has had some that did not go well. The ten-year success achievable in long term studies is 96% after 10 years. That amazing success rate is not easy to achieve, and it means that even under the best of circumstances, 4 out of every 100 fail. I would propose that an honest, competent, confident, experienced surgeon will be happy to discuss problems and reasonable expectations.
  5. What type of training have you had? Was this a university-based program, or an extensive training program offered by a well known accomplished educator, or was it a weekend seminar offered by an implant manufacturer to sell their implants? Good answers would include an externship or several months of a long-term program. The most recognized implant training program is the Misch International Implant Institute. If someone has completed the full program, you are likely in good hands. Other well-known educators would include the Pikos Institute, International Congress of Oral Implantology, and American Institute of Osseous Integration. Dentists who are serious about their implant continuing education will be members of one or more of these organizations – in my opinion.
  6. Is intravenous sedation available for this surgery? This question will be controversial with some dentists and may seem self-serving, as Dr. Frost and I are licensed, please let me explain. Dental implants can be done with local anesthetic; in fact, the vast majority of implants I place are done with local anesthetic. And, there are some oral sedative medications which can be used successfully for patients who have anxiety about the surgery. The reason I list the question here is that getting licensed in NYS to be allowed to perform IV sedation is no easy task. You as a dentist must be willing to invest considerable time and money, jump through many regulatory hoops, and maintain certification in advanced cardiac life support and airway management, among other things. This is not required for good implant placement. But to me, it shows a dentist with a very strong interest in surgery. Only if the dentist is doing a significant amount of surgery does it make sense to invest the effort to achieve and maintain an iv-sedation license in New York State. I’d consider this nice, but not essential. It’s like asking if you like icing on your donut.
  7. Do you have a cone beam in the office? A cone beam is a digital 3-D dental imaging system. It is considered the “standard of care” for dental implant placement. It is also a very expensive piece of equipment. Typically only dentists who are placing many implants, and want to do them to high standards, will be willing to invest in this equipment.
  8. Are the implant surgery and the implant restoration all done in the same office or with the same dentist? Ok – I’ll admit, this one is self-serving too, but hear me out. General dentists and prosthodontists work with teeth position and shape and occlusion (how they fit together) all day, every day. We develop a deep understanding of how teeth need to be for proper function and esthetics. And where the implant tooth or teeth end up is very closely related to where and how the implant is positioned during surgery. On the other hand, many specialists, especially surgeons, have minimal if any training in occlusion, form or function of teeth. They are experts in bone and gums. As a result, they often put the implant where the bone and gum looks most favorable, which is not necessarily where it needs to be for proper tooth position. Honestly, this problem is lessening as the profession is better educated on implants. However, in my opinion, the best situation is to have the dentist who will be making the teeth, be the dentist to decide where the implant goes, which often translates into the same person placing the implant being responsible for restoring the implant. That’s what we do, and some prosthodontists do as well. This is not to say that it can’t be done well in the two-location two-person way. I just think having one person accountable and responsible for the entire process works better for the patient.

Well, that’s it. Thanks for reading, and as always, feel free to send me your questions on implants, dentistry, or whatever!