Raising the bar for dental implant training

When it comes to implant dentistry, I share a common philosophy with many colleagues that each case should begin with the end in mind. Success for patients seeking implant restorations depends on our ability to provide long-term functional and esthetic results.

Today, this is easier than ever before. Innovative tools such as digital imaging and cone beam computed tomography (CBCT) 3D imaging enable dental professionals to diagnose and treat cases with precision. Guided surgical techniques allow for predictable placement of implant fixtures in the ideal position for prosthetic restorations. Additional technologies continue to be introduced at a rapid pace; something once considered state-of-the art moves quickly toward becoming standard of care in dental implant practice.

After more than 25 years in private practice, I welcome the many advances we enjoy as providers of dental implant surgery. It is indeed an exciting time for our profession. The successes we have enjoyed have resulted in increased public demand. Naturally, this has catalyzed an increase in the number of dental professionals who are hoping to expand the focus of their practice to include implant services. This growing number of implant dentists requires increased concern to ensure that they are well prepared to provide these expanded services.

Comprehensive dental implant treatment requires a wide range of skills. These span the entire process — from being able to provide a comprehensive pre-op evaluation of patients to the actual ability to perform the surgical techniques that have been planned in each case. These techniques include the extraction of teeth, hard and soft tissue augmentation, and placement of dental implant fixtures. In addition, the surgeon must be prepared to address complications that arise both during the operation and in postoperative recovery — namely, the extraction of teeth, bleeding, sinus pathology, infection, swelling, implant failure, and many others.

Because of the wide range of skills needed to provide comprehensive surgical implant services, many discussions revolve around whether only ADA-recognized dental specialists — i.e., oral and maxillofacial surgeons, periodontists, and prosthodontists — should perform dental implant surgery. These specializations involve multiple years of hospital-based residency training, which provides invaluable experience in both patient evaluation and surgery. Working with attending faculty staff, the resident doctors learn to treat complications and interact with interdisciplinary departments in all phases of patient care. As a result, dental specialists are able to provide the highest standards of care in the delivery of dental implant surgery. As demand continues to increase, it is important that all new practitioners are prepared to meet a similar standard.

The need for surgical training through continuing education has never been higher. Fortunately, advanced dental implant surgical training programs for general dentists have dramatically increased. The restorative dental community has long shown expertise in the diagnosis, treatment planning, and restorative phases of implant dentistry. Through participation in CE courses and national and international dental implant organizations, restorative dentists are acquiring additional surgical expertise that allows them to provide treatment in their practices. For example, the American Board of Oral Implantology (ABOI) is a bona fide credentialing organization that evaluates the standards of appropriate knowledge and experience to credential dentists in implant dentistry.

Implant fellowships ranging from 1 to 2 years also provide a much needed opportunity for dental school graduates to receive advanced dental implant and surgical training. This increase in training opportunities has resulted in a stronger team approach among all dental health providers.

The time seems right for our professional community to work towards implementation of new forms of mandatory hands-on experience beyond dental school. One possibility would be for all dental school graduates to serve a 1-year general practice residency if not entering a specialty or fellowship program. Each graduate should have the opportunity to work with trained mentors to not only practice existing skills, but also develop additional ones to better prepare for private practice. In this way, each dental school graduate gets to begin with the end in mind — to launch a lifelong commitment to continuing dental education.

Joseph A. Leonetti, DMD, received his dental degree from the Tufts University School of Dental Medicine in 1983 and completed his anesthesia fellowship at the Medical College of Pennsylvania in 1984. He then completed his oral surgery internship and residency in oral and maxillofacial surgery at New York University Hospital System in 1987. Dr. Leonetti is a Diplomate of the American Academy of Oral and Maxillofacial Surgeons (AAOMS), the American Board of Oral Implantology (ABOI), and the American Dental Society of Anesthesiology (ADSA). He is also a Fellow of the American Academy of Implant Dentistry (AAID) and the International Congress of Oral Implantology (ICOI). Dr. Leonetti currently is in private practice in Paoli, Pennsylvania.

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