Why Aren’t You Placing Implants?

Since the introduction of modern endosseous implants 35 years ago, the efficacy and predictability of dental implant treatment have become well established. One systematic review of longitudinal studies that included 7711 implants with a mean follow-up of 13.4 years found a cumulative mean survival rate of 94.6% and minimal long-term marginal bone resorption.¹ Success rates are as high as 98% for dental implants. For many patients who are edentulous or partially edentulous, implants can represent a better treatment choice than full or fixed partial dentures, eliminating the need to prepare adjacent teeth to serve as abutments and dramatically reducing alveolar bone loss.

The number of patients requiring tooth replacement is significant and growing. More than 35 million Americans are completely edentulous, and some 178 million are missing at least 1 tooth. With aging baby boomers who have more active lifestyles than previous generations, the demand for implant-related services is likely to increase. The AAID reports the US and European markets for dental implants could be worth $4.2 billion by 2022.

The mathematical advantage for the general dentist is simple. The general dentist who begins placing and restoring just 20 implants per year (less than 1% of the missing teeth seen in a typical solo practice operating 4 days a week and 48 weeks per year) can expect to increase production by $70,000 annually, assuming a cost of $3,500 for the implant and restoration. Replacing 5% of the missing teeth in such a practice would amount to $378,000 in additional production.

While complex cases may require the expertise of a specialist trained in the surgical placement of dental implants, many cases are less technically difficult than some general dental procedures, such as preparation of a second-molar crown. Experts estimate that approximately 80% of implants today are placed in single-tooth sites, with an estimated 70% in the posterior. Furthermore, technological advancements in recent years have helped simplify diagnosis and treatment planning and make it easier to maintain or regenerate bone, place implants, and restore them. Minichetti notes that although starting an implant service at a general practice carries some cost, the amount is not prohibitive.

“There is certainly an investment in it,” Minichetti says. “But it’s not hundreds of thousands of dollars.”

If costs are a factor, dentists have choices. For instance, the general dentist who is just beginning to place implants may initially choose to refer patients to a scanning center or choosing a mobile service. A 3D image may not be necessary for single-tooth sites that have sufficient bone and/or those for which implant placement poses little risk for impinging on adjacent anatomic structures.

Experienced implant practitioners recommend that general dentists who wish to expand into implant services should seek implant-training programs aimed at the general dentist.

Minichetti suggests that enrolling in programs offered through organizations such as AAID, American Association of Oral and Maxillofacial Surgeons, Academy of Osseointegration, and American Academy of Periodontology, and many dental schools are an excellent beginning to success. Also, dentists can earn board certification in implant dentistry from the American Board of Oral Implantology.

“Dentists taking these programs are better educated, have more hands-on experience, and are more apt to do these procedures in the right way rather than the guys who took a weekend course,” Minichetti says.

By learning from instructors who have practices similar to theirs, general dentists can gain key insights into how to integrate implant services smoothly. They should consider joining implant organizations that include many other general dentists, such as the International Congress of Oral Implantologists, Academy of Osseointegration, and AAID. Because implant dentistry is evolving rapidly, participation in an implant organization can make it easier to stay abreast of new developments.

“If general dentists can get the proper education and use the right technology, it will make it easier for them to do these techniques. The systems are so much more user friendly than they were years ago. The labs can plan much better than they could years ago. CAD/CAM technology, 3D imaging, the regenerative materials, bone-graft materials—all these things make it easier for general dentists to get involved in implant dentistry today,” Minichetti says.

1. Moraschini V, Poubel LA, Ferreira VF, Barboza Edos S. Evaluation of survival and success rates of dental implants reported in longitudinal studies with a follow-up period of at least 10 years: a systematic review. Int J Oral Maxillofac Surg. 2015;44(3):377-388.