Helaine Smith DMD

As the next “new” thing, dental implants have received considerable press of late. And it’s no wonder. With implants, consumers can replace missing teeth with a strong, stable device that looks and feels just like a real tooth.

Mini dental implants also let dentists give patients with dentures a new lease on life as they hold dentures in place — eliminating the goopy denture adhesives and ill-fitting devices of yore.

As with any medical procedure, however, consumers really need to do their homework before agreeing to an implant.

In an effort to educate you, the consumer, I’ve written this two part-article about dental implants and what you need to know before you have anyone work on your mouth. In Part One I’ll cover who is trained to place dental implants. In Part Two I’ll cover the procedure itself.

The dental implant defined

A dental implant is simply a hollow titanium pin that is surgically placed into your jaw. An “abutment” or piece of metal is screwed into the pin once healing is complete. Dentists then place the “tooth” or crown on this abutment — giving you a very natural looking tooth.

Dentists often use implants instead of crowns and bridges as implants last longer and are much stronger.

General dentists don’t learn implants in dental school

Although the procedure itself sounds relatively straightforward, placing a dental implant does require surgery in the mouth — and as such, anything can go wrong, including hitting (or severing) cranial-facial nerves, drilling into the sinus cavity, and or severing the mandibular artery, which can cause death.

As a dentist myself (and one with advanced training), I would not even consider having another general dentist place an implant in my mouth.

This is because general dentists do not receive much dental implant training in school — nor do they receive surgical training! Having a general dentist place a dental implant is akin to having your family doctor replace your knee.

In the dental world, periodontists are now the recognized dental implant experts as they receive an additional three years of training on top of   their general dentistry training. They also spend one full year of this extra training on dental implants.

Periodontists are trained to conserve gum tissue and bone and can also perform all types of reconstructive surgeries such as sinus lifts and bone grafting.

Periodontists also know the facial and cranial bone structure inside and out and are trained to consider the entire structure of the cranium and face when placing an implant. These considerations include: surrounding teeth and roots, nerves, the sinus, shape of the jaw, and blood vessels.

In short, placing a dental implant is a very complex procedure — which is one reason I don’t do them and instead rely on Dr. Favaloro, my in-house periodontist. (After Dr. Favaloro places the titanium pin and abutment, I then place the crown which sits on top of the abutment.)

Can oral surgeons do the same work?

Many dentists will work with oral surgeons who place the titanium pin into the jaw bone. Many good oral surgeons exist, but their training is mostly geared toward extractions (e.g. wisdom teeth), biopsies, and cancer surgeries. So while an oral surgeon can competently perform implant surgery, they don’t receive the intense implant training the way periodontists do.

(And to define other dental specialties, an endodontist performs root canals while a prosthodontist does crowns and bridges.)

Dentists can take continuing education courses but . . .

General dentists, oral surgeons, and endodontists can all take continuing education courses and learn how to do implants. The quality of these courses varies, however. You can take months of coursework from the Las Vegas Institute in Nevada, which is the gold standard as far as advanced dental training goes.

Or, dentists can take what I refer to as “mill” courses — those one- or two-day courses that allow the dentist to then hang a “certificate” on the wall announcing he/she is now a dental implant expert.

So, how can you tell the good from the bad and the ugly? If  you’re considering a dental implant, ask your dentist the following questions:

1. Am I even a dental implant candidate?

Not everyone can accept dental implants, especially if the jaw bone has receded or if the person has other medical issues. If you’re going to be undergoing open heart surgery, for example, I would advise you to wait until after you receive the “ok” from your doctor as the medications you take can pre-surgery (on the heart) can cause serious complications during your implant surgery.

2. What is your training?

Using the information above, ask your dentist point blank where he or she learned how to do dental implants — and how intensive was the training?

Be very wary of the dentist who brushes off this question. Surgery is serious stuff. You don’t want someone who doesn’t know what he/she is doing drilling around in your jaw bone — trust me.

3. How many dental implant procedures have you performed?

Sure, a dentist can tell you he or she is “certified” to perform implant procedures but what if he or she took the course 18 months ago and hasn’t performed one implant? Scary!

4. Do you work with a periodontist or oral surgeon or do you do the surgery yourself?

Knowing what you now know, it should be pretty obvious that having a periodontist perform your surgery is preferable to a general dentist performing it.

Which do you prefer? A periodontist with three years of advanced training . . .  or a general dentist who “graduated” after 16 hours?

5. Do you have references?

Always ask for at least three references, and then call them! You can also do a bit of detective work on your own: do a search for the dentist online and see if he/she has any negative reviews as well as calling the Better Business Bureau.

In Part Two I’ll cover how the implant procedure is performed and some of the questions I’m often asked about dental implants. If you have any questions about periodontists or the training general dentists receive, please feel free to ask them in the comments section.