by Kim A. Gowey, DDS
General dentists seeking to expand practices have learned that continuing education in dental implantology is a high-performing investment. Many GPs face competition from specialists for certain procedures, like implant dentistry. However, the increasing popularity of dental implants offers an opportunity for practice expansion for general dentists and specialists with appropriate training.
Patients have a stake in this, too. When replacing missing or severely compromised teeth, more patients have seen the benefits of implants and ask for them rather than traditional bridgework. Educated consumers seek dentists with strong qualifications in implant dentistry, knowing that strenuous credentialing offers the best assurance for excellent care and outcomes. General dentists insufficiently trained in implant dentistry are losing patients who decide implants are the best long-term option. Why concede these patients to oral surgeons, periodontists, or other dentists?
Implants are a “win-win” for patients and dentists. With success rates of more than 95 percent, they significantly exceed the long-term success rates of bridges placed on natural teeth or root canals, posts, and crowns. Implants will stabilize loose dentures, making them more functional. Single-tooth implants have had success rates of 99 percent, and don’t require preparation of adjacent healthy teeth.
So, why do dentists recommend bridgework when patients want implants? Is training the obstacle, or is it lack of time to become proficient in implant dentistry? It’s possible to take fast-track courses on implants. But to become highly skilled, the dentist must be knowledgable about bone grafting and tissue augmentation to assure optimal functional and cosmetic outcomes of implant surgery.
“Bone sets the tone but tissue is the issue,” joked Jack A. Hahn, DDS, of Cincinnati in a plenary session presentation at the recent American Association of Implant Dentistry (AAID) annual meeting in Chicago. However, he was serious when stating that bone foundation is critical for implant success. Also, the way gingival tissue is formed around implant restorations determines the ultimate cosmetic outcome. The complexities of tissue and bone grafting and regeneration cannot be learned in a weekend.
Dental implant surgery has bolted into the digital age with sophisticated computer technology and 3-D imaging modalities. This helps make the procedure more convenient and less risky. It also has eliminated some guesswork from the surgery. Digital images enable the dentist to assess bone density and deficiencies, locate nerves, sinuses, determine trajectory, and find unusual anatomy before surgery. This eliminates uncertainty and increases predictability of the surgical procedures for implant placement.
Has technology made implant surgery simple enough that a competent dentist can be successful with limited experience? No. The best outcomes still occur with dentists who are skilled and experienced in implant surgery based on comprehensive education.
Although implant dentistry is not recognized officially as a specialty by the American Dental Association, the AAID has been in existence since 1951. The academy’s mission is to promote the highest professional standards in the field via a rigorous implantology credentialing program. Implants are not restricted to specialists; they can be performed by general dentists. Eight in 10 AAID members are general dentists. Within this group, 25 percent are credentialed implant dentists. Implant dentistry offers excellent opportunities for general dentists and specialists to expand their practices.
For general dentists and specialists, the AAID credentialing program is an investment in the future as the popularity and success of implants continue to rise. Practitioners seeking new levels of excellence can achieve their goals through the AAID credentialing program. The AAID testing process, which is guided by consultants who are psychometricians, conforms to the psychometric principles of validity and reliability. They work with the examining board to develop the content outlines for examinations, write and select test questions, develop the standardized cases for oral examinations, evaluate cases submitted by candidates, and orient examiners to the use of rating scales for these oral/case examinations.
The AAID Admissions and Credential Board offers two levels of credentials: Associate Fellow and Fellow. The exam for the Associate Fellow credential consists of a written test and an oral examination, which includes defense of three clinical cases that a candidate has completed. Applicants must be licensed dentists who have at least 300 hours of postdoctoral or continuing education in implant dentistry. These hours must be divided between the sciences related to implant dentistry (such as anatomy, immunology, and pharmacology) and clinical implant education.
The Associate Fellow candidate must pass a written exam before applying to take the oral/case part. Both must be completed successfully within four years. All three cases must include implants and be fully restored with a final prosthesis. The three case types that are required are a single tooth, an edentulous segment of two or more adjacent teeth, and a completely edentulous arch.
To be credentialed as an AAID Fellow, Associate Fellows in good standing must have at least five years’ experience in implant dentistry, complete an additional 100 hours of postdoctoral instruction in the field, and have attended an AAID annual scientific session or course within two years before the exam. They also must have completed at least 50 arches of treatment, provided both the surgical and restorative phases of treatment, and meet the professional and leadership credentials requirement. Ten implant cases are presented in the oral exam. All must be more complex than cases presented for the Associate Fellow credential. Three of these cases are required to be with totally edentulous arches while two others must show severe bone deficiencies. Two of the cases must have been in function for at least five years.
John R. Hargreaves III, DDS, and his wife, Olinga Hargreaves, DDS - general dentists in Denver - became Associate Fellows in 2005. They are the first husband and wife to accomplish this distinction.
“We wanted to be regarded as competent implant dentists so we prepared by taking the AAID Maxicourse® and studying various textbooks,” Dr. John Hargreaves said. “Credentialing allowed us to gain confidence and establish camaraderie and support from the academy.”
Added Olinga: “The exam concentrated on severe atrophy cases, which was a challenge but a great sense of accomplishment. Overall, hard work caused us to gain competency and self-confidence. Eventually, we want to limit our practice to implant dentistry.”
Oral and maxillofacial surgeon H. Dexter Barber, DDS, of Philadelphia received his Fellow credential in 2005. He believed it was worthwhile even though implant dentistry has been a part of his practice for 17 years. In 1996, Dr. Barber passed the written and oral exams of the American Board of Oral Implantology/Implant Dentistry. As an ABOI/ID diplomate, he qualified for Fellowship distinction without further examination. But he was required to meet the other criteria for Fellow membership.
“The next step for me in being the best I could be was to be at the highest level within AAID,” Dr. Barber said. “My future goals with respect to implant dentistry are to continue to learn and evolve my practice with the continued changes in grafting and reconstructive procedures.”
While the professional quality represented by AAID credentialing is widely accepted, a legal battle is raging about whether credentialed implant dentists can announce their AAID educational achievement to the public. To date, AAID has spent more than $1 million in federal and state courts defending the right of its credentialed implant dentists to announce their credentials. In California, the issue is a state law that was struck down in U.S. District Court for unconstitutionally restricting dentists from advertising credentials obtained from bona fide organizations.
In that case, the AAID successfully argued in federal court that giving truthful information about the credentials of general dentists who perform implant procedures protects the public. Any dentist, regardless of education or experience, can offer implants to patients. AAID, therefore, advocated that educating the public about recognized implant experience - validated by a legitimate credentialing organization - is vital to the public interest. AAID and ABOI/ID were supported in briefs submitted by the Academy of General Dentistry and the American Academy of Cosmetic Dentistry. This decision was appealed by the California Dental Board, and oral arguments have been heard for the appeal. A decision is expected in six months.
According to Frank Recker, AAID legal counsel, AAID’s credentials have been scrutinized in litigation and their credibility has never been challenged.
When evaluating the potential benefits of implant credentials, do not forget that a dental practice is a business. Good businesses thrive by responding to market demands ahead of the competition. To capitalize on the surging popularity of dental implants, dentists must invest in the right training to better differentiate their practices. Credentialing is a wise investment and should reap career-long financial and personal benefits for dentists as well as provide safe, top-quality care for implant patients.Dr. Kim A. Gowey, the immediate past president of the American Academy of Implant Dentistry, is in private practice in Medford, Wisc. He is a Diplomate of the American Board of Oral Implantology/Implant Dentistry and an Honored Fellow of AAID. Contact Dr. Gowey via the Web at www.goweydental.com, or by e-mail at [email protected].
