Implant Team Approach Not the Best Option
*I was intrigued to read your article on the team approach to dental implant treatment. You covered everything based on dental economics very well. The only thing missing was the subtitle that could have read “Infomercial or advertisement paid for by the American Association of Oral and Maxillofacial Surgeons (AAOMS).”
The team approach to dental implantology is wonderful in theory, but unless all team members practice in the same location, it is as a practical matter about as far from the ideal scene as possible. I am curious as to why there was neither a perodontist nor a prosthodonist include on the panel. This article appears to be a continuation of the recent media blitz by the AAOMS in an attempt to hoodwink the public and the profession into believing the oral surgeons have vast dental-implant experience, which, for the most part, they don’t. Most implant training for oral surgeons has been attendance at a weekend course provided by a manufacturer.
There is more to oral implantology than the ability to lay a flap and drill a hole; ask any periodontist or prosthodontist involved with dental implantology.
The real issue should be how can the public be best served. Unfortunately, the almighty dollar is the real driving force behind all the divisiveness within the profession as it relates to dental-implant treatment. Each special-interest group is afraid it is going to be left out of the implant game. These groups should re-evaluate their political positions as they relate to implantology as a specialty and help reverse the ADA’s fear-based moratorium on any new dental-specialty applications. If the public is to be best served, implantology should be the next dental specialty. There is enough room for all the dental implant political groups to get a piece of the implant pie. The most important aspect to be remembered is to serve the public well. The team approach is one way to do this, but it’s not the most effective and economical approach.
The case for specialization is mainiford. The patients’ costs for implant treatment are inherently high due to the nature of the treatment. Who is going to pay for the restoring doctor’s time while observing and directing the surgery? Does each doctor involved charge a fee for the consultation and treatment-planning appointments? How do you coordinate multiple meetings with different doctors and the patient when they live and practice in areas that can be large distances apart? When implants fail, who is responsible-the surgeon or the restorative dentist? Who provides for maintenance after the treatment is completed? Does the patient pay for both doctors’ recall visits at different offices or do they all meet together? Who provides rescue services when problems arise? Is the oral surgeon going to use guided tissue-regeneration procedures or is the patient referred to a periodontist? Who pays for the periodontist?
Today, the public is not being well-served. Few surgeons are offering more than cylinder implants, which are only indicated in 30 percent of edentulous areas. The contention that nerve repositions and rib graphs are alternatives to allow the use of cylinders is ludicrous. These types of heroic techniques are unnecessary and too expensive for patient acceptance-let alone the additional surgical risk, trauma and potential nerve damage-when osseointegrated or biointegrated blades and subperiosteal implants are proven alternatives recognized by the 1988 National Institute of Health Consensus Conference on Dental Implants to be viable options.
A single doctor trained in all aspects of dental implantology, competent to use all implant modalities, not just cylinders, will be the best way to serve the public and profession. One doctor/specialist can charge less and provide better care than multiple-doctor teams. He/she can act as a source of diagnostic information for other doctors who want to become involved with implantology and as a source of treatment for those who don’t. Once the profession realizes what is involved with quality dental-implant treatment, there will be a groundswell of support for specialization. Unfortunately, it probably will not happen until the economic problems associated with the busyness problem are resolved.*
Found in Dental Economics/August 1991 Written by: Rodney S. Mayberry, DDS Tysons Corner, VA
