How to choose a dentist for complex dental implant in Singapore?

Recently, a patient from a nearby country flew in for a consultation for dental implant treatment. He had already gone to several clinics for consultation and was comparing what the different clinics can offer. After a physical examination and some xrays, I worked out a treatment plan for him together with a prosthodontist. The treatment plan included various options. We had a long discussion on the pros and cons of each option and finally decided on one plan. He was to check his schedule and get back to me with an appointment date. A few days later, he called to request for a change of prosthodontist. As the joint consultation with the prosthodontist had gone quite well, I was surprise and asked him why?

He evaded the question initially. Instead, he started giving me names of other prosthodontists and asked if I can work with them instead. I, however, persisted in asking why and he finally told me. He said he did some internet search and could not find much information on him. Furthermore, he said that he did not have a Master’s degree. I explained to him that a dentist’s online presence was a reflection of his marketing and not his skills. As for the Master’s degree, I explained that in the USA, where he was trained, a Master’s degree is a research degree which has no bearing on clinical skills. He was an American Board-Certified Prosthodontist, which was an indication of a higher level of training compared with most Master degree clinical programs. He was also accredited by the Singapore Dental Specialist Accreditation Board as a specialist, something which not all Master’s degree holders can claim to be. 

Then the patient conceded that he was happy with the plan and the prosthodontist seemed like a nice guy too. But he just did not feel comfortable with him. And when his wife, who was also at the consultation, expressed the same feeling, they decided that they must change.

This episode tells me that sometimes, in fact maybe most times, patients choose their dentist base on a gut feel. Here is an intelligent patient who did his research. He knew about specialists with Master’s degrees (which is the general norm in Singapore), and he knew that complex dental implant treatment requires a team of specialists comprising an oral maxillofacial surgeon and a prosthodontist. But he still followed his gut instincts. Which is not wrong. Because even the best dentists have complications and failures. If the vibes are not good even at the start, then any complication will only breed trouble due to the lack of trust or simply chemistry between dentist and patient.

Putting gut feel aside, there are more objective considerations that comes into play in complex cases. Given a complex situation, there are many options. Each option will come with a compromise. Complex cases typically takes a year to complete. If time is a consideration, as in the case of medical tourists who live out of town, there may need to be a compromise in terms of time. A long treatment duration, even if it produces the best results, may not be suitable for such a patient. We will need a plan that can reduce the number of visits and the total duration. When that is done, something else got to give. Sometimes, it can be the patient’s medical history that would require a lot of preoperative medical management each time he undergoes surgery. For this, we need to minimize the number of times invasive procedures are done. In full mouth clearance and reconstruction cases, some patients may not be able to tolerate even a short period of using removable prosthesis. For this patients, we may resort to other means such as zygomatic implants while waiting for the bone graftto heal.

However, different dentist will have different preference for different options, depending on his personal experience and success with them. As such, it is pointless to take one dentist’s plan and go to another dentist for a quotation just to compare prices. A plan that works well in Dentist A’s hands may be disastrous if Dentist B did it.

Sometimes, some patients chose a dentist base on his fees. While the finances is a big consideration, it should not be the main one. Sometimes, a cheaper plan may turn out to be more expensive if complications arise due oversimplication of the treatment plan. In a complex case, which may involve many stages such as bone grafting, nerve transposition, etc, there are many expensive components and extra costs involve. Some clinic may list down everything in the initial cost estimate but others may not. Occasionally, I received emails from foreign patients containing the treatment plan given by their local dentist, asking me for a quote base on that treatment plan. These patients are missing the big picture. A complex dental implant treatment plan is just too variable to do a cost estimate comparison.

Ultimately, the selection process should involve some degree of objective credentials checking, which, thanks to the internet, can be done relatively easily. Complex cases are best done by a team of specialists rather than a single dentist, as a team ensure alternative options would be discussed and considered. Cost is a consideration but do not take one treatment plan you like and go around searching for the cheapest guy who can carry it out. Look for a cheaper alternative but do not dictate the plan as the execution of the plan may be compromised if it was someone else’s idea in the first place. Finally, trust your gut instincts.