How to choose a dentist for dental implants?

Implant dentistry is a relatively new field in dentistry but it has dominated much of the development in dentistry for the past decade. Today, dental implants are the treatment modality of choice for replacing missing teeth. This is not surprising as they do not involve sacrificing good tooth structure like what traditional dental bridge does, nor does it sacrifice function and convenience that invariably affects removable dentures. It is estimated that more than half the dental clinics in Singapore are already providing dental implants despite the fact that this is not something that is taught in undergraduate programs in dental schools. This means that not all dentists are trained in implant dentistry. So how does a potential patient choose an implant dentist?

1. Oral & Maxillofacial Surgeons

In the beginning, dental implant treatment were the domain of the Oral & Maxillofacial Surgeon. This was the era whereby concept of osseointegration was new and getting an implant to integrate with bone was the main focus. Once an implant has integrated with bone, it was considered a success. Back then, the main implant manufacturers will only sell implants to Oral & Maxillofacial Surgeons as implant placement was deemed to be a technique sensitive procedure that was best done by a surgeon. Oral & Maxillofacial Surgeons were the main providers of dental implant surgeries.

2. Prosthodontists 

As osseointegration became predictably achieved, the focus shifted to the crowns that are fitted onto the implants. After all, it was argued that the patient wants teeth, and the implants are just there to support the teeth. This shifted the primary management of the dental implant patients to the prosthodontists, the dentists who specialize in restoring missing teeth. These prosthodontists usually work with an Oral & Maxillofacial Surgeon as a team to provide the best of both worlds to the patient.

3. Periodontists

As more and more dental implants are placed, some of the long term complications of implants arise. Just as natural teeth can develop gum disease due to poor oral hygiene maintenance, dental implants are not spared. The periodontists, dentists specializing in treatment of gum diseases also became more and more involved in implant dentistry.

4. General Dentists

As implant dentistry is not a discipline specific to any particular dental specialty, general dentists are also involved in the provision of dental implant services. While specialists like Oral & Maxillofacial Surgeons, Prosthodontists and Periodontists undergo structured training in implant dentistry as part of their specialist training program, general dentists get their training from various other sources. Some attend implant training courses organized by various dental societies or by the implant manufacturers themselves. Others may choose to undergo a university diploma program in implant dentistry which is available both on a full time or part time basis.

Plastic Surgeon and Hemorrhoidectomies (true story)...

So, given that there are so many dentists with different backgrounds in training, how does a potential patient choose? The traditional way is to ask friends and relatives for recommendations. This kind of recommendation usually carries a lot of weight because it comes from someone that you know and trust. However, lay recommendation can sometimes be dead wrong. For example, a relative of mine once told me that she recommended a particular surgeon to a friend who was looking for a surgeon to do her piles. I was rather puzzled at her recommendation and asked her why. Her reason was that he did it for her many years ago when he was a young doctor in a public hospital. I then asked if she knew that in the intervening years, this doctor has gone on to specialize in plastic surgery and is now a senior plastic surgeon in a private hospital. She replied that she knew and that that would make him an even better surgeon for hemorrhoids as his plastic surgery training would make him pay closer attention to details. That was shocking to me. But such anecdotes are a dime a dozen.

Research, Google and gut feel

When choosing an implant dentist, start off with your regular dentist (you should have one). If your regular dentist does implants, then he may be just the person you need. The trust is already established and there is no need go through that phase again. However, if he does not, he can usually refer you to somebody who does. If you do not have a regular dentist that you trust, then you can do a first sieve on the internet. The internet will give you some names which you can then research further. Most Oral and Maxillofacial Surgeons and Periodontists are trained in implant surgery while the prosthodontists are trained in restoring them with crowns. Some specialists do both the surgical and prosthetic parts while others work as a team. There are many general dentists who are very competent with implant dentistry. These are the ones that have undergone additional training either through a long period of continuing education or a university diploma program. Start with these and then filter through using your own subjective criteria such as whether you like his face or not, whether you can communicate, opinions of friends, etc. Do bear in mind that a specialist is not always better than a generalist for the more common cases. However, for the more complex cases, a team of specialists may be needed to achieve the best results.

Portfolio

When you go for the consultation visit, check on the cleanliness of the place. If they can’t even keep their place clean, the instruments are also likely to be dirty. At the consultation, ask for some photos of work they have done before. In Singapore, we are not allowed to post before and after photos on websites or any publicity material. We are only allowed to show such photos in the clinic to patients only. Looking at the photos can shed some light on their experience, the breadth of work that they have managed. It’s a bit like looking at an architect’s portfolio before you engage him to design your house.

Point A to B- walk, cycle or drive...

After the consultation, ask for a treatment plan and fee estimate. The treatment plan and fee estimate will tell you what is involved. Patients only see the end result, which is the tooth. But every implant tooth goes through a different path before it sits in your mouth. The choice of implant, the way the crown is attached, the material used, the surgeries involved, etc. As such, it is not wise to deem a particular dentist as expensive or cheap simply from the fee per implant. Some dentists hold themselves to the highest level and will only use the best material and protocol while others may be content with providing a basic minimum standard. You need to decide for yourself what level of dentistry you desire and make then make the appropriate choice. Of course, more expensive does not always mean better. But if there is a breakdown in the fees, you will be able to judge whether there is value for your money.

Choosing an implant dentist can be confusing at times but reading up and becoming more knowledgeable will help you to make good choices.