Dental implants are not really taught at University. Yes, students may be given a 1-2 day course on them, practicing on models, but actual clinical experience is very limited. As such students qualify with little or no regard for dental implant therapy. Moving forward to qualification, only 9% of students surveyed (via a student social media platform) had any intention of learning about dental implants in their careers.
One of the barriers to entry was stated as being indemnity costs. The standard indemnity fee for an associate in the UK appears to vary between £2500 – £5000 with most of the major dental insurance/indemnity providers. If implant placement is added to the policy this can rise to almost £13,000 if sinus lifting is included.
For the average dental associate this is a huge price increase and makes the provision of implant therapy, along with the added costs of equipment, training and time taken to become proficient a large barrier to entry. This explains why implant dentistry is one of the slowest growing areas of dentistry in the UK when compared to facial aesthetics and Invisalign/STO.
What is the justification that indemnity organisations use for such high premiums for those carrying out implant work?
By its very nature, implant dentistry can be the most challenging of all dental modalities. We must be aware of not only the surgical envelope, but also the restorative with many complications being encountered by even the most gifted surgeons on a regular basis.
The UK has no specialist list in implant dentistry, which means those placing implants have varying levels of training. Compared with a specialist Endodontist who has passed standardised exam/approved training pathways, implant surgeons can partake in a 1-day, 1-week or 2-year programme depending on their circumstance. This can make it hard for indemnity organisations to tailor indemnity risks.
As a result, there appears to be a general band which implant surgeons fall into when placing implants. Non sinus placements, and non-graft cases are at a lower banding when compared with complicated bone graft and sinus cases. Sinus cases and full arch cases have a higher level of complication attributed to them compared with simple premolar/molar placements requiring neither.
At DDS (Dental Defence Society) we judge each application for indemnity cover individually. We assess education, experience and competency in implant dentistry before offering a tailor-made indemnity proposal.
When implant work goes wrong either from an integration/function or an aesthetic viewpoint, they can be difficult and time consuming to fix. Senior implant surgeons seem to spend more clinical time treating peri-implant disease or re-doing work which has failed. One of the hardest tasks is attributing blame. Implant dentistry is only provided privately in the UK (except small cases from teaching hospitals) and as such, there is a huge expectation placed upon the work. A failed implant solution does attract a high risk of complaints leading to extra pressure on indemnity organisations to increase premiums for implant work.
Implants surgery can have serious complications such as nerve damage, sinus membrane tears and post-surgical infections. All of these can attract large claims, with certain dental legal firms pursuing implant cases for compensation on a regular basis knowing that these, if successful, can attract large payouts.
So where does the future lie for implant dentistry?
Having a standardised training programme would aim to ‘level up’ all dentists placing implants, making indemnity offers for these individuals potentially less risky. Certain providers are asking for proof of training and judging indemnity based on the quality of the implant teaching received, with those who have achieved post-graduated awards being considered lower risk than those who have not.
Implant dentistry remains one of the most challenging and rewarding areas of dentistry. If we are to maintain a healthy number of skilled implant surgeons in the UK, then more needs to be done to encourage adequate training, and some of the barriers to entry for potential implant surgeons need to be removed.
Please contact DDS for any further information.