Pathway for general dentist to learn implants

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steven21

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I've noticed there are many routes someone can take to learn implants. It seems like some specialty programs (perhaps oral surgery) will teach students how to place implants during the residency. Also, it looks like some schools have a program for specialists to learn how to place implants after their residency (example: http://dental.columbia.edu/page/certificate-professional-achievement-implantology).
I've also noticed something called maxicourses (example: http://sdm.rutgers.edu/CDE/MaxiCourse/). It seems like a general dentist can complete a maxicourse and learn how to place implants. I just Googled around for a bit so I'm pretty sure I don't have the full picture, but I'm wonder if there are other ways for general dentists to learn implants and if completing a maxicourse gives the proper certification? Thanks.

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YouTube.

All learning is going online. (ie: Khan Academy) There is a real wealth of videos you can watch to give you an idea. Follow them. Go over the anatomy and be aware of the precautions. Obviously know your patient's med history. Then identify location of IA/mental for mand and Sinus floor for max. I think most GPs are timid at first because they are not comfortable laying down a flap. This is an unwarranted fear. Lay a clear flap - patient will not bleed out and gingiva regenerates pretty well. (I promise) - look at where you are drilling and just do it. Whatever system you purchase the sales rep will go over drill sequence, its all pretty straightforward.

First and foremost, pick an easy case (posterior mandible with plenty of bone, Tricky part first time is angulation. Don't do distal extensions). Carefully pick out the right cases and patients to practice on. And add onto your skillset (immediate placement, sinus lifts, full mouth). You will make mistakes along the way and fail, but each one will be a huge learning experience and you will comeback 10x the clinician.

Placement and surgery is only half of it. Restoring is another journey in itself. I believe in the future with CT and guided surgery, implants will be as common as surgical extractions for all GP's. Also I believe one person should be responsible for placing and restoring implants to warranty its long term success. Both parts go hand in hand and are interdependent for the implant's success.

Good luck my friend. All comes down to stop overthinking and just doing.
 
thanks. so no additional certification beyond a DMD/DDS is required?
 
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and how many cases have you completed?
Start with post-extracting bone grafting and mini implants. Choose a short simple implant course and start doing simple implants. From there you can take it as far as you want. If you live in SoCal I give in-office clinical training with 60 unlimited support for $1500.
 
When you fail (and you will), just remember you will be held to the same standard of care as someone who did 4 extra years of training. Your YouTube videos will not hold up in court then.
 
YouTube.

All learning is going online. (ie: Khan Academy) There is a real wealth of videos you can watch to give you an idea. Follow them. Go over the anatomy and be aware of the precautions. Obviously know your patient's med history. Then identify location of IA/mental for mand and Sinus floor for max. I think most GPs are timid at first because they are not comfortable laying down a flap. This is an unwarranted fear. Lay a clear flap - patient will not bleed out and gingiva regenerates pretty well. (I promise) - look at where you are drilling and just do it. Whatever system you purchase the sales rep will go over drill sequence, its all pretty straightforward.

First and foremost, pick an easy case (posterior mandible with plenty of bone, Tricky part first time is angulation. Don't do distal extensions). Carefully pick out the right cases and patients to practice on. And add onto your skillset (immediate placement, sinus lifts, full mouth). You will make mistakes along the way and fail, but each one will be a huge learning experience and you will comeback 10x the clinician.

Placement and surgery is only half of it. Restoring is another journey in itself. I believe in the future with CT and guided surgery, implants will be as common as surgical extractions for all GP's. Also I believe one person should be responsible for placing and restoring implants to warranty its long term success. Both parts go hand in hand and are interdependent for the implant's success.

Good luck my friend. All comes down to stop overthinking and just doing.

And who cares if these are real people you are practicing on.

And you don't lay a flap, you reflect a flap.
 
When you fail (and you will), just remember you will be held to the same standard of care as someone who did 4 extra years of training. Your YouTube videos will not hold up in court then.
yeah because you spent all four years of OMS doing implants. Seriously how many implants do you actually place during residency. It's harder to do a really good molar endo, than it is to do most simple single implant cases.
 
yeah because you spent all four years of OMS doing implants. Seriously how many implants do you actually place during residency. It's harder to do a really good molar endo, than it is to do most simple single implant cases.

Definitely harder to do molar endo. I just said that when your implants fail, you will be held to the standard of care of a specialist (perio or OMS). Sorry, but that's fact. That's why it's called a specialty.
 
Definitely harder to do molar endo. I just said that when your implants fail, you will be held to the standard of care of a specialist (perio or OMS). Sorry, but that's fact. That's why it's called a specialty.
I couldn't agree more. The only exception would be in the case of the rural dentist without a specialist within a reasonable distance. In this case the rural dentist is the standard of care.

Even though I agree, I know quite a few dentists willing to take on molar endo, so why wouldn't they also do something that is arguably even easier...haha, but you gotta be desperate as a dentist to do lots of removable.
 
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I heard there are some good hands-on training course/seminar out of States...Any input? I heard they can let you do more than 50 implants/month
 

Carefully pick out the right cases and patients to practice on.

Hi. Yes I offer implant placement services here in my office. For the low price of a couple thousand dollars I will surgically insert a piece of titanium into your jaw through techniques learned on Youtube. I do not anticipate many complications as I consider your dental treatment in this situation to be "practice". Sign this consent.
 
Molar endo, simple implants, dentures are as easy a Class II composite. Dental school professors and ballerina lecturers present it as hard so they look smart. Most molar root canal can be done in 45 minutes, implants in 20. Dentures just require 2 critical measurements everybody ignores. Don't make things more complicated then they need to be.
 
And who cares if these are real people you are practicing on.

And you don't lay a flap, you reflect a flap.

wow.... grammar police in full patrol here. I can almost guarantee I've done more implants in my first year of placing than you will do your entire residency (including lifts, splits, gbr, fm). I've had failures, yes, but I learn and become better. This isn't open-heart-surgery. If I get sued. I get sued. You won't be perfect out of residency, you will make mistakes, but become better for it. The "p" in GP stands for "practice".

Honestly, I have waaay more trouble with the Prosth side of implants than the actually surgery.

Don't be a Hater.
 
wow.... grammar police in full patrol here. I can almost guarantee I've done more implants in my first year of placing than you will do your entire residency (including lifts, splits, gbr, fm). I've had failures, yes, but I learn and become better. This isn't open-heart-surgery. If I get sued. I get sued. You won't be perfect out of residency, you will make mistakes, but become better for it. The "p" in GP stands for "practice".

Honestly, I have waaay more trouble with the Prosth side of implants than the actually surgery.

Don't be a Hater.


Haha. I'll stop hating when you stop posing.
 
sigh... you'll never learn. wait until you get outta school. the world is gonna be a scary place for you.

2 more months and I'll be out of residency. I finished school 4 years ago. See, some people continue their education in a more formal manner than Youtube. Do you put that on your website? "I'm an implant surgeon with 96 combined Youtube hours of implant experience and fail videos"

You are very right though my friend. It is a scary place with "superdentists" practicing IV sedation, certain full bony impacted third molars and certain implant cases on real live people. I'll probably be too busy being the expert witness discussing the standard of care to be scared though.
 
2 more months and I'll be out of residency. I finished school 4 years ago. See, some people continue their education in a more formal manner than Youtube. Do you put that on your website? "I'm an implant surgeon with 96 combined Youtube hours of implant experience and fail videos"

You are very right though my friend. It is a scary place with "superdentists" practicing IV sedation, certain full bony impacted third molars and certain implant cases on real live people. I'll probably be too busy being the expert witness discussing the standard of care to be scared though.

Yea I agree, it is very scary for you. GP's taking food off your table. Maybe you can earn a living just being an expert witness in lawsuits against other dentists? That's probably more lucrative than 3rds and implants.
 
Yea I agree, it is very scary for you. GP's taking food off your table. Maybe you can earn a living just being an expert witness in lawsuits against other dentists? That's probably more lucrative than 3rds and implants.

Based off my new contract, I'm pretty sure that OMS guys are doing ok.

Sorry man, didn't mean to turn this into a measuring contest.

And by the way.........I'm bigger.
 
i agree with dale that learning from youtube is a joke...as a practicing gp you will need good continuing education courses to become solid at placing implants...the good courses will also tell you about which cases to punt to your local omfs and which cases you should be able to handle...ive gotten to the point of my career where i place about 80% of the implants without a need to refer out..there still cases out there that i think my local periodontist can handle better than i can so i refer to him.
 
That's really cool psiyung
 
Honestly, I have waaay more trouble with the Prosth side of implants than the actually surgery.

It's easy to place an implant (peri-operative management aside). It's a lot harder to place an implant in the right spot. When planned and placed correctly, the prosthetics should be easy. Be sure that any CE you take includes a prosthetic planning component to the training.
 
Has anyone here even tried looking up implant courses online? I mean YouTube is a joke, it really is. You think every implant site is gonna have enough bone? Trying researching tenting procedures and block grafts then you'll see implant surgery, then imagine not doing it right and having to do it all over again totally eliminating your profit margin. No, I'm not advocating implants are only meant for oms or perio. No specialty owns it. If your a GP with advanced training you Could be as good as the specialist, but it all comes down to case selection. Hell, just because someone is a specialist doesn't mean they are God. I've heard horror stories from doctors saying they stopped working with a particular periodontist or omfs because they were so awful at implant positioning or would not corrodinste treatment with the restoring dentist. At the end of the day it comes down to the individual. There is so much to learn regarding implants-the surgical and restorative aspect.

Here are some good courses to look at
Misch implant institute- this guy literally wrote the book
Pikos institute
Implant educators
Kois center and spears- this is an occlusion curriculum but they go over implant restorations

Go to dentalxp.com and read the implant and grafting articles. It'll open you're eyes.
 
Has anyone here even tried looking up implant courses online? I mean YouTube is a joke, it really is. You think every implant site is gonna have enough bone? Trying researching tenting procedures and block grafts then you'll see implant surgery, then imagine not doing it right and having to do it all over again totally eliminating your profit margin. No, I'm not advocating implants are only meant for oms or perio. No specialty owns it. If your a GP with advanced training you Could be as good as the specialist, but it all comes down to case selection and knowing when to refer. Hell, just because someone is a specialist doesn't mean they are God. I've heard horror stories from doctors saying they stopped working with a particular periodontist or omfs because they were so awful at implant positioning or would not corrodinste treatment with the restoring dentist. At the end of the day it comes down to the individual. There is so much to learn regarding implants-the surgical and restorative aspect.

Here are some good courses to look at
Misch implant institute- this guy literally wrote the book
Pikos institute
Implant educators
Kois center and spears- this is an occlusion curriculum but they go over implant restorations

Go to dentalxp.com and read the implant and grafting articles. It'll open you're eyes.
 
2 more months and I'll be out of residency. I finished school 4 years ago. See, some people continue their education in a more formal manner than Youtube. Do you put that on your website? "I'm an implant surgeon with 96 combined Youtube hours of implant experience and fail videos"

You are very right though my friend. It is a scary place with "superdentists" practicing IV sedation, certain full bony impacted third molars and certain implant cases on real live people. I'll probably be too busy being the expert witness discussing the standard of care to be scared though.

I am a graduating OMFS and have no problem with general dentists placing implants when they have the adequate training. With that being said, you should be aware that there will soon be a change in the dental educational curriculum where dental students will be trained to surgically place dental implants. There are a couple dental schools already doing that. The fact that all general dentists will be doing straight forward dental implant cases is inevitable. What that means is, all graduating OMS should be more concerned with doing FULL SCOPE OMS than restricting the trade of their referral base. OMS will have to fill their time with a variety of cases rather than just teeth and titanium.
 
I am a graduating OMFS and have no problem with general dentists placing implants when they have the adequate training. With that being said, you should be aware that there will soon be a change in the dental educational curriculum where dental students will be trained to surgically place dental implants. There are a couple dental schools already doing that. The fact that all general dentists will be doing straight forward dental implant cases is inevitable. What that means is, all graduating OMS should be more concerned with doing FULL SCOPE OMS than restricting the trade of their referral base. OMS will have to fill their time with a variety of cases rather than just teeth and titanium.

Oh man, I know that day is coming. I'm finishing up too and agree 100% that we, as a specialty, will have some tough decisions ahead.

And I have some great friends that are going to refer their tough implant cases to me, but even I tell them not to dump their complication on me. I gladly discuss cases with them and even pick their brain from a restorative side, but I'm not going to let them dump on me. With more schools giving basic training in implant placement, I just see more complications. Realistically, there aren't enough patients to properly educate every dental student that graduates.
 
Oh man, I know that day is coming. I'm finishing up too and agree 100% that we, as a specialty, will have some tough decisions ahead.

And I have some great friends that are going to refer their tough implant cases to me, but even I tell them not to dump their complication on me. I gladly discuss cases with them and even pick their brain from a restorative side, but I'm not going to let them dump on me. With more schools giving basic training in implant placement, I just see more complications. Realistically, there aren't enough patients to properly educate every dental student that graduates.
as an OMFS arent you more qualified than them?
 
as an OMFS arent you more qualified than them?

Personally, I believe that complications are a part of the comprehensive care of the patient. If you can't handle the complications of the surgery (implants, wisdom teeth, orthognathic surgery, etc.), then you shouldn't do the surgery. Legally, a general dentist can perform a LeFort I maxillary osteotomy in their office. Of course, it wouldn't be wise because of the potential complications (bleeding, pain control, etc.). It's the same thing with anesthesia training. In my opinion, you have to be prepared for the worst complications (loss of airway) to do any type of sedation because it's such a slippery slope.

If I'm the expert when it comes to the complications of the surgery, why doesn't the patient deserve the expert when it comes to the surgery? It's truly a struggle for me. Again, I have very good friends and referrals that do their own simple implants. I have no problem with it and they do a fantastic job. For me, I want to build my practice on things I can control.

Hope that answered your backhanded question.
 
Personally, I believe that complications are a part of the comprehensive care of the patient. If you can't handle the complications of the surgery (implants, wisdom teeth, orthognathic surgery, etc.), then you shouldn't do the surgery. Legally, a general dentist can perform a LeFort I maxillary osteotomy in their office. Of course, it wouldn't be wise because of the potential complications (bleeding, pain control, etc.). It's the same thing with anesthesia training. In my opinion, you have to be prepared for the worst complications (loss of airway) to do any type of sedation because it's such a slippery slope.

If I'm the expert when it comes to the complications of the surgery, why doesn't the patient deserve the expert when it comes to the surgery? It's truly a struggle for me. Again, I have very good friends and referrals that do their own simple implants. I have no problem with it and they do a fantastic job. For me, I want to build my practice on things I can control.

Hope that answered your backhanded question.
I like that quote. Its true.

it wasnt meant to be a backhanded question... I work with an OMSF and the work he does is inspiring, he told me he watched tons and tons of implants placements before his first one, so thats what Im doing with him, it looks easy when he does it, it looks like a mess when his students do it... hope I can reach his level one day
 
Personally, I believe that complications are a part of the comprehensive care of the patient. If you can't handle the complications of the surgery (implants, wisdom teeth, orthognathic surgery, etc.), then you shouldn't do the surgery. Legally, a general dentist can perform a LeFort I maxillary osteotomy in their office. Of course, it wouldn't be wise because of the potential complications (bleeding, pain control, etc.). It's the same thing with anesthesia training. In my opinion, you have to be prepared for the worst complications (loss of airway) to do any type of sedation because it's such a slippery slope.

If I'm the expert when it comes to the complications of the surgery, why doesn't the patient deserve the expert when it comes to the surgery? It's truly a struggle for me. Again, I have very good friends and referrals that do their own simple implants. I have no problem with it and they do a fantastic job. For me, I want to build my practice on things I can control.

Hope that answered your backhanded question.

I agree with you 100% that all practioners need to be able to manage intraoperative and life threatening complications (bleeding, airway etc). You shouldnt be doing sedation unless you know how to manage an airway or intubate. However, I don't believe they are required to manage all the delayed complications that may arise from the surgeries that they perform. OMFS as a specialty sometimes relies on other specialists to manage our complications. Examples: General surgery for hernia repair after AICBG or intraperitoneal hematoma, Interventional Radiologist due to internal maxillary bleed in a LeFort, Occuloplastic for entropion repair, ectropion repair, or lid retraction repair due orbital ORIF or bleph, Microvascular surgeon after debridement of BRONJ which leads to pathologic fracture. The role of practioner is to recognize potential pitfalls/complications, take steps to minimize them and ask for help when they are not able to manage it. These practitioners should not rely on others to bail them out due to negligence, lack of training or preparation for a surgery.
 
I agree with you 100% that all practioners need to be able to manage intraoperative and life threatening complications (bleeding, airway etc). You shouldnt be doing sedation unless you know how to manage an airway or intubate. However, I don't believe they are required to manage all the delayed complications that may arise from the surgeries that they perform. OMFS as a specialty sometimes relies on other specialists to manage our complications. Examples: General surgery for hernia repair after AICBG or intraperitoneal hematoma, Interventional Radiologist due to internal maxillary bleed in a LeFort, Occuloplastic for entropion repair, ectropion repair, or lid retraction repair due orbital ORIF or bleph, Microvascular surgeon after debridement of BRONJ which leads to pathologic fracture. The role of practioner is to recognize potential pitfalls/complications, take steps to minimize them and ask for help when they are not able to manage it. These practitioners should not rely on others to bail them out due to negligence, lack of training or preparation for a surgery.

Agree. It does likely become more of a turf war then. The post-op IMA bleed is slightly different bc an IR doesn't compete for the same procedure, the Lefort. That's why I struggle with the implant discussion.

Good post though.
 
Agree. It does likely become more of a turf war then. The post-op IMA bleed is slightly different bc an IR doesn't compete for the same procedure, the Lefort. That's why I struggle with the implant discussion.

Is there an ethical dilemma here? If a GP sends a patient your way with post-op complications does it make a difference if that GP sends you a bunch of referrals or not?
 
Is there an ethical dilemma here? If a GP sends a patient your way with post-op complications does it make a difference if that GP sends you a bunch of referrals or not?

That's a great question and to ride the fence, it all depends I think. So I've discussed this with a few friends who are going to be good referrals to me (hopefully). I've told them I don't want to treat their complications like I stated earlier. At the same time, if they or their patient comes to me seeking my help, do I decline to see them? If a patient comes to me from another provider, do I just tell them to go back and see that other provider? Is that what is best for the patient? I honestly don't know how this will all play out in my future practice. I think a bunch of it will depend on if it's a one time problem or a recurrent theme. Either way, I think a good discussion about te case and where it went wrong is warranted.

My future partner is stone cold when it comes to this stuff. He refuses to see any patient like that and will call the dentist to tell them why. He also has 20+ years in our town and is wildly successful. For a guy starting out, it's unrealistic to be an jerk and expect the best. I think the point about educating your referrals is still the best point.

I don't think it is an ethical dilemma, but more of a personal decision on the way you want to run your practice. If a patient truly seeks my expertise, for me, I will have trouble refusing that patient.
 
Dear all,

With all above discussion, main question is still not answered anywhere.

Does any one recommend Rutger's AAID Maxi-course, DC AAID Maxi-course, Columbia university implant, MISCH Implant or Charlotte, NC one? You may still need to practice after learning, but advice at least for 1st level from increase knowledge and skills. Please share your experience if you have attended.

I am looking for DC AAID Maxi-course to begin, but these are all very expensive courses and better to get other GP's advice (specialist have different vision and like to get advice from GP)

Thank you
 
2 more months and I'll be out of residency. I finished school 4 years ago. See, some people continue their education in a more formal manner than Youtube. Do you put that on your website? "I'm an implant surgeon with 96 combined Youtube hours of implant experience and fail videos"

You are very right though my friend. It is a scary place with "superdentists" practicing IV sedation, certain full bony impacted third molars and certain implant cases on real live people. I'll probably be too busy being the expert witness discussing the standard of care to be scared though.
Lol
 
AAID Maxi-courses are very solid. There are some regional differences depending on the site you choose. Courses also take most of a calendar year to complete. It is a huge commitment of time and money but very worthwhile if you put in the effort. Wherever you go, you should look at the faculty bios to see how the instructors learned what they teach. This might help to figure out if you will be able to maximize your education from them. You might also consider Kois and MISCH.
 
When you fail (and you will), just remember you will be held to the same standard of care as someone who did 4 extra years of training. Your YouTube videos will not hold up in court then.
Can you please explain what the difference in standard of care is for someone who did four extra years of training vs. a general dentist?
 
Dear all,

With all above discussion, main question is still not answered anywhere.

Does any one recommend Rutger's AAID Maxi-course, DC AAID Maxi-course, Columbia university implant, MISCH Implant or Charlotte, NC one? You may still need to practice after learning, but advice at least for 1st level from increase knowledge and skills. Please share your experience if you have attended.

I am looking for DC AAID Maxi-course to begin, but these are all very expensive courses and better to get other GP's advice (specialist have different vision and like to get advice from GP)

Thank you
I wouldn't recommend any of those. Not because they are bad courses, I don't know, but because unless you hold an specialty (periodontics, omfs, whatever) they don't hold a good value on their own. There are many things that somebody could learn, that doesn't mean it is a good idea to do it. Besides, there are many lawyers out there waiting for an ingenious general dentist, who has surgical skills, some courses, and no specialty.
 
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Dear all,

With all above discussion, main question is still not answered anywhere.

Does any one recommend Rutger's AAID Maxi-course, DC AAID Maxi-course, Columbia university implant, MISCH Implant or Charlotte, NC one? You may still need to practice after learning, but advice at least for 1st level from increase knowledge and skills. Please share your experience if you have attended.

I am looking for DC AAID Maxi-course to begin, but these are all very expensive courses and better to get other GP's advice (specialist have different vision and like to get advice from GP)

Thank you

I think it all depends if you need a lot of guidance with implant placement or a basic primer course. If all you need is a system to start with and a basic primer course, look for a weekend implant course. Placing an implant is just like placing a screw in particle board. Except you gotta avoid vital structures, avoid perforation, avoid overheating, and look at it from a biological perspective (medical hx, habits, occlusion, etc...). When it fails, back it out or trephine, regraft and start again. I think this is where most people struggle... what to do when things fail. Once I started placing implants, I realize that most cases are a cakewalk (3-5 unit implant bridges, single tooth implants and mini's). CT with tooth borne surgical guides make implants a lot easier. Non-full arch restorations are even easier. Do easy cases, punt difficult cases. If you really want to do more difficult cases, then you should definitely go to more intensive courses such as the ones offered in south america, tijuana, or carribean. I've heard good things about the programs outside the country

Edit:
You are held to the standard of care of specialists, as the standard of care of specialists is the standard of care for GP's. There is no difference. However, standard of care for implants does have some subjectivity (i.e survival v. success). An implant can survive, but if you have the implant fixture showing on the anteriors, it's a failure (even in the absence of pathology, inflammation, etc...). In the posteriors, the patient may be more accepting of it as a success. Or if there's inadequate keratinized tissue but the perimplant tissue is not inflammed and appears healthy. From a clinical persepctive, you may say that it's not a success due to lack of keratinized tissue, but from the patient perspective, it looks good and functions well.

If you really want to get started without going through these long courses, do easy cases first. If you want to make it nearly idiot proof, screen the "easy cases" (first molars, non-smoker, non-diabetic, good OH, a lot of width and height), get a CT + digital impression or PVS, hire a treatment planning company to plan the treatment for you and fabricate the surgical guide, and do the surgery flapless. I think it's a good way to get your feet wet.

Easy tips for starting out implants:
- Preop abx 1 hour po before procedure + CHX rinse
- Sharp drills and drill quickly (but not forcefully) to reduce heat generation. If you have to force it, your drill is probably dull or you're about to perforate. If it suddenly slips, good chance of perf especially if your planned implant is close to sinus or lingual/buccal plate. Ball tip probe is a great way to detect perforations.
- Refrigerated irrigation (I keep mine at 40 degrees F)
- Most implants fail by week 3. Do a 3 week post-op (besides other post-ops)
 
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