08 • Clinical risk


Dr Abhi Pal highlights key risks associated with an increasingly popular treatment option


MANAGING IMPLANT RISKS


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HE provision of implant dentistry in the UK has been rising for some years and so has the number of patient complaints associated with this treatment modality. This is likely to be related both to the costs and complexity. Implant dentistry is not yet recognised as a


specialty by the General Dental Council, but it is a mode of treatment for replacing missing teeth that does require specific training. The main areas where practitioners face challenges to their care are largely related to competency and training, adequate assessment, treatment planning and consent.


Competency Dentists contemplating implant training can find more details in the Faculty of General Dental Practice’s (FGDP) Training Standards in Implant Dentistry. Be sure your course is well structured with an adequate balance between theoretical teaching and mentored clinical experience. The value of mentoring cannot be under-estimated and is the key to ensuring a safe and competent practitioner. Practitioners whose training pre-dates existing formal


courses should be able to demonstrate their training and experience, ideally with a portfolio. Such a portfolio, which should also be maintained by those with formal training, will form the foundation of evidence that a practitioner was competent to undertake implant treatment in the first place. Additionally, a practitioner needs to provide care within their skillset and be aware of when it is appropriate to refer.


Full assessment Assessing the medical history is of paramount importance. It is especially important to identify smokers, patients with diabetes, patients on medications that affect bone metabolism and bleeding tendency. The failure to carry out a full mouth assessment and


instead focus solely on implant treatment leaves a dentist vulnerable to allegations of poor treatment. This includes addressing caries, periodontal disease and considering the prognosis of other teeth. Not managing primary disease before embarking upon


implant treatment creates the potential for problems further down the line. Patients can become unhappy when they have paid large amounts for implant treatment but then find there were other treatment needs that were not addressed. For example, if an anterior implant bridge was carried out but caries in other teeth were not managed, leading to their early loss, a patient could rightly consider that a different treatment plan would have been more appropriate from the outset.


Periodontal risks Implant provision in periodontally compromised patients requires particular mention. It is accepted that periodontitis is a risk factor for peri-implantitis and therefore for the failure of implants. It is essential that a proper periodontal assessment is carried out and periodontal care provided that is appropriate to that assessment, before embarking on implant treatment. The advice given in The Good Practitioner’s Guide from the British Society of Periodontology is still the accepted standard for periodontal care. If the services of a hygienist are to be used, the dentist leading the care must maintain responsibilities for diagnosing and treatment planning the periodontal condition. Cases involving a failure to adequately manage a patient’s periodontal condition before implant treatment can lead to large settlement sums. Post-treatment monitoring of peri-implant tissues is also essential for early detection and management of peri- implantitis. There needs to be a clear understanding whose role this will be in the case of referral patients, since monitoring of these tissues can often become the responsibility of a GDP.


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