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MyView: Rebuttal: Implant specialty status

September 21, 2015

By Michael F. Cuenin, D.M.D.

Dr. Cuenin
I am writing in response to Dr. Dennis Flanagan's My View, "Surgical and Prosthetic Implant Treatment," published in the ADA News on July 13. I appreciate Dr. Flanagan's opinion but take issue with his conclusions.

The American Dental Association currently recognizes nine separate dental specialties: dental public health; endodontics; oral and maxillofacial pathology; oral and maxillofacial radiology; oral and maxillofacial surgery; orthodontics and dentofacial orthopedics; pediatric dentistry; periodontics; and prosthodontics. According to the ADA:  "Dental specialties are recognized by the Association to protect the public, nurture the art and science of dentistry and improve the quality of care."

Dr. Flanagan concludes: "Therefore it is time for the American Dental Association to approve oral implantology as a recognized dental specialty. Dental schools should begin training in this arena. Dental implant treatment has become a viable modality that benefits our society."

Dental implants are a single procedure. One procedure does not constitute or mean it deserves a "specialty" status. A dental specialty entails residency training in understanding varying pathologies and conditions with an appropriate analytic process (SOAP — subjective, objective, assessment and plan) to develop the best alternative treatment for each and every patient. Evidence-based dentistry is based on three tenets: the dentist's expertise; the patient's needs and preferences; and scientific evidence. If a dentist has sufficient expertise and is basing his or her treatment on sound scientific evidence to meet the patient's needs and preferences then the procedure is indicated. We are training surgical and prosthetic skills at the undergraduate and graduate level in dental schools. Dental implants are currently a core part of educational curriculum (both didactic and clinical).

As a board-certified periodontist and active clinician and educator, I believe that endosseous dental implants are one treatment option for the partially edentulous or fully edentulous patient. Sound communication between the surgeon and the restorative dentist is at the core of the treatment success. Of course, any licensed dentist may surgically place them or restore appropriately. Dentists may gain the skills needed to surgically place and restore endosseous dental implants as this is part of many continuing education opportunities currently available.  The "gold standard" for surgical placement remains a surgically trained dentist (periodontist or oral and maxillofacial surgeon) trained in residency in the full management of the patient along with this particular procedure. If another dentist or specialist meets this clinical standard then the procedure is one they should feel comfortable providing.  However, providing one treatment procedure does not constitute a specialty.

Dr. Cuenin practices in periodontics and implant dentistry in North Charleston, South Carolina. He is a diplomate of the American Board of Periodontology and a clinical instructor at the James B. Edwards College of Dental Medicine. He wrote this as a counterpoint to Dr. Flanagan's My View.