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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Best Practices in Implant Dentistry meets the need for a thorough, accessible guide to the knowledge and skills required to provide dental implant treatment. Aimed at all members of the dental team, from general practitioners to surgeons to nurses, this book begins with regulations, standards, and patients’ safety before moving through well-organized sections on clinical aspects, including biomechanics, implant design, human factors, patient assessment, and implant maintenance. The growth of nanotechnology and digital workflows in the field of implant dentistry are also covered.
Best Practices in Implant Dentistry readers will also find:
- Coverage of all stages of treatment, from assessment to maintenance phases
- Detailed incorporation of principles from General Dental Council (GDC), Faculty of General Dental Practice (FGDP) good practice guidelines, and the Committee of Postgraduate Dental Deans and Directors (COPDEND) curriculum, International team for implantology (ITI), European association for osseointegration (EAO) and Association for dental implantology (ADI).
- Promotion of high standards of education, documentation, and delivery of implant treatment
- Updated guidance on digital implant workflows, nanotechnology, and surface treatment of implants
Best Practices in Implant Dentistry is fully informed by the latest approaches and institutional guidelines. It is a must-have purchase for dental professionals at every level who work with implants, including dentists, dental nurses, and oral surgeons.
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Seitenzahl: 308
Veröffentlichungsjahr: 2025
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Foreword
Preface
Acknowledgements
CHAPTER 1: Standards in Implant Dentistry
1.1 INTRODUCTION
1.2 AIMS FOR STANDARDS IN IMPLANT DENTISTRY
1.3 KEY FEATURES AND OBJECTIVES OF THE STANDARDS IN IMPLANT DENTISTRY
1.4 THE LEGAL STANDARD OF CARE
1.5 THE CLINICAL STANDARD OF CARE
1.6 TRAINING STANDARDS IN IMPLANT DENTISTRY DOMAINS OF COMPETENCE AND CLINICAL APPLICATION
1.7 OTHER SOURCES OF GUIDANCE IN IMPLANT DENTISTRY
REFERENCES
CHAPTER 2: Assessment
2.1 INTRODUCTION
2.2 DENTAL HISTORY
2.3 MEDICAL HISTORY
2.4 INTRAORAL AND EXTRAORAL EXAMINATION
2.5 PROVISIONAL DIAGNOSIS
2.6 INVESTIGATIONS AND DIAGNOSTIC IMAGING
2.7 DEFINITIVE DIAGNOSIS
2.8 TREATMENT PLANNING
2.9 DEFINITIVE TREATMENT PLAN
2.10 COMPLEXITY
2.11 PREPARATION FOR SURGERY
REFERENCES
CHAPTER 3: Patient Management
3.1 INTRODUCTION
3.2 MEDICALLY COMPROMISED PATIENT
3.3 PATIENT INFORMATION
3.4 PATIENT EDUCATION
3.5 MANAGING EXPECTATIONS
3.6 PATIENT ON REFERRAL
3.7 PATIENT RECORDS
REFERENCES
CHAPTER 4: Risk Management
4.1 INTRODUCTION
4.2 HUMAN FACTORS
4.3 DEFINITION OF SUCCESS
4.4 EVIDENCE‐BASED TREATMENT PLANNING METHODOLOGY
4.5 TREATMENT OBJECTIVES AND ENDPOINTS IN IMPLANTOLOGY
4.6 PATIENT‐RELATED SYSTEMIC FACTORS
4.7 PATIENT‐RELATED LOCAL RISK FACTORS
4.8 CLINICAL‐RELATED RISK FACTORS
4.9 SURGICAL RISK FACTORS
4.10 STRATEGIES FOR MANAGEMENT OF RISK FACTORS RELATING TO HUMAN FACTORS
REFERENCES
CHAPTER 5: Consent
5.1 INTRODUCTION
5.2 VALID INFORMED CONSENT
5.3 PATIENT CENTRED
5.4 PATIENT INFORMATION AND EDUCATION
REFERENCES
CHAPTER 6: Imaging
6.1 INTRODUCTION
6.2 IMAGING IN TREATMENT PLANNING
6.3 IMAGING DURING SURGERY
6.4 IMAGING POST TREATMENT AND REVIEW
REFERENCES
CHAPTER 7: Pain Control
7.1 INTRODUCTION
7.2 ACUTE DENTAL PAIN
7.3 PREOPERATIVE PROPHYLAXIS
7.4 SURGICAL ANAESTHESIA
7.5 POSTOPERATIVE PAIN
REFERENCES
CHAPTER 8: Anxiety
8.1 INTRODUCTION
8.2 PATIENT MANAGEMENT
8.3 PREOPERATIVE CARE, ADMINISTRATION AND POSTOPERATIVE CARE IN ANXIETY MANAGEMENT
8.4 COMMUNICATION AND PROFESSIONALISM
REFERENCES
CHAPTER 9: Surgical Management
9.1 INTRODUCTION
9.2 SURGICAL PREPARATION
9.3 BONE AND SOFT TISSUE MANAGEMENT
9.4 IMPLANT PLACEMENT
9.5 EXPOSURE AND TEMPORISATION
9.6 ORGANISATION
REFERENCES
CHAPTER 10: Restorative Approach
10.1 INTRODUCTION
10.2 SOFT TISSUE MANAGEMENT
10.3 IMPLANT ABUTMENT AND SUPER STRUCTURE
10.4 PROVISIONAL RESTORATION
10.5 RESTORATIVE DESIGN AND MATERIALS
10.6 CLINICAL PROCEDURES
10.7 AESTHETICS
10.8 OCCLUSION
10.9 PATIENT NOTES
REFERENCES
CHAPTER 11: Postoperative
11.1 INTRODUCTION
11.2 PAIN CONTROL
11.3 INFECTION
11.4 SUTURE REMOVAL
11.5 REVIEW AND FOLLOW‐UP
REFERENCES
CHAPTER 12: Maintenance
12.1 INTRODUCTION
12.2 RECALL INTERVAL
12.3 RADIOGRAPHIC REVIEW
12.4 CLINICAL EXAMINATION
12.5 ORAL HYGIENE AND PATIENT EDUCATION
REFERENCES
CHAPTER 13: The Digital Workflow in Implant Dentistry
13.1 INTRODUCTION
13.2 COMPONENTS AND STEPS OF THE DIGITAL IMPLANT WORKFLOW
REFERENCE
CHAPTER 14: Complications
14.1 INTRODUCTION
14.2 PATIENT MANAGEMENT
14.3 DOCUMENTATION
14.4 DIAGNOSIS
14.5 SURGICAL COMPLICATIONS
14.6 RESTORATIVE COMPLICATIONS
14.7 PERI‐IMPLANT DISEASE
REFERENCES
CHAPTER 15: Regulation and Legislation
15.1 OVERVIEW OF REGULATION AND LEGISLATION
REFERENCES
CHAPTER 16: Team Management
16.1 INTRODUCTION
REFERENCES
CHAPTER 17: Clinical Audit
17.1 INTRODUCTION
17.2 DECONTAMINATION
17.3 TREATMENT
17.4 CONTINUING PROFESSIONAL DEVELOPMENT AND SKILL ASSESSMENT
17.5 EQUIPMENT AND DEVICES
REFERENCES
CHAPTER 18: Communication
18.1 OVERVIEW OF COMMUNICATION
18.2 PATIENT EDUCATION
18.3 COMMUNICATION BARRIERS
18.4 INFORMED CONSENT
18.5 INTERPROFESSIONAL COMMUNICATION
18.6 CONCLUSION
REFERENCES
CHAPTER 19: Human Factors
19.1 INTRODUCTION
19.2 THREAT AND ERROR MANAGEMENT
19.3 TEAM RESOURCE MANAGEMENT
19.4 CHECKLISTS
19.5 REPORTING
19.6 STANDARD OPERATING PROTOCOL
19.7 ADDITIONAL INFORMATION
REFERENCES
CHAPTER 20: Technical Procedures
20.1 INTRODUCTION
20.2 COMMUNICATION
20.3 RESTORATIVE DESIGN
20.4 MATERIALS
20.5 DISINFECTION
REFERENCES
CHAPTER 21: Education and Training
21.1 INTRODUCTION
21.2 PERSONAL DEVELOPMENT PLAN
21.3 MENTORING
21.4 QUALIFICATIONS, COMPETENCE AND COURSES
REFERENCES
Appendix A
A.1 SUMMARY OF STANDARDS IN IMPLANT DENTISTRY
A.2 APPLICATION OF KNOWLEDGE, SKILLS AND COMPETENCE
A.3 SAFETY AND QUALITY OF TREATMENT, EQUIPMENT AND PRODUCTS
A.4 PROVISION OF ADEQUATE INFORMATION AND COMMUNICATION AND CONSENT
Appendix B: Standard Operating Procedures
B.1 PROTOCOL 1
B.2 PROTOCOL 2
B.3 PROTOCOL 3
B.4 PROTOCOL 4
B.5 PROTOCOL 5
B.6 PROTOCOL 6
B.7 PROTOCOL 7
B.8 PROTOCOL 8
B.9 PROTOCOL 9 – ICE
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 Upholding competence, care, and patient autonomy as the foundation...
Table 1.2 Ensuring informed, evidence‐based, and safe adoption of new dental...
Chapter 4
Table 4.1 Prerequisites for achieving and maintaining satisfactory osseoint...
Table 4.2 Risk factors and treatment modifiers in implant dentistry
Table 4.3 Human factor‐related errors in healthcare can occur as a result o...
Table 4.4 Success in implant treatment is multifactorial and requires well‐...
Table 4.5 An evidence‐based treatment methodology will benefit the patient ...
Table 4.6 Success in dental implant treatment is determined by achieving an...
Chapter 9
Table 9.1 Prerequisites for satisfactory completion of an implant surgical ...
Chapter 14
Table 14.1 Patient factors in dental implant restoration
Table 14.2 Human factors in dental implant restoration
Table 14.3 Technical factors in dental implant restoration
List of Illustrations
Chapter 1
Figure 1.1 Diagrammatic representation of dental implants in jaw.
Figure 1.2 Educational requirements and constraints.
Figure 1.3 Creating an individualised professional growth strategy for every...
Figure 1.4 The applicability of schema theory in the context of dentistry.
Figure 1.5 The
Training Standards in Implant Dentistry
framework consists of...
Figure 1.6 Standards in implant dentistry have been mapped with the competen...
Figure 1.7 Clinical and non‐clinical domains of competence in implant dentis...
Figure 1.8 The constituents of clinical proficiency and execution, adapted f...
Chapter 2
Figure 2.1 Treatment plan decision‐making tree for implant dentistry. The pa...
Figure 2.2 Sample dental chart showing the detailed documentation of a patie...
Figure 2.3 Comprehensive treatment and careful digital planning are essentia...
Figure 2.4 The importance of comprehensive treatment planning for dental imp...
Figure 2.5 The process of implant treatment planning. The various stages of ...
Figure 2.6 Preparation for implant surgery involves a comprehensive dental e...
Chapter 3
Figure 3.1 Empowering patients through education: tools for informed consent...
Figure 3.2 Patients with medical conditions often need special attention whe...
Figure 3.3 Algorithm for patients with (a) diabetes and (b) metabolic bone d...
Figure 3.4 Hard and soft tissue healing of a single tooth extraction. (a) Cl...
Figure 3.5 (a, b) Teeth 11 and 21 indicated for extraction. (c) Minimally tr...
Figure 3.6 Implant Pro software that helps patients to monitor their own den...
Chapter 4
Figure 4.1 Risk scale of soft tissue management before, during and after imp...
Figure 4.2 Osseointegration is the process by which a dental implant fuses w...
Figure 4.3 Success in dental implant treatment is determined by achieving an...
Figure 4.4 Progressive healing of extraction socket. BC, blood clot; GT, gra...
Figure 4.5 Innervation and vascular supply of the maxillary and mandibular d...
Figure 4.6 Anatomical rendering of head and neck.
Chapter 6
Figure 6.1 Coronal and sagittal cross‐sectional images of region 14 from pat...
Figure 6.2 In patient 1, magnetic resonance imaging data and a virtual stone...
Figure 6.3 This set of images depict various cross‐sectional views of fractu...
Figure 6.4 The figure illustrates sagittal and coronal cross‐sectional views...
Figure 6.5 The top left image shows a sagittal cross‐sectional view along th...
Chapter 7
Figure 7.1 Experiencing sharp and intense dental pain can be debilitating an...
Figure 7.2 The blood and nerve supply of hard palate for anaesthesia.
Chapter 9
Figure 9.1 Triad of contemporary implant dentistry.
Figure 9.2 The Pink Esthetic Score criteria assess: a) mesial papilla, b) di...
Figure 9.3 Clinical surgical procedure in sterile environment with necessary...
Figure 9.4 Clinical case of soft tissue management simultaneous to ridge pre...
Figure 9.5 Bone graft material placement.
Figure 9.6 Membrane placement for guided bone regeneration.
Figure 9.7 Immediate implant placement on day of tooth extraction. Use of a ...
Figure 9.8 Implant placement following maxillary sinus augmentation in a sta...
Chapter 10
Figure 10.1 A clinical case involving the management of soft tissue prior to...
Figure 10.2 Left: The taper joint‐type model is illustrated. This system rel...
Figure 10.3 Customised impression coping in place, supporting and reproducin...
Figure 10.4 Screw‐retained crowns require an access hole on the cingulum to ...
Figure 10.5 (a) Tooth 11 is affected by external resorption, and the patient...
Figure 10.6 Left: Optimal loading condition with occlusal forces directed al...
Chapter 11
Figure 11.1 Interocclusal space requirements with different restorative opti...
Chapter 12
Figure 12.1 Comparison of peri‐implant mucositis and healthy peri‐implant ti...
Figure 12.2 Series of radiographs and photographs permitting evaluation of p...
Figure 12.3 The biological width of natural tooth is 1 mm of connective tiss...
Figure 12.4 Evaluation of soft tissue includes swollen tissue, gum recession...
Chapter 13
Figure 13.1 Cone beam computed tomography scan.
Figure 13.2 Digital planning of implant placement based on a restorative per...
Figure 13.3 Guided implant surgery.
Figure 13.4 Intraoral scan markers in situ intraorally.
Chapter 14
Figure 14.1 Outline of common complications during implant surgery.
Figure 14.2 The correlation between immune reactions and dental implant fail...
Figure 14.3 Periodontal and peri‐implant interfaces. The implant interface c...
Figure 14.4 Patient with peri‐implantitis treated surgically with full‐thick...
Figure 14.5 Patient with peri‐implantitis treated surgically 2 weeks after a...
Chapter 19
Figure 19.1 Checklists.
Figure 19.2 Reporting.
Appendix B
Figure B.1 Initial assessment and initial therapy.
Figure B.2 Surgery.
Figure B.3 Restoration and review.
Figure B.4 Patient information checklist.
Figure B.5 Relevant medical history form.
Figure B.6 Treatment options.
Figure B.7 Letter to referring GDP.
Figure B.8 Initial clinical assessment checklist.
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Foreword
Preface
Acknowledgements
Begin Reading
Appendix A
Appendix B: Standard Operating Procedures
Index
Wiley End User License Agreement
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Best Practices in Implant Dentistry
Simon Wright
Cemal Ucer
Rabia Khan
This edition first published 2025© 2025 John Wiley & Sons Ltd
All rights reserved, including rights for text and data mining and training of artificial intelligence technologies or similar technologies. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.
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Foreword
Dental implant technology has revolutionized the way we approach tooth replacement and transformed the lives of millions of people worldwide. As a result, it has become more important than ever to establish and maintain high standards of care when it comes to dental implants.
In this book, we explore the latest developments and best practices in dental implant technology, as well as the essential standards of care that are necessary to ensure successful outcomes for patients. Everything from presurgical planning to postsurgical management is covered, with a focus on providing patients with safe, effective and long‐lasting solutions to their dental problems.
Whether you are a dental professional, a patient considering dental implants or simply interested in the science and technology behind this remarkable field, this book will provide you with the knowledge and insights you need to make informed decisions and achieve the best possible outcomes. So, join us on this exciting journey as we explore the fascinating world of dental implant technology and the high standards of care that underpin it.
Preface
Dental implant technology has made significant strides in recent years, providing patients with safe, effective and long‐lasting solutions to tooth loss. Dental implants are now widely accepted as the gold standard in tooth replacement, offering a range of benefits over traditional dentures and bridges.
As with any medical procedure, however, the success of dental implant treatment relies heavily on the expertise and skill of the dental professional involved. It is essential that the highest standards of care are followed to ensure the best possible outcomes for patients.
This book is intended as a guide for dental professionals, patients and anyone interested in the field of dental implant technology. We aim to provide a comprehensive overview of the latest developments in the field, as well as essential information on the standards of care that are necessary for successful outcomes.
In this book we explore the science and technology behind dental implants, from their development and design to their placement and postsurgical management. We also examine the ethical and legal considerations involved in the use of dental implants and the role of the dental professional in ensuring the safety and wellbeing of their patients.
We hope that this book will serve as a valuable resource for all those interested in dental implant technology and that it will contribute to the ongoing efforts to maintain high standards of care and excellence in the field.
Simon WrightCemal UcerRabia Khan
Acknowledgements
Prof Simon
I would like to express my heartfelt appreciation to my wife for her unwavering support, patience, and understanding throughout the development of this work. Her encouragement made the long hours dedicated to researching and writing this book possible.
To my children, Benjamin and Jacob, thank you for your quiet inspiration and constant reminder of the importance of clarity, precision, and purpose—principles that are as vital in life as they are in standards.
Prof Cemal
"As a co‐author of this book, I extend my deepest gratitude to all who have supported my journey.
To my wife, Nilay—thank you for your patience, unconditional love, and understanding. To my son, Emre whose presence brings clarity and joy—I am endlessly grateful.
I am profoundly thankful to the many mentors, colleagues, and peers who have guided and inspired me throughout my surgical career. Your wisdom, values, and commitment to excellence have left a lasting impression on my practice and perspective.
I am especially grateful to the patients who have entrusted me with their care over the years. Your trust has been both an honour and a responsibility that continues to inspire my professional growth.
This book was written with a shared purpose of advancing best practices in implant surgery and enhance the quality, safety, and standards of patient care and I dedicate this work to everyone who continues to pursue excellence in surgical care.”
Prof Rabia
My appreciation goes to my dad, who has been my greatest strength, giving me the wings to fly. His continuous support and confidence in me have shaped my career path.
I also wish to acknowledge my dedication and effort invested in compiling and researching this work, which has helped bring this project to completion.
I sincerely thank Prof. Simon Wright and Prof. Cemal Ucer for trusting in me and guiding me with their wisdom and encouragement throughout this journey.
I would also like to thank my advisors who empowered me with the knowledge and confidence to successfully undertake the research and write this book. I dedicate it to everyone striving to achieve excellence and make a meaningful impact in their profession.
CHAPTER 1Standards in Implant Dentistry
1.1 INTRODUCTION
Dental implant treatment has become routinely available in the UK for the management of tooth loss to restore dental function and aesthetics [1]. Currently, implant treatment is provided by dentists from different backgrounds and training, ranging from general dental practitioners to specialists in oral and maxillofacial surgery. Apart from guidance by the Faculty of General Dental Practice UK (FGDP(UK)) in Training Standards in Implant Dentistry (2016) [2] that set the standards for training in implant dentistry for dentists who wish to practise dental implant treatment, there are no specific national guidelines in this field. Nevertheless, it should be noted that Training Standards in Implant Dentistry has been adapted by the General Dental Council (GDC) to set the training standards for acquiring clinical competence in this field of dentistry.
Delivery of satisfactory dental implant treatment and its long‐term success and maintenance require complex and invasive surgical and restorative procedures using a variety of highly specialised products, biomaterials and equipment. These interact with the host tissues both biologically and mechanically [3]. Satisfactory delivery of dental implant treatment also requires a well‐trained team of dental professionals, therefore dentists who provide dental implant treatment have a legal and ethical duty to develop and maintain up‐to‐date evidence‐based knowledge and competence in the field. The treatment provided should involve the use of evidence‐based techniques and products, with the exception of a clinical trial consented to explicitly by the patient. The patient is entitled to, and expects, that the members of the dental team have the right skills, and that the products they use are safe and proven [3]. The patient is also entitled to have adequate information and advice on the alternative techniques, products, risks and outcomes, as well as the experience and scope of practise of the clinician proposing to carry it out before autonomously deciding to commence treatment [4].
Dental implant treatment is mainly an elective dental treatment option that requires complex and invasive procedures, followed by a need for meticulous life‐long maintenance. Patients' understanding of the nature and the mechanics of treatment, as well as their expectations regarding a realistic result, can often be lacking Figure 1.1. Thus, as in all elective surgery, dental implant treatment requires a higher standard of patient education and documentation, as well as meticulous attention to detail throughout every stage of treatment, from assessment and planning to delivery of treatment and maintenance phases.
These dynamic standards are intended to be good practice guidelines that could be applied to any clinical practice to promote safety and quality of care, rather than didactic or prescriptive rules that dictate how treatment should be delivered. Training Standards in Implant Dentistry is intended for the whole dental implant team. It covers all stages of treatment from assessment and surgery to maintenance phases. In this context, greater responsibility rests with the most experienced member of the team, particularly within the domains of professionalism, communication, leadership and management [2].
FIGURE 1.1 Diagrammatic representation of dental implants in jaw.
The standard of implant dentistry refers to the expectations and requirements that dental professionals must meet when providing implant treatment to patients. This standard is established to ensure that dental implants are placed safely, effectively and with the best possible outcomes for the patient. The standard of implant dentistry is constantly evolving with new research and developments in implant technology and techniques [5].
The standard of implant dentistry encompasses several areas, including the application of knowledge, skills and competence, professionalism, teamwork, safety and the quality of treatment equipment and products, and the provision of adequate information, communication and consent to patients. Dental professionals must gain adequate training and experience appropriate to each level of complexity of implant treatment offered, and recognise and work within the limits of their competence. They must update their knowledge and skills regularly through structured continuing professional development (CPD) in implant dentistry and take care and prudence in applying their knowledge and skills to deliver the treatment satisfactorily as planned [6].
Dental professionals must also seek and act on feedback from patients, colleagues and their team using specific outcome measures, audit results and treatment outcomes regularly, and use these to improve any shortcomings in their dental implant practice. They must follow best practice guidelines and keep up to date with evidence‐based developments in materials and procedures to ensure safe, predictable and effective treatment outcomes. The techniques, treatment and products used must be safe and predictable, and unproven products or techniques should be avoided unless carrying out clinical trials with explicit patient information and consent.
When providing implant treatment, dental professionals must work closely with patients and other colleagues in formulating patient‐centred, evidence‐based treatment plans to ensure that the desired expectations of the outcome can be achieved effectively for each patient. They must carry out a full risk assessment and consider the anatomical, functional, psychological and financial needs of the patient when formulating a treatment plan for each individual patient. They must also discuss the relative indications, advantages and disadvantages of the alternatives and provide adequate information, communication and consent to patients [7]. This includes informing patients of the expected prognosis of the proposed treatment with specific reference to the possible impact of each patient's individual systemic and local risk factors on the intended outcome, discussing the likely impact of the patient's dental and medical history, systemic condition and vulnerabilities on the prognosis of the proposed treatment, and providing itemised and transparent financial information.
Implant dentistry is a well‐established and rapidly growing field in the United Kingdom, and there are a number of standard practices and guidelines that are followed to ensure the safety and success of implant treatments. Here are some of the key training standards in implant dentistry in the United Kingdom:
Qualifications and training
: To practise implant dentistry in the United Kingdom, dentists must have completed specific training and qualifications in implantology. The GDC has established standards for implant dentistry training, and dentists must be registered with the GDC to practise in the United Kingdom.
Consent and patient selection
: Prior to any implant treatment, the dentist must obtain informed consent from the patient. This includes discussing the risks, benefits and alternatives to implant treatment, as well as ensuring that the patient is a suitable candidate for implants.
Sterilisation and infection control
: Implant treatment requires a sterile environment to minimise the risk of infection. Dental practices must follow strict protocols for sterilising instruments and equipment, as well as maintaining a clean and hygienic environment.
Implant placement
: The placement of dental implants must be carried out in accordance with established guidelines and protocols. This includes careful planning and assessment of the patient's oral health, as well as the use of appropriate techniques and materials.
Follow‐up and maintenance
: After implant treatment, patients require ongoing care and maintenance to ensure the longevity of the implant. This may include regular check‐ups, cleaning and adjustments, as well as appropriate hygiene and home‐care instructions [
2
–
4
,
8
].
Implant dentistry in the United Kingdom is subject to strict regulations and standards to ensure the safety and success of treatment. Dentists who practise implantology must have the necessary qualifications and training, and must adhere to established guidelines for patient selection, treatment and follow‐up care.
1.2 AIMS FOR STANDARDS IN IMPLANT DENTISTRY
The key aim of Training Standards in Implant Dentistry is to provide good practice guidelines on the knowledge, clinical competence and skills required of dentists who provide dental implant treatment to enhance the national standards of quality and safety of care (Figure 1.2).
Training Standards in Implant Dentistry incorporates general principles from the GDC guidance to dentists, FGDP good practice guidelines as well as Committee of Postgraduate Dental Deans and Directors (COPDEND) curriculum for Dental Foundation Training.
FIGURE 1.2 Educational requirements and constraints.
1.3 KEY FEATURES AND OBJECTIVES OF THE STANDARDS IN IMPLANT DENTISTRY
Application of knowledge, skills and competence:
Gain adequate training and experience appropriate to each level of complexity of implant treatment offered.
Recognise and work within the limits of your competence, seeking advice or referral to another colleague when the complexity of the case falls out of your scope of practise.
Update knowledge and skills regularly by undertaking structured CPD in implant dentistry using your
personal development plan
(
Figure 1.3
).
Take care and prudence in applying your knowledge and skills correctly to deliver the treatment satisfactorily as planned.
Professionalism, teamwork, safety and quality of treatment equipment and products:
Seek and act on feedback from patients, colleagues and your team using specific outcome measures.
Audit results and treatment outcomes regularly, and use these to improve any shortcomings in your dental implant practice.
Follow best practice guidelines and keep up to date with evidence‐based developments in materials and procedures to ensure safe, predictable and effective treatment outcomes.
Ensure that techniques, treatment and products used are safe and predictable.
Avoid using unproven products or techniques unless carrying out clinical trials with explicit patient information and consent.
Maintain a log book or register of techniques and products used.
Schema theory proposes that our knowledge and experiences are organised into mental frameworks or ‘schemas’ that guide our perception, interpretation and memory of new information. In the context of implant dentistry, schema theory can be applied to understand how a patient's pre‐existing schemas about tooth loss, dental treatments and dental professionals can influence their perception and response to dental implant procedures (Figure 1.4).
FIGURE 1.3 Creating an individualised professional growth strategy for every member of the dental team. PDP, personal development plan.
FIGURE 1.4 The applicability of schema theory in the context of dentistry.
For example, a patient who has negative schemas about dental procedures may have increased anxiety or fear about undergoing a dental implant surgery. Alternatively, a patient who has positive schemas about dental professionals may be more receptive to treatment recommendations and more likely to follow postoperative care instructions [9].
By understanding a patient's pre‐existing schemas, dental professionals can tailor their communication and patient management strategies to address any misconceptions or concerns and improve patient outcomes. Additionally, incorporating schema‐based cognitive and behavioural interventions, such as cognitive restructuring or exposure therapy, may also help alleviate negative schemas and improve treatment acceptance and adherence.
Provision of adequate information, communication and consent:
Work closely with patients and other colleagues in formulating patient‐centred, evidence‐based treatment plans to ensure that the desired expectations of the outcome can be achieved effectively for each patient.
Carry out a full risk assessment and consider the anatomical, functional, psychological and financial needs of the patient when formulating a treatment plan for each individual patient.
Discuss the relative indications, advantages and disadvantages of the alternatives.
Inform patients of the expected prognosis of the proposed treatment with specific reference to the possible impact of each patient's individual systemic and local risk factors on the intended outcome.
Make sure patients are given enough information to make an autonomous decision and have time to reflect before deciding whether or not to have dental implant treatment.
Discuss the likely impact of the patient's dental and medical history, systemic condition and vulnerabilities on the prognosis of the proposed treatment, and how these may impact any additional remedial treatment that may become necessary in case of failures or complications.
Discuss the strength of the need to treat, including risks complication, side effects if treatment fails, possible remedial treatment that may become necessary as well as the consequences of failure to treat if any.
Provide itemised and transparent financial information, fees and charges, and provide structured policy information on how to deal with any failures or future remedial treatment if needed.
1.4 THE LEGAL STANDARD OF CARE
Whilst clinicians are generally required to exercise the degree of skill and competence ordinarily possessed by their fellow practitioners (‘peers’) under similar circumstances, any practitioner (generalist or specialist) undertaking any surgical and/or prosthodontic procedure that is particularly deemed to be of an advanced or complex nature should do so to the same standard of care (SOC) expected of a specialist or, in the case of a specialist, to a standard equal to a reasonable body of his/her peers [10]. A clinician could be legally held responsible for failing to refer to a specialist or more experienced colleague.
1.5 THE CLINICAL STANDARD OF CARE
The doctrine of the clinical SOC is a highly relevant concept to risk management, and therefore setting standards in healthcare is an essential prerequisite for achieving a high quality of patient care. Standards or ‘good practice guidelines’ help clinicians to achieve better outcomes by benchmarking their clinical activities and how they practise. This reduces variations in quality of healthcare and establishes national norms by helping to increase the ability of practitioners to predict, recognise and treat complications arising from any treatment they provide. The standard of care is a dynamic concept that evolves continually with the introduction of new techniques, products and case law.
On the other hand, the SOC does not mean a clinician should possess a minimum standard of extraordinary knowledge or skills or provide treatment that never fails. The SOC is the manner in which a clinician must practise bringing about a good result.
It must be noted that as long as the clinician can show that he/she has applied reasonable care, knowledge and skills correctly in a prudent way, treatment that ends in a bad result will not be a successful cause of action because of the doctrine of ‘error in judgement’.
Training Standards in Implant Dentistry provides a framework of good practice guidelines in implant dentistry to ensure that an intervention can be skilfully planned, executed and delivered to bring about a good result that has been predicted using reasonable care and caution. Tables 1.1 and 1.2 summarise the key features of the clinical doctrine of SOCs.
1.6 TRAINING STANDARDS IN IMPLANT DENTISTRY DOMAINS OF COMPETENCE AND CLINICAL APPLICATION
The Training Standards in Implant Dentistry are presented in a framework consisting of two distinct categories of clinical and non‐clinical domains (Figure 1.5). These are in turn mapped against the four main domains of dentists' competence (Figures 1.6 and 1.7).
TABLE 1.1 Upholding competence, care, and patient autonomy as the foundation of clinical standards.
The standard of care means that a clinician should:
Have a reasonable degree of knowledge and skills that is ordinarily possessed by a skilled and prudent clinician acting in the locality.
Use reasonable care, prudence and best judgement in correctly applying knowledge and skills that a reasonably prudent practitioner would apply under similar circumstances to bring about a good result that has been planned or predicted.
Keep up to date with evidence‐based knowledge and skills development.
Use approved or evidence‐based methods in general use. When adopting new products and techniques must use prudence and be competent in their use.
Give proper advice and instructions to patients regarding how they need to care for themselves after treatment.
Respect patients' autonomy about making decisions concerning their healthcare.
TABLE 1.2 Ensuring informed, evidence‐based, and safe adoption of new dental materials and devices.
When employing new materials, devices or products a dentist should:
Consider the strength of the evidence when comparing the availability, effectiveness and safety of the new method or products with the established ones.
Be properly trained in the use of the new method or product.
Obtain informed consent with full disclosure of adequate information and any material risks to allow for autonomy.
Ensure that safety and efficiency of the medical devices have been documented and conform to the guidelines of the Medicines and Healthcare Products Regulatory Agency and/or the European Union's Medical Devices Directive.
Follow the recommendations of the manufacturers for the use of products.
FIGURE 1.5 The Training Standards in Implant Dentistry framework consists of clinical and non‐clinical domains.
FIGURE 1.6 Standards in implant dentistry have been mapped with the competencies expected of practicing dentists.
1.6.1 Level of Evidence
The level of evidence supporting each competency is graded as (i), (ii) or (iii).
Level (i)
