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The Faculty of General Dental Practice updated its guidance on its training standards for implant dentistry in June 2012. The standards distinguish between complex and straight-forward cases. As a patient it is useful to understand the complexity of your case. This will allow you to appreciate the level of expertise required for the operation and the costs involved. You can assume prices quoted on websites will be for straight forward cases. The FGDP lists the following factors as adding to the complexity of cases:
- The end result cannot be easily visualised without extensive diagnostic and planning techniques. Treatment will include multiple stages to achieve the desired outcome and may involve multidisciplinary planning. The aesthetic requirements or limitations of the case are high, as are the expectations of the patient.
- Due to age or physical/medical compromise, the patient requires special care and management.
- There are no adjacent teeth, or those present are in an unsuitable position. There is a need to carry out extensive diagnostic procedures to determine the optimal tooth/implant position for aesthetics and function.
- The implant surgery has anatomically related risks and might require significant hard tissue grafting (this includes onlay bone grafting and sinus grafting). Surgery will involve significant alteration to anatomical structures with potential risk of damage to vital structures.
- There is a need to substantially change the existing occlusal scheme or the occlusal vertical dimension. (Occlusal scheme relates to the surfaces of opposing teeth especially the biting or chewing surfaces.)
- The patient has active periodontitis with advanced bone loss and tooth mobility. There are lifestyle issues or co-morbidities such as smoking, diabetes or bruxism.
- Implants are loaded immediately or soon after their placement.
- Surgical management of periimplantitis or implants that require removal by surgical approach. (Periimplantitis is an inflammation in and around the area of a dental implant that may also affect abutment areas)
A dentist must be surgically experienced in the placement of straightforward implants before progressing onto the treatment of complex cases. Some clinicians may possess all the skills needed to treat a complex case single-handedly, but this is the exception. It is likely that the planning and treatment of complex cases will require a team approach resulting in a higher cost for the operation.