Trends in Dentistry: Entering a New Age

Based on current statistics, an estimated 5 million patients have already received implant procedures to replace missing dentition, with that number growing at a projected rate of 500,000 a year. Increased awareness and demand among the high proportion of untreated patients for improved function and esthetics in addition to technological advances in the field that reduce treatment times and increase predictability are all factors fueling the market and offering untapped opportunities for market growth. In the US, it is estimated that by 2020 the number of dental implants placed will rise to 2.5 million per year with the worth of the dental implant market expected to hit the $2 billion mark.⁴ These projections are buoyed by current reports of a stabilized and more positive consumer confidence outlook for next year and beyond as well as a projected increase in consumer spending as disposable income increases.⁵

Other important factors positively contributing to and influencing the growth of the implant field are its high 98% success rate,² a gradual increase in the numbers of insurance companies adding implants to covered services, and the declining cost of implant services.⁴

Added to these positive market growth indicators is the growing pool of general dentists offering implant dentistry as a service in their practices. Although the exact percentage of total GPs in the US placing implants is not known, estimates run from as low as 10% to as high as 50% or more. Richard Mercurio, DDS, 2016 President of the American Association of Implant Dentistry (AAID), indicated a majority of the association’s general dentist members are practicing implant dentistry.

“The days of automatic referral to a specialist for implant placement are waning,” Mercurio says. “Of our total 5,500 membership, 83% are general dentists and 17% are specialists. A recent benchmark survey we conducted of our membership showed that 72% of our general dentist members are currently placing and restoring implants.” According to Mercurio, the advent of CBCT scanning technology, the accuracy it affords virtual implant placement planning, and the creation of precision surgical guides by the laboratory have spawned the increase in general dentists practicing implant placement procedures.

All these favorable projections are good news for laboratories involved in the treatment planning and restorative phases of implant dentistry. However, as robust as the dental implant industry is and is projected to be in the future, one factor that may be holding it back from even faster growth is the fact that implant dentistry is not formally recognized by the American Dental Association (ADA) as a specialty “where advanced knowledge and skills are essential to maintain or restore oral health.” Therefore, Mercurio notes there is no “standard” curriculum in undergraduate or graduate curriculums for gaining the complete knowledge and skills required for practicing implant dentistry.

“Implantology requires the combined knowledge and skills of three of the nine dental specialties—periodontics, oral surgery, and prosthodontics,” he says. “That is what separates implant dentistry from those other specialties. Periodontists understand the tissue, oral surgeons the bone and implant placement, and prosthodontists have expertise in the function and esthetics of the final restoration, but clinicians diagnosing, treatment planning, placing, and restoring implants need a deep understanding of each of these specialty areas.”

Establishing professional educational standards and credentialing programs for dentists and specialists practicing implant dentistry to achieve specialist status has been left to professional associations such as the AAID to determine and teach.

“The Academy and our credentialing board, the American Board of Oral Implantology/Implant Dentistry, have been in existence for nearly 50 years and have established rigorous educational standards that applicants must pass to achieve Associate, Fellow, or Diplomate certified credentialed status,” Mercurio says. The AAID, he notes, has also successfully defended in three state courts the right of practitioners graduating from these programs to advertise their credential status to the public.

Official recognition of implant dentistry as a specialty has been a politically charged battle fought over the past 25 years. However, at the end of October 2016, during the AAID’s annual conference, the ADA issued a memo that an amendment to Section 5H of the dental code had been made: “We permit dentists who are qualified and practice in areas of dental specialties that are recognized as specialties in their jurisdictions but not by the ADA to announce themselves as specialists.”

The victory means that the ADA is no longer the sole determiner of who is a specialist and may open the door for AAID members as well as members of other bona fide organizations who have successfully completed established and widely accepted specialty credentialing programs to advertise their credential status to the public. The onus is now on the state boards to revise their regulations to adhere to the ADA change in the dental code.

As for the AAID and its continued push toward implant specialty education, the next stop is the Commission on Dental Accreditation (CODA).

“We have just recently embarked in the process of putting together an application to CODA to set standards for what an implant residency program should be,” Mercurio says. “There has never been a more exciting time in implant dentistry. The advances in technology and techniques that have occurred, and those we are currently exploring, are making implant dentistry more sophisticated and successful, bringing it to the forefront of the dental field.”

And may be giving birth to the recognition of implant dentistry at some point in the future as the 10th officially recognized specialty field in dentistry.