Don't Give 'Them' Ammunition - T-Bone Speaks

Don’t Give ‘Them’ Ammunition

Turf wars have been going on in the world since the very beginning.  In recent years they have really become heated in dentistry – especially when it comes to dental implants.  Dental implants have long been considered a ‘specialist’ procedure.  With the advent of technology, availability of advanced training, and increasing business pressures to keep more procedures ‘in house’, dental implants are starting to switch to a general dentist driven procedure.

It is very important to remember – THERE IS NO SPECIALTY FOR IMPLANT DENTISTRY.  There is nothing that says or has said that dental implants should only be placed by oral surgeons or periodontists.  I would take a bet that if your oral surgeon or periodontist has been in practice more than 20-25 years, he/she didn’t receive any significant formal training in dental implants through residency.

This is just the beginning of this turf war.  If you are a general dentist and placing and/or thinking about placing dental implants be prepared.  Don’t be afraid, but be prepared.

Recently, there was an ‘investigative’ report by a news station in Arizona that featured a couple of oral surgeons who were giving a ‘public service announcement’ about dentists placing dental implants.  Personally, I was angered by this.  Who made these two surgeons the saviors of the public.  Do they never make mistakes?  They even went as far as using scare tactics about a situation where a dentist was making dental implants in his/her garage to place in patients.  I may be naive, but I find that pretty preposterous.

Look, I am not saying there aren’t bad apples in our profession.  I’m not saying there aren’t general dentists who have no business placing implants.  But this all goes every which way – there are oral surgeons (substitute any speciality in here as well) who have no business placing implants.  We are a profession – one that depends on each other for ultimate success and survival.


Having personally felt the attack from other dentists in my practice area, let me give you a few pointers to keep yourself above the turf war.

1.  Use ‘Name Brand’ dental implants.

I began my implant journey using ‘compatible’ implants because they were cheaper and saved money.  To this day I feel that ‘compatible’ implants (from reputable companies – Implant Direct, Blue Sky Bio, Inclusive, and many others) are just as good as ‘name brand’ implants – in terms of success rate.  Unfortunately, some of the other dentists in your area may use this against you.  The typical implant friendly general dentist is placing around 50 fixtures annually.  This amounts to a savings of $7,500-$10,000 per year in using ‘compatible’ vs ‘name brand’ implants.  Is this really worth the stigma and potential backlash?

While these ‘name brand’ implants are more expensive – they do come with local rep support, scientific testing, FDA approval, stringent manufacturing process, educational programs, and etc.

2.  Follow proper protocol and instrumentation.  Stop being cheap!

I’ll be the first to tell you that an osteotomy is an osteotomy – whether it’s drilled by implant drill A or drill B.  But there are too many ‘educators’ out there teaching other dentists how to save money by mixing and matching systems.  Technically, there is nothing wrong with this.  In my opinion, it sends the wrong message and is just one more thing the specialists can use against us.

Let me be specific.  In a recent online social forum, a implant ‘educator’ advised another general dentist (who is relatively new to implants) to use the Camlog guided drill and system to place a Straumann implant – but remember to offset for the difference in length of the two implants since they aren’t the same length.  ARE YOU FREAKING KIDDING ME!  What if a novice and impressionable dentist reads this and does this, but forgets the offset for lengths and hits a nerve or perfs the buccal plate?

As an educator myself, it drives me crazy to see this type of advice being given in a public forum.  I may even be guilty of this in the past, but I can promise you that moving forward I will do my absolute best to teach proper manufacturer protocol.

3.  Consistently participate in implant education.

Implant dentistry is constantly changing and evolving.  If you aren’t taking formal education every year you are doing yourself and your patients a disservice.  One of the main arguments specialists are using against us is our lack of training.  So go overboard with training.  There is no such thing as too much education!  The added benefit of this will be growth in your skills and ability to tackle even more cases.

4.  Work closely with a local specialist

Don’t put yourself on an island.  I have been able to grow my implant abilities because of the relationship I have established with my local oral surgeon and periodontist.  They have been wonderful sounding boards and have been there to assist me when things don’t go well.  And trust me – we all make mistakes and/or have adverse outcomes.  No person is immune to this.

Also – the truth is that you won’t be able to (or want to) do every case that walks in your office.  A good working relationship is in the best interest of the patient.


General dentists are your friends.  You were a general dentist at one time – when you graduated from dental school until you completed your residency.  The name of the game is the PATIENT.  You weren’t born with implant training – you gained it with education, time, and experience.  This same thing can be completed by general dentists.  Scare tactics will not make things better.  In fact, those specialists who embrace other dentists and partner with them will be the big winners.  Their practices will grow and the relationship between specialist and general dentist will be rock solid.

Also, remember that the vast majority of your patients come to you by referral of a general dentist.   Ultimately, the success of your practice greatly hinges on a friendly relationship with  your general dentist.

MAY I ASK A SMALL FAVOR OF YOU?  If you are a general dentist reading this do me a favor.  Support your local specialists who support general dentists.  Stop sending your patients to ‘small minded’ specialists who don’t embrace general dentists expanding their skill sets.  There is nothing that will speak louder than this!  And a second favor.  A rising tide lifts all boats.  Encourage your fellow general dentists to participate in advanced education and push themselves to learn about new things.  In my opinion, our profession isn’t taking enough continuing education.

About the Author Tarun Agarwal

Dr. Tarun Agarwal represents the next generation of leadership for the dental profession. As a respected speaker, author and opinion leader, he is changing the way general dentists and their teams practice.

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  • Andres Powditch says:

    Absolutelly true.
    In LatinAmerica its the same issue…..from dental school they start teaching your inability and need to be a “Specialist” or be ready to drive a cab (with all due respect to cab drivers) as its the only way to success ( $$$$$)
    Soon they’ll invent the CERECist……Full Rehab Orto & Implant Digital Specialist…..
    Be aware……or prepared.

  • Jared Ottley says:

    TBone nice article. Have to disagree with #1 though. Although there are some shady copy cat implant companies and dentist should be aware and chose wisely, to me, Implant Direct is as reputable as any implant company you can name. From state of the art production facilities to world class research and development, these guys do it all and do it right. In fact, I don’t consider them a “compatible” company at all. Yes, they have compatible implants…that they have researched,developed, and IMPROVED. Last time I checked we use compatible materials all day everyday…company A bonding agent with company B composite cured with company C’s curing light. So what it boils down to is just like everything we do, know what your using and know what your doing. Don’t fly blind!!!!

    • T-Bone says:

      I don’t disagree or totally agree. Certainly all implants work and we are moving towards the name not meaning as much as it use to.

  • Good article. While there is no such thing as a specialist in dental implants, oral surgeons, periodontists and prosthodontists do tend to have more training and experience placing and restoring dental implants than most general dentists. In fact, prosthodontists do receive formal training in dental implants, Nevertheless, more and more GPs are receiving advanced training in dental implants making them perfectly qualified to perform implant procedures. No specialty should claim to be the only one qualified for implant procedures. We all count on each other for support and referrals, and there is no reason we shouldn’t all be able to benefit from one of the most significant advancements in dentistry in the past century (i.e. dental implants).

    • T-Bone says:

      Howard… You are absolutely correct. Unfortunately there is too much of a turd war going on. I understand both sides, but the scare tactics are what makes it sad

      • T-Bone – my comment above may be a bit confusing. I mention “placing and restoring dental implants” after oral surgeons, periodontists and prosthodontists. Oral surgeons and periodontists generally don’t handle the restoration phase of dental implants.

        Scare tactics like the one in the video news story you shared are unfortunate. I can understand their concern with regard to dentists claiming to be specialists when, in fact, they aren’t. Sure, there are unqualified general dentists performing dental implant procedures. Yet, many general dentists do have the necessary training and experience required to successfully place implants. I’m not sure whether to point the finger at the news station or the board-certified oral surgeons for spinning such a ridiculously biased story.

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