Sometimes a patient may come to you with treatment needs that exceed your current skillset. Every clinician, at some point in their career, has encountered it. Today, this may be common when patients are looking to receive a dental implant, or require maintenance care for one that has previously been placed.
Not all dentists will be adequately equipped to provide an effective solution when a patient requires such care. In particular, the ability to place dental implants requires advanced, dedicated training in order to reliably provide high-quality and safe treatments. You may not have focused your time on acquiring the necessary skills to treat such cases, but you must know the options available to you for making the correct referral.
Directing a patient to another clinician is required of all professionals when the case in front of them may be pushing their clinical capabilities a step too far, and can ensure each individual recieves the care they need.
The importance of referral
Dental implant treatment may be necessary for a variety of reasons, from tooth loss through injury or disease, to attempts to improve the stability and function of a restoration for patients that already use dentures.
The case may demand experience of advanced techniques, but dental professionals must only carry out treatments if they are appropriately trained, competent and confident, working solely within their mental and physical capabilities.ii For example, a patient may be lacking adequate bone structure for a straightforward implant placement, so may require more complex implant solutions. If you have not yet undergone training for augmentation workflows, taking on such a case would be wholly irresponsible.
Similarly, patients may have specific non-clinical needs related to their care that make dental provision difficult, and therefore require a referral. The General Dental Council’s Standards for the Dental Team notes that patients’ disabilities must be considered, and where reasonable adjustments to your care cannot be made, a referral must be considered.[i]
In either case, the patient’s best interests must be put before anything else – including your developing clinical experience, your relationship with other clinicians, and other such motivations for either taking on treatment, or referring them to another practitioner.
Identifying complex cases
Providing treatment without the adequate skills may increase the risk of developing issues such as infection, damage to surrounding structures, or even implant failure.
Referring the case will not only better support you from a medicolegal stand point, where the current atmosphere amongst dental professionals is one of particular concern and worry, but also improve the patient’s happiness with the treatment outcome. With fewer complications, they may be able to experience an improved quality of life sooner, and for longer.
Studies have found that early dental implant failure is twice as common as late implant failure. [ii] The former is commonly associated with impaired bone healing, or inadequate osseointegration due to heat-induced necrosis and incorrect positioning at the time of surgery, amongst other factors. However, late implant failure is considered to be heavily impacted by patient-related factors, such as oral hygiene management and infection prevention.
By referring the original treatment, you would maximise the quality of care that is provided, and reduce the chance of early failure. You may then care for the patient in the months following, where your skills may be better applied to managing the recovery of the treatment site. If any complications are met, you would be able to speak to the referral clinician for support and insight on the unique case.
Finding clinicians you can trust
Identifying dental professionals that can confidently take on complex dental implant cases can, at first, be a challenging process. Consider the GDC Standards for the Dental Team; they state that although you can delegate the responsibility for a task, you may still be held accountable for the treatment.ii Therefore, in such cases you must ensure the dental professional you are referring the patient to is appropriately trained, indemnified, and competent, in order to carry out the procedure.ii
For difficult cases concerning dental implantology, consider Dr Fazeela Khan-Osborne and Dr Nikolas Vourakis at The One to One Dental Clinic of Harley Street, London. Both clinicians are highly experienced and celebrated in their fields, with the ability to take on a variety of complex dental implant referrals. Dr Khan-Osborne is the founder of One to One Dental Implant Education, where she teaches clinicians how to treat advanced implant cases with the help of Dr Vourakis, emphasising their skill and expertise within the discipline.
Referring difficult implant cases to clinicians you can trust is essential when you cannot provide effective treatment with complete confidence. Consistently choosing dental professionals that are known to provide high quality care can also help your patients further trust your recommendations for treatment long into the future.
To learn more about referrals to The One to One Dental Clinic, visit https://121dental.co.uk/for-dentists/referrals/ or contact 0207 486 0000
Nik Bio:
Nikolas is a Senior Implant and Restorative Surgeon in private clinics in London and Edinburgh.
His special interest and main qualifications are in Oral Surgery and Oral Implantology, while he has vast experience in all areas of Aesthetic Dentistry.
He has been a practising Dental Surgeon since 2005 after graduating from the prestigious Military Academy Medical School at the University of Thessaloniki, Greece.
Nikolas started his training in the Oral and Maxillofacial Surgery Department of the 401 Military Hospital in Athens, Greece. As a military officer, he then went on to serve as a team leader in a field hospital in Kabul, Afghanistan – an experience, which shaped his commitment and dedication to his chosen field. On returning to Greece, he furthered his
training completing a Postgraduate Diploma in Oral Implantology from the University of Athens, Greece and a Master of Science Degree in Oral Surgery/Implantology from Göethe University of Frankfurt, Germany.
He recently obtained an Advanced Surgical Master Curriculum in Regenerative Implant Dentistry next to Dr Istvan Urban in Budapest, Hungary.
Nikolas is lecturing about Dental Implants and Regenerative Dentistry, and he is holding a program for introducing and mentoring dentists in Implant Dentistry.
He is a Member of the Association of Dental Implantology and the International Team for Implantology.
Dr Fazeela Bio
Author bio:
Dr Fazeela Khan-Osborne is the founding clinician of the FACE dental implant multi-disciplinary team for the One To One Dental Clinic based on Harley Street, London. She has always had a passion and special interest in implant dentistry, particularly in surgical and restorative full arch rehabilitation of the maxilla. She has been involved in developing treatment modalities for peri-implantitis within clinical practice.
Dr Khan-Osborne is also the Founding Course Lead for the One To One Education Programme, now in its 20thyear. As a former Lead Tutor on the Diploma in Implant Dentistry course at the Royal College of Surgeons (England), she lectures worldwide on implant dentistry and is an active full member of the Association of Dental Implantology, the British Academy of Aesthetic Dentistry and the International Congress of Oral Implantologists.
[i] General Dental Council, (2019). Standards for the Dental Team. (Online) Available at: https://www.gdc-uk.org/standards-guidance/standards-and-guidance/standards-for-the-dental-team [Accessed April 2024]
[ii] Staedt, H., Rossa, M., Lehmann, K. M., Al-Nawas, B., Kämmerer, P. W., & Heimes, D. (2020). Potential risk factors for early and late dental implant failure: a retrospective clinical study on 9080 implants. International journal of implant dentistry, 6, 1-10.
