The General Dental Council requires that all dentists placing implants have undertaken appropriate postgraduate training and to have had their competency assessed. Dentists must not just be specifically trained in implant system protocols, but should also be able to prove they are competent to deal with any immediate or long-term complications of the treatment provided. Those who find themselves in the unfortunate position of answering a patient complaint will have to demonstrate to the GDC they have received suitable training and have not practised implant dentistry beyond the limits of their expertise.
Demonstrating competency
Mentoring is a key element of a well-structured training programme and is important in developing competency in implant dentistry. This means a dentist who undertakes patient assessment, treatment planning and implant therapy with a suitably experienced supervising clinician.
This case demonstrates what on the face of it should be a straightforward case of replacing a missing tooth (fig 1). The basic principles of maximising implant length and diameter have been applied without regard to the final prosthetic outcome (figs 2 and 3). In order to accommodate the implant it has been incorrectly positioned too far labially resulting in a soft tissue deficiency. Although the implant has integrated, the final result has failed in terms of aesthetics and occlusal stability, the final crown frequently debonding (fig 4). The patient, a young woman, was very unhappy with the final aesthetic result, which was visible on smiling. It would be hard to justify such a result as it does not demonstrate competent treatment planning and is not what should be expected from modern implant restorative dentistry.
Competency appraisal
Mentoring is much more than merely having an experienced clinician hand holding during a procedure or offering advice, it is an in-depth structured appraisal of key clinical abilities or competencies. A competency is an observable skill or ability to complete a task or job successfully and may require variable levels of clinical and managerial expertise. The key abilities or attributes which are necessary for effective clinical performance are incorporated into the appraisal to make assessment objective and meaningful.
For example a mentor may carry out a competency appraisal at four key stages during the case supervision:
- consultation
- implant placement
- implant exposure
- restorative
The actual treatment may require more stages or appointments than the four key stages identified in this article. Appraisal is conducted according to the identified competencies, which are written standards that govern the way the surgeon is expected to operate during the delivery of a treatment or service. Appraisal is a two way process whereby the mentor will be looking for evidence that the clinician has displayed or performed a competency to a satisfactory level of expertise. It should normally be carried out directly following the procedure giving the opportunity to participate in and contribute to the assessment process.
The real strength of such a system is not in comparing individuals with one another in a competitive way, but in analysing the progress of a clinician in their own sense. This directs attention to those areas where they are excelling or where skills may be improved.
Appraisal feedback sessions provide the opportunity for constructive dialogue with the mentor and help in identifying training needs. It is not a way for mentors to find fault with performance, but a medium through which strengths and areas for development can be identified. The mentor will identify the aspects of the procedures causing difficulty and discuss these advising on personal development plans and strategies.
Audit and portfolios
It is imperative dentists compile a detailed portfolio of their training, the courses they have attended relative to implant dentistry, details of mentoring received and the complexity of the implant cases treated.
Another requirement is implant activity and clinical outcomes be audited. Such documentation will help support competence in implant dentistry should a complaint arise before the GDC. It should contain clinical data on the type of cases treated, number of implants placed and success rates achieved with follow up of previously treated cases to support long term success. What needs to be answered is: could you convince the GDC you are competent and what is your evidence?
Essential course features
Ideally your training should have the following two essential features:
1. Mentored training provided by an individual with extensive implant experience. Educational experience able to appraise and record your competency.
2. Support and guidance developing a portfolio of evidence containing; case details, educational activity and an audit of treated cases.