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. 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 are 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 receives the care they need.
The art 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 capabilities. 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 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 (GDC) standards for the dental team have noted that patients’ disabilities must be considered, and where reasonable adjustments to your care cannot be made, a referral must be considered.
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 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 standpoint, 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. Early dental implant failure 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 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. In such cases you must ensure the dental professional you are referring the patient to is appropriately trained, indemnified, and competent, to carry out the procedure.
For difficult cases concerning dental implantology, consider The One to One Dental Clinic on Harley Street, London. We are highly experienced clinicians who are celebrated in our fields, and we can take on a variety of complex dental implant referrals. Fazeela is the founder of One to One Dental Implant Education, where she teaches clinicians how to treat advanced implant cases with Nikolas's help.
Referring difficult implant cases to clinicians you can trust is essential when you cannot provide effective treatment with complete confidence. Consistently choosing dental professionals who are known to provide high-quality care can also help your patients further trust your recommendations for treatment long into the future.
References available on request.