Julian Perry reflects on how standards in dentistry have increased and become more stringent over the years, and why it’s a good thing.
I had an interesting chat with dentist ‘A’ today.
He had received a complaint about an implant placement. His patient had been to see another dentist (dentist ‘B’) because of food packing associated with the newly fitted bridge.
Dentist B had said that the implants placed weren’t in the right position. Dentist A was upset and angered by these comments.
However, when I looked at the radiographs, clinical notes, and images, dentist A was, in my opinion, wrong to be so upset. He had simply been caught out. He had indeed placed the implants in a poor position, and here is how it happened.
What went wrong
Dentist A failed to plan the case and failed in his duty to exercise reasonable care.
He didn’t carry out a diagnostic wax up and therefore didn’t create a placement stent. Without a placement stent, there’s no way the placements can be in the ideal position. Just like building a house and putting the foundations in the wrong place!
Dentist A has been offering implants to his patients for some 12 years and yet, like so many colleagues, he just guessed where the implant should go.
Some clinicians I know are good at guessing, but the reality is that many aren’t, and when you get found out, there is nowhere to hide.
The technician, like so many technicians I talk to, had made a valiant attempt to correct the dentist’s mistakes, but it was still a compromise that resulted in food packing and an unsatisfactory outcome.
Things have changed
The world post-2021 has changed. Allow me to explain with an analogy.
In the late 60s and early 70s, if you wanted to build a house, you spoke to a builder who sketched out a basic plan and he built the house, correcting problems on the way. ‘Experience’, a ‘bit of modification’ during the build and a little bit of luck would see him through.
In 2022, if you build a house, you need precision, not guesswork.
You need architects, structural engineers, plans and planning, landscaping, a quantity surveyor, a project manager and many other experts all making sure it’s fit for purpose and that the build complies to an appropriate and exacting standard.
The same is true in dentistry, and it’s no bad thing. Whether we like it or not, or think it’s fair and right or not, is irrelevant.
‘I’ve always done it this way’ is no defence, and for those who tell me that they’ve been doing it this way for many years, it simply means that they may well have been doing it badly for many years.
The number of years offering implants to patients is not a testament to quality or experience. Doing it right is.
Putting the patient first, exercising reasonable care and skill are the most basic of requirements.
The absence of demonstrable planning will automatically put any clinician in a difficult and indefensible position.
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