7 Habits of Highly Successful Implant Surgeons

Ashley Watson • February 17, 2021

Do you sometimes feel like you are just hanging in there?

I find the best way to reduce stress in my working life is to have routines and protocols for the day to day stuff so that when things get challenging, it is more fun that frantic.

I'm not talking about becoming an automaton and carrying out treatment or due process without consideration, just merely having a framework to work around to reduce the number of decisions that have to be made on the spot.

One of the best books to read for any professional is the "Seven Habits of highly effective people" by Stephen R Covey you will hear people refer to specific tasks in daily conversation. This article refers to this book as it identifies habits that help you achieve your goals, and dentistry isn't so different.

There are many other great texts to read that also apply but I decided to steal this title.

The basic principles of implant care are really quite simple:

Risk Assessments
Patient expectations
Clinical considerations
Implant placement
Restoration
Design & Planning
Good guides - the nearer to fully guided the better
Contemporaneous log of treatment
Audit & Review

Ok, I know that is not neatly 7 but it's close enough.

Risk assessments should be ordered and methodical. I use a custom screen on Exact, and before you ask - No! it is not prefilled, all data fields have to be clicked on for a response or it stays blank. Atul Gawande wrote "The Checklist Manifesto - How to Get Things Right" with me specifically in mind, I think. If you don't have a custom screen available, then the ITI have the SAC assessment tool, which will give you an idea of the complexity of the case, and you can print this as a pdf and save it in the patients notes, but it only tells you how complex it is, a comprehensive assessment of patient expectations and clinical considerations is absolutely essential, and if you don't know what this means the ITI have some great links to CPD on this.
All implants should be planned based on the final restoration, and any radiographic imaging (esp. CBCTs) should ideally be directly related to the guides you are using and not just a guess. You don't have to run out and demand the latest digital 3D intraoral camera to do this either. Making a denture with a radio-opaque tooth before the xrays, and converting this to a guide can be almost as good.
It is not controversial to say that guided surgery is now definitively more accurate than freehand placements, so the closer you can get the better. Good planning at the beginning makes life easier as mistakes are only amplified the further you get down the treatment sequence. Your lab will love you and your implants will suffer less from inflammation and infection. Do not accept poor quality guides from a laboratory, even if you think they have years of experience, it is really stressful using a guide that isn't stable and doesn't really help, and even worse value for money if you don't use it. Having a guide is not a defence for a poor placement!
If you are not keeping a log of the treatment, along with the types, makes and serial numbers of the implant hardware you are using, then you should not be placing. It is your moral duty to make sure the patient has a product that can be traced and replaced with the least amount of stress, and this includes taking responsibility for choosing a company to supply you when they might go bust!
Checking that the patient is looking after your implants is your responsibility, even if you delegate it to your referrers or auxiliaries. People referring to you need to know what they are looking for when it comes to failure and need to report it early. Auditing your success annually (or even per implant) will allow you to improve your technique("sharpening the saw"), as long as you are totally transparent and honest with your self-reflection.

Whenever someone asks me about mentoring I like to know that the above principles are in place before we start, I think they have to be regarded as the basic minimum when it comes to implant treatments.

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ID Blog

Keep Calm and Carry On with the Carry On! - Dealing with a power outage

By Ashley Watson • September 27, 2021

There are plenty of things you can do without power, and I don’t mean just handing out antibiotics because the guidelines have been relaxed to meet the need of the current government failings! My trip to Ghana with 30 undergraduates taught me this. Prepare yourself for action: 1. Buy a head torch and a really good hand torch that your nurse can hold 2. Stock up on cotton swabs 3. Make sure you have a go to temporary filling material that is sedative where possible 4. Don’t back yourself into any corners you can’t retreat from When your dental unit stops working the most annoying thing to fail is not the chair or the handpiece, its not even the suction, because even if you get the last wheeze of air from your compressor, if you can’t see what you are doing it is useless. I found that a head-torch or better still your loupes with a light are a dentist’s best friend in these situations. Because head torches were designed for making a cup of tea in a tent, if your nurse can hold a good quality hand torch as well this helps. Moisture control need not be an issue if you have enough sterile swabs and cotton rolls and you are a master in the art without suction. Saliva is easily soaked up or spat into a spittoon and in the worst scenario where a patient is bleeding, pressure and a reassuring manner can slow even the most persistent sites. It’s unlikely that you are going to be worrying about keeping patients waiting so you have all the time in the world to look after the patient in the chair. Whenever you work, you will have an end goal in mind, but remember your training and don’t cut away all your options too early in the preparation. It’s much easier to put on a temporary crown with two interproximal slices rather than just the occlusal reduction, so rethink your protocols, and build in some provision for temporisation at every stage. Even if you are in the middle of an extraction you don’t have to finish if you have an emergency power outage. I often think dentists make a mistake spending hours trying to find a root tip or chasing a brittle, dilacerated monster. If you give up after a maximum of 20 minutes, the patient rarely gets as much pain healing if you leave them alone, than if you successfully retrieved the root. After six weeks the gum would have healed over so a grateful surgeon can go in retrieve the last bit and will have some tissue to raise a flap and cover it all up again afterwards. So, in summary, when an extraction doesn’t go your way; drain any infection, remove all the irritating sharp supragingival dentine and then give up! I have had to escort a patient from the chair midway through an implant procedure and dump them on the gilded streets of London because of a fire alarm and evacuation, but thanks to a neat flap and plenty of swabs this wasn’t a problem. Keeping calm in the weirdest situations can almost be amusing for you and the patients. The patient in the chair will appreciate that you are doing your best in difficult times, and the patients waiting will understand as long as they are kept informed. The most important thing is that you have a plan which will keep you calm and the patients will feel reassured they are in the right place. Don’t be too quick to send everyone home either, you’ll be surprised how much you can do for someone in pain even without power, and it won’t be long before the power comes back on!