Caveat – first do no harm.

The big medical news at the moment is concerning the rupture rate and safety issues surrounding a particular type of breast implant that was manufactured using industrial grade silicon. Arguments are being tossed around. Should they be removed or can they be left in place? What is the actual rupture rate? If they require removal who should foot the bill- the NHS, the patients or the private healthcare companies who placed the implants? The company who manufactured the implants no longer exists so is out of the picture and the argument. The lawyers must be loving this.

So who is responsible? And how does this impact our own world where increasing numbers of dental implants are being placed in patients within the private sector. This article will look at different facets of this argument and explain how we approach this issue in our own practice.

Recently the media has been reporting that some of the private health companies are prepared to put foot the bill for replacement of the implants in those women who want it. Good on them. They appear to be accepting full responsibility. Other companies appear to be arguing the toss and laying blame at the door of the regulatory bodies that passed the implants for use. Where the responsibility ultimately lies could be dependent upon a number of factors including why these companies chose to use these particular implants in the first place as opposed to other manufacturers’ products. Was the decision based on high quality scientific data, limited and perhaps poor data, spurious scientific data or perhaps a really good job lot deal? I don’t know and I cannot answer this question but how we choose what we use is perhaps critical to this argument.

Some companies are suggesting that if they replace the implants themselves then they will go bust. My opinion is that sadly this is part of business and if you are prepared to take the profits in the first place, then you must be prepared to face the downside. Some of this may be laid at the door of pricing. In our practice we place a 5 year guarantee on our dental implants, the only caveat being that patients attend for regular review appointments as prescribed at the outset, the frequency being based on their individual risk profiles. For example, patients susceptible to gum disease need to attend at least 3 monthly (often with our well trained Hygienist), other low risk patients perhaps annually. On the simple basis that most implants, once integrated will be fine then once they have reached 5 years the patient has had significant benefit and the majority of the dental implant structures are likely to last well beyond that point. We believe that it is a fair, very reasonable and open policy. However we do not come cheap and that is deliberate: we use top dental implant systems and take responsibility for our work. Simple and clear. (Some suggest that dental implant failures can peak at about 13 years – my instinct is that this is likely to be in patients who fail to attend for review appointments, highlighting the need for encouragement of on-going maintenance for life, just like teeth and gums).

In our practice we have only worked with dental implant companies with good long-term track records. We avoid new companies who have limited data. Caution must still exist because these larger companies innovate and perhaps bring some of these new innovations to market rather too soon. Commercial judgement calls can be difficult and I do not envy them in having to make sometimes very difficult decisions, but at the end of the day it is the clinician who has to truly face the music and the patient if things go wrong.

The other reason we work with the larger, well established companies is because they are less likely to go bust or get taken over. What happens down the line if an implant fails and you can no longer get the parts because the company no longer exists? As Truman said “The Buck Stops Here”. As clinicians we ultimately have to stand by our decisions. A good rule of thumb is would I allow this to be done to my loved ones- “the daughter test” – if you wouldn’t put this into the mouth of your nearest and dearest don’t do it.

We don’t always get everything right but we get very high success rates and are prepared to deal with the few problems that inevitably arise in the real world. We are constantly working on our practice philosophies and protocols to achieve our very best. A few simple and practical rules that we suggest are as follows:

•  Choose the dental implant system carefully and don’t just go for the best financial offer, bulk buy deals and packages
• Go for a larger well established dental implant company with a proven record, strong balance sheet and good cashflow – they are less likely to go bust down the line creating future problems
• Be cautious about the latest innovation, even with well-established and ethical companies – some clinicians are prepared to sit at this cutting edge and can do very well out of it but there are also casualties of this frontier style policy
• Reasonable and fair guarantees should be available on the treatment
• Consider very carefully whether dental implant insurance policies may be suitable

Any dentist placing dental implants must be highly trained and working well within their competency. We are very lucky that we work within a team of exceptional individuals, each of us working to our particular strengths. Our clinical audits exhibit very high success rates – approximately 97% over 5 years and figures are starting to suggest that this figure includes bone grafted areas where additional bone has to be built up. Watch this space. In the real world there is no perfect answer to everything. However, after this latest medical hiccup becomes resigned to yesterday’s news it might be worthwhile looking at the fallout and deciding which of the private healthcare companies you would rather deal with.

Ian Peace