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Editorial

Implant Specialization

A Logical Progression or a Quagmire?

Judy, Kenneth W. M. DDS, FAGD, FACD, MICD

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doi: 10.1097/ID.0000000000000934
  • Free

In the mid-1970s, the International Congress of Oral Implantologists (ICOI) applied directly to the American Dental Association's (ADA) Council on Dental Education in Chicago seeking specialty status for dental implantology. The effort was headed by Dr. Yahia Ismail, a prosthodontist, and by Dr. Roland Meffert, a periodontist, who both had extensive teaching, research, and clinical experience. They both served as Presidents of the ICOI. I was the third member of the ICOI team who applied to the Council on Dental Education (CDE). I was a general dentist and Chairman of the Board of Directors of the ICOI. We believed that the arguments we made to the ADA for creating a specialty of implant dentistry were compelling. We were, however, not permitted to ask any questions of the CDE members. There was no opportunity for interchange. This was their policy.

Weeks later, we were informed that we had satisfied 4 of the 5 requirements for ADA recognition of a new specialty. The requirement which we did not satisfy according to the CDE was that the ADA could not recognize a new specialty if the subject matter of the proposed specialty could be “subsumed” into an existing ADA specialty. We were confused since at the time, there were very few implant courses or departments. We were not informed of which ADA existing specialty(s) could fairly “subsume” oral implantology, clinically as well as scientifically.

Despite numerous editorials (a few of which are listed below) calling for implant specialization, the ADA has never substantially changed its mind.1–11 Personally, I have always felt that their attitude was extremely reactionary and resulted in needless competition between existing ADA specialties, many of which wanted a monopolistic form of control over dental implants. General dentists were ignored as was much of the great clinical and scientific advances that were made by innumerable clinicians and basic scientists over the past 4 decades.

What has forced a much-needed change, at least in the United States, has been dentists who have extensively trained and who want to responsibly offer, perhaps even advertise their services to an informed public. Is where we are at today the result of fair processes, which recognize the cooperative work of all engaged specialties or has it simply become a prolonged organizational turf war?

In 1982, Branenark introduced specific endosteal systems into North America. Oral surgeons were the only dentists who they permitted to do their implants. Many dentists, myself included, had been placing implants successfully for over 10 years. Commercial control had reared its ugly head. Thankfully, the ADA saw this monopolistic attitude as a clear case of restraint of trade. What was really required of all of its members, both specialists and generalist, was adequate current education and a commitment to future research findings and associated continuing education.

Three prominent implant societies rapidly took the lead educational role in the United States. They were the American Academy of Implant Dentistry, the Academy of Osseointegration, and the ICOI. I became a member of all 3 of these organizations. Representatives of these societies finally met in Chicago to explore working together to benefit existing and future dentists and patients. After a lengthy discussion with no progress, a proposal was finally made to publish a joint list of members, so patients would have a resource to go to. This was voted down, and all 3 societies went their own way. No subsequent leadership was shown by the ADA hierarchy or at the House of Delegates level for years, even after multiple consensus conferences on aspects of dental implantology.

In my opinion, the exact same conditions exist today. Clinicians want to advertise. The ADA is still being standoffish. The major societies listed above have their own agendas.

Has the enormous amount of well-published basic research and clinical experience made any difference? Have we been a part of a logical progression to specialization or has the result been leaving US dentists in a quagmire? After 50 years of experience in clinical implant practice and education, I know where “we” are. Do you?

References

1. Judy KW, Misch CE. An imperative context for recognition of oral implantology as a dental specialty. N Y J Dent. 1985;55:33–35.
2. Misch C, Judy K. Oral implantology: Specialty status. Mo Dent J. 1985.
3. Judy KW. Dental implants: The need for expanded educational commitments. N Y State Dent J. 1986;52:7–8.
4. Judy K. Dental implants: The need for expanded educational commitments. Int J Oral Implant. 1987;4.
5. Judy K. Implantology as a dental specialty: A moral and an educational focus. Int J Oral Implant. 1987;4.
6. Judy K. The impact of implants on dental practice: A review of the 1988 NIH consensus development—conference. N Y State Dent J. 1989;55.
7. Judy K. The future of implant education: A prediction (editorial). Implant Dent. 1993;2.
8. Judy K. Protecting the public: An agenda for all implant societies. Implant Dent. 1996;5.
9. Judy K. Twenty-five years—where courage has led the ICOI (editorial). Implant Dent. 1997;6.
10. Judy K. Dental implantology through the millennium: A personal perspective and commentary. Oral Health. 1998;88.
11. Judy K. Dental licenses are not issued by implant manufacturers. Dental Econ. 2008.
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